Medical prescription practices and patientsÓ? adherence to chronic pain treatment with opioids in Portugal

Some countries, like the United States of America, witnessed a rise in opioid prescriptions for chronic pain (CP) treatment and opioid-related deaths. This generates concerns and raises questions on whether the same can be happening in Portugal. Little research is available regarding opioid prescription practices and patients' adherence to them in the country. This narrative review aims to describe Portuguese physicians' opioid prescription practices for managing CP and patients' adherence to them. A digital literature research was carried out from September 20, 2022, to January 8, 2023, in seven electronic databases (b-on, EBSCO, PubMed, Scopus, USC Libraries, VHL, and Web of Science) and on the websites of Associao Portuguesa Para o Estudo da Dor and International Association for the Study of Pain. Twenty-six studies were included in this review (14 cross-sectional studies, eight cohort studies, one validation study, one comparative study, and two experts' opinions). Opioid consumption in Portugal is low, but an ascending tendency has been occurring and requires further investigation and monitoring. Studies show that Portuguese physicians typically resort to tramadol as a weak opioid and to fentanyl, buprenorphine, tapentadol, and morphine as strong opioids. Patients' therapeutic adherence to opioids for CP seems low and is related to cultural misconceptions among patients and physicians. Up-to-date investigation is needed as there is a lack of research in these fields of knowledge in the country.