--- title: "Introduction to Oral Opioids" author: "Ankona Banerjee & Erik Stricker " date: "`r Sys.Date()`" output: rmarkdown::html_document vignette: > %\VignetteIndexEntry{OralOpioids} %\VignetteEngine{knitr::rmarkdown} %\VignetteEncoding{UTF-8} --- ------------ ## Description Provides details such as Morphine Equivalent Dose (MED), brand name and opioid content which are calculated of all oral opioids authorized for sale by Health Canada based on their Drug Identification Number (DIN) or FDA based on their Product ID for Opioids authorized for sale in Canadian or US markets. For US Opioids, MEDs are calculated using Von Korff et al. (2008) and information obtained from FDA's daily National Drug Code Directory [/drug/ndc] download MEDs are calculated based on recommendations by Canadian Institute for Health Information (CIHI) and information obtained from Health Canada’s Drug Product Database’s monthly data dump for Canadian Opioids. Please note in no way should output from this package be a substitute for medical advise. All medications should only be consumed on prescription from a licensed healthcare provider ------------ ## Functions ### Loading/updating the FDA dataset ```R library(OralOpioids) US_Opioid_Table <- load_Opioid_Table(country="US") ``` ```R Your FDA_Opioid_Table is outdated. Do you want to download the latest data from FDA? (y/n) 1: Y 2: N Selection: Y trying URL 'https://download.open.fda.gov/drug/ndc/drug-ndc-0001-of-0001.json.zip' Content type 'application/zip' length 27647880 bytes (26.4 MB) downloaded 26.4 MB The FDA_Opioid_Table was successfully updated to 2023-12-20. DISCLAIMER: Not a substitute for medical advise. Please note that the output generated by the package should not be substituted for clinical advise and any medication should be only consumed at the advise of a licensed healthcare provider. Source url of the data: https://download.open.fda.gov/drug/ndc/drug-ndc-0001-of-0001.json.zip Source url used for dosing: Von Korff M, Saunders K, Thomas Ray G, et al. De facto long-term opioid therapy for noncancer pain. Clin J Pain 2008; 24: 521-527. 2008/06/25. DOI: 10.1097/AJP.0b013e318169d03b. ``` ```R head(US_Opioid_Table) ``` ```R Drug_ID name strength Base1 Base2 Base3 Brand 1 0054-0176 BUPRENORPHINE HYDROCHLORIDE 2 mg/1 2.0 1 Buprenorphine HCl 2 0054-0177 BUPRENORPHINE HYDROCHLORIDE 8 mg/1 8.0 1 Buprenorphine HCl 3 0054-0188 BUPRENORPHINE HYDROCHLORIDE 2 mg/1 2.0 1 buprenorphine hydrochloride and naloxone hydrochloride dihydrate 4 0054-0188 NALOXONE HYDROCHLORIDE DIHYDRATE .5 mg/1 0.5 1 buprenorphine hydrochloride and naloxone hydrochloride dihydrate 5 0054-0189 BUPRENORPHINE HYDROCHLORIDE 8 mg/1 8.0 1 buprenorphine hydrochloride and naloxone hydrochloride dihydrate 6 0054-0189 NALOXONE HYDROCHLORIDE DIHYDRATE 2 mg/1 2.0 1 buprenorphine hydrochloride and naloxone hydrochloride dihydrate active_ingredients marketing_category Form Route 1 BUPRENORPHINE HYDROCHLORIDE, 2 mg/1 ANDA TABLET SUBLINGUAL 2 BUPRENORPHINE HYDROCHLORIDE, 8 mg/1 ANDA TABLET SUBLINGUAL 3 BUPRENORPHINE HYDROCHLORIDE, NALOXONE HYDROCHLORIDE DIHYDRATE, 2 mg/1, .5 mg/1 ANDA TABLET SUBLINGUAL 4 BUPRENORPHINE HYDROCHLORIDE, NALOXONE HYDROCHLORIDE DIHYDRATE, 2 mg/1, .5 mg/1 ANDA TABLET SUBLINGUAL 5 BUPRENORPHINE HYDROCHLORIDE, NALOXONE HYDROCHLORIDE DIHYDRATE, 8 mg/1, 2 mg/1 ANDA TABLET SUBLINGUAL 6 BUPRENORPHINE HYDROCHLORIDE, NALOXONE HYDROCHLORIDE DIHYDRATE, 8 mg/1, 2 mg/1 ANDA TABLET SUBLINGUAL Opioid Opioid_1 MED_per_dispensing_unit 1 BUPRENORPHINE HYDROCHLORIDE 2 mg/1 BUPRENORPHINE NA 2 BUPRENORPHINE HYDROCHLORIDE 8 mg/1 BUPRENORPHINE NA 3 BUPRENORPHINE HYDROCHLORIDE 2 mg/1 + NALOXONE HYDROCHLORIDE DIHYDRATE .5 mg/1 BUPRENORPHINE NA 4 BUPRENORPHINE HYDROCHLORIDE 2 mg/1 + NALOXONE HYDROCHLORIDE DIHYDRATE .5 mg/1 NALOXONE NA 5 BUPRENORPHINE HYDROCHLORIDE 8 mg/1 + NALOXONE HYDROCHLORIDE DIHYDRATE 2 mg/1 BUPRENORPHINE NA 6 BUPRENORPHINE HYDROCHLORIDE 8 mg/1 + NALOXONE HYDROCHLORIDE DIHYDRATE 2 mg/1 NALOXONE NA No_tabs/ml assuming 50 MED limit per day No_tabs/ml assuming 90 MED limit per day Maximum No_tabs/ml assuming 50 MED limit for 7 days 1 NA NA NA 2 NA NA NA 3 NA NA NA 4 NA NA NA 5 NA NA NA 6 NA NA NA Maximum No_tabs/ml assuming 50 MED limit for 14 days Maximum No_tabs/ml assuming 50 MED limit for 30 days last_updated 1 NA NA 2023-12-20 2 NA NA 2023-12-20 3 NA NA 2023-12-20 4 NA NA 2023-12-20 5 NA NA 2023-12-20 6 NA NA 2023-12-20 ``` ### Loading/updating the Health Canada dataset ```R library(OralOpioids) Canada_Opioid_Table <- load_Opioid_Table(country="Canada") ``` ```R ## No HealthCanada_Opioid_Tables are currently in the filelocation. Do you want to download the latest data from Health Canada? (y/n) ## ## 1: Y ## 2: N ## ## Selection: Y ## trying URL 'https://www.canada.ca/content/dam/hc-sc/documents/services/drug-product-database/allfiles.zip' ## Content type 'application/zip' length unknown ## downloaded 1.4 MB ## ## trying URL 'https://www.canada.ca/content/dam/hc-sc/documents/services/drug-product-database/allfiles_ap.zip' ## Content type 'application/zip' length unknown ## downloaded 407 KB ## ## trying URL 'https://www.canada.ca/content/dam/hc-sc/documents/services/drug-product-database/allfiles_dr.zip' ## Content type 'application/zip' length unknown ## downloaded 317 KB ## ## trying URL 'https://www.canada.ca/content/dam/hc-sc/documents/services/drug-product-database/allfiles_ia.zip' ## Content type 'application/zip' length unknown ## downloaded 4.9 MB ## ## The HealthCanada_Opioid_Table was successfully updated to 2023-01-03. ## DISCLAIMER: Not a substitute for medical advise. Please note that the output generated by the package should not be substituted for clinical advise and any medication ## should be only consumed at the advise of a licensed healthcare provider. ## ## Source url of the data: https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-product-database/what-data-extract-drug-product-database.html ## Source url used for dosing: https://www.cihi.ca/sites/default/files/document/opioid-prescribing-canada-trends-en-web.pdf ``` ```R head(Canada_Opioid_Table) ``` ```R ## DIN MED_per_dispensing_unit Base1 Base2 Base3 Opioid Route Form Brand No_tabs/ml assuming 50 MED limit per day ## 1 2517175 Couldn't be calculated 1 N BUPRENORPHINE 2 MG SUBLINGUAL TABLET TARO-BUPRENORPHINE/NALOXONE Couldn't be calculated ## 2 2517175 Couldn't be calculated 1 N NALOXONE 0.5 MG SUBLINGUAL TABLET TARO-BUPRENORPHINE/NALOXONE Couldn't be calculated ## 3 2517183 Couldn't be calculated 1 N BUPRENORPHINE 8 MG SUBLINGUAL TABLET TARO-BUPRENORPHINE/NALOXONE Couldn't be calculated ## 4 2517183 Couldn't be calculated 1 N NALOXONE 2 MG SUBLINGUAL TABLET TARO-BUPRENORPHINE/NALOXONE Couldn't be calculated ## 5 2518759 5 1 N TRAMADOL 50 MG ORAL TABLET JAMP TRAMADOL HCL 10 ## 6 763527 1.2 1 N CODEINE 8 MG ORAL TABLET ORADRINE TABLETS 42 ## No_tabs/ml assuming 90 MED limit per day Maximum No_tabs/ml assuming 50 MED limit for 7 days Maximum No_tabs/ml assuming 50 MED limit for 14 days ## 1 Couldn't be calculated Couldn't be calculated Couldn't be calculated ## 2 Couldn't be calculated Couldn't be calculated Couldn't be calculated ## 3 Couldn't be calculated Couldn't be calculated Couldn't be calculated ## 4 Couldn't be calculated Couldn't be calculated Couldn't be calculated ## 5 18 70 140 ## 6 75 294 588 ## Maximum No_tabs/ml assuming 50 MED limit for 30 days Status_1 last_updated ## 1 Couldn't be calculated APPROVED 2023-01-03 ## 2 Couldn't be calculated APPROVED 2023-01-03 ## 3 Couldn't be calculated APPROVED 2023-01-03 ## 4 Couldn't be calculated APPROVED 2023-01-03 ## 5 300 APPROVED 2023-01-03 ## 6 1260 CANCELLED POST MARKET 2023-01-03 ``` ### Get the Morphine Equivalent Dose (MED) from FDA by using the Product ID ```R MED("0093-0058",US_Opioid_Table) ``` ```R [1] 5 ``` ### Get the Morphine Equivalent Dose (MED) from Health Canada by using DIN ```R MED(786535, Canada_Opioid_Table) ``` ```R [1] 5 ``` ### Get the Brand name from FDA by using the Product ID ```R Brand("0093-0058", US_Opioid_Table) ``` ```R [1] "Tramadol Hydrochloride" ``` ### Get the Brand name from Health Canada by using DIN ```R Brand(786535, Canada_Opioid_Table) ``` ```R [1] "DILAUDID" ``` ### Get the Opioid content from FDA by using the Product ID ```R Opioid("0093-0058",US_Opioid_Table) ``` ```R [1] "TRAMADOL HYDROCHLORIDE 50 mg/1 " ``` ### Get the Opioid content from Health Canada by using DIN ```R Opioid(786535, Canada_Opioid_Table) ``` ```R [1] "HYDROMORPHONE 1 MG" ``` ### Get the Maximum number of units/millilitres of oral opioids allowed per day assuming a daily limit of 50 MED/day from FDA by using the Product ID ```R MED_50("0093-0058",US_Opioid_Table) ``` ```R [1] 10 ``` ### Get the Maximum number of units/millilitres of oral opioids allowed per day assuming a daily limit of 50 MED/day from Health Canada by using DIN ```R MED_50(786535, Canada_Opioid_Table) ``` ```R [1] 10 ``` ### Get the Maximum number of units/millilitres of oral opioids allowed per day assuming a daily limit of 90 MED/day from FDA by using the Product ID ```R MED_90("0093-0058",US_Opioid_Table) ``` ```R [1] 18 ``` ### Get the Maximum number of units/millilitres of oral opioids allowed per day assuming a daily limit of 90 MED/day from Health Canada by using DIN ```R MED_90(786535, Canada_Opioid_Table) ``` ```R [1] 18 ```