Nationwide Trends in Opioid Consumption in Costa Rica, 2017–2024: Implications for Regulatory Policy and Public Health

INTRODUCTION: The global opioid crisis has highlighted substantial differences in prescribing, monitoring, and regulatory practices across health systems. In Costa Rica, comprehensive national data on opioid use have been limited. This study aimed to describe temporal trends in legally prescribed opioid consumption between 2017 and 2024 using nationwide administrative data. METHODS: A nationwide, retrospective, population-based analysis was conducted using data from the Costa Rican Ministry of Health's narcotics registry. Dispensation records for morphine, methadone, fentanyl, oxycodone, and tapentadol were included. Opioid consumption was standardized to Morphine Milligram Equivalents (MME) using NIH HEAL conversion factors. Temporal trends were assessed using descriptive statistics and simple linear regression. RESULTS: A total of 31.9 million opioid dispensations were recorded during the study period. National opioid consumption peaked in 2018 (395.1 million MME), followed by an approximate 70% decline through 2023 and a modest increase in 2024. Consumption of morphine and methadone declined substantially (-72.2% and -82.4%, respectively), while oxycodone and tapentadol showed moderate increases over time. These findings indicate a marked reduction in overall opioid consumption alongside changes in the distribution of use across opioid agents. CONCLUSIONS: Between 2017 and 2024, Costa Rica experienced a sustained decline in total opioid dispensing and a redistribution of opioid use across substances. These trends occurred in the context of strengthened regulatory oversight and expanded digital monitoring of controlled substances. While causal relationships cannot be established, the findings provide relevant population-level evidence to support opioid stewardship and inform regulatory and public health strategies in middle-income health systems.