The use of tramadol and other opioids for pain management has been accompanied by a multitude of challenges and concerns worldwide. The use of tramadol saw a decline in Denmark during 2017-2019 accompanied by a slight increase in the use of morphine and oxycodone. Using the Danish National Prescription Registry and utilizing data until and including 2023, we aimed to provide updated data on the utilization patterns of tramadol and other opioids in Denmark. We found a 35% decline in the use of tramadol from 2017-2023 most likely due to media attention, regulatory actions, health campaigns, and targeted education of physicians and patients by the Danish health authorities. This decline was accompanied by an increase in the number of new (+90%) and current users of morphine (+57%) which surpassed those of tramadol, oxycodone, and other opioids in 2023.

Purpose To describe utilization patterns, characteristics of users and prescriber responsibility of the new oral antiviral medication, molnupiravir, indicated for mild-to-moderate COVID-19. Methods Using nationwide registries, we identified all Danish adults who filled a prescription for molnupiravir from December 16 th, 2021, to August 31 st, 2022. We described weekly incidence rates and patient characteristics over time, prescriber responsibility as well as time between molnupiravir initiation and a positive SARs-CoV-2 test. Patient characteristics were compared to an untreated SARS-CoV-2 positive cohort. Results By August 31 st, 2022, 5,847 individuals had filled a prescription for molnupiravir. The incidence rate gradually increased to 2,000 weekly prescriptions per 100,000 RT-PCR SARS-CoV-2 positives. Users of molnupiravir were most often men (55% vs. 45% women). The majority (81%) had a positive RT-PCR SARS-CoV-2 test and few (2.9%) redeemed molnupiravir outside the recommended window of 5 days from the positive test result. Compared to an untreated SARS-CoV-2 positive cohort, users of molnupiravir had a median age of 74 years vs. 44 years, a higher proportion resided in a nursing home (12% vs. 1.1%) and had a higher number of comorbidities (median of 3 vs. 0); most commonly hypertension (38%), chronic lung disease (35%), diabetes (20%) and mood disorders (20%). General practitioners were the primary prescribers of molnupiravir (91%). Conclusions Molnupiravir was mainly prescribed by general practitioners to RT-PCR SARS-CoV-2 positive individuals who had a potentially increased risk of severe COVID-19. Though some off-label prescribing occurred, our study indicates a high level of adherence to contemporary guidelines.