Home > Time trends and prescribing patterns of opioid drugs in UK primary care patients with non-cancer pain: A retrospective cohort study.

Jani, Meghna and Birlie Yimer, Belay and Sheppard, Therese and Lunt, Mark and Dixon, William G (2020) Time trends and prescribing patterns of opioid drugs in UK primary care patients with non-cancer pain: A retrospective cohort study. PLoS Medicine, 17, (10), e1003270. https://doi.org/10.1371/journal.pmed.1003270.

External website: https://journals.plos.org/plosmedicine/article?id=...

Why was this study done?

  • Whilst opioid prescribing for non-cancer pain has risen in the US and Canada, trends over time are less clear in the UK.
  • No studies to our knowledge have evaluated how opioid dose/potency changes over time in UK patients started an opioid for the first time for non-cancer pain, to assess escalation, tapering, and long-term use.
  • Physician prescribing behaviour has been implicated as a key driver of rising opioid prescriptions and long-term opioid use; however, this needs to be interpreted in the context of regional and individual patient differences.
  • The association of region, practice, prescriber, and individual factors with long-term opioid use is highly important, as this has implications for policy and future targeted public health interventions.

What did the researchers do and find?

  • We conducted a study of 1,968,742 new opioid users without cancer from primary care electronic health records across the UK.
  • We found that between 2006 and 2017 codeine was the most commonly prescribed opioid: There was a 5-fold increase in codeine prescriptions, a 7-fold increase in tramadol prescriptions, and a 30-fold increase in oxycodone prescriptions for non-cancer pain.
  • Prescribing factors (e.g., high dose/potency of opioid or concurrent gabapentinoid use), older age, higher socioeconomic deprivation score, and other conditions including fibromyalgia, rheumatological conditions, history of substance abuse, suicide/self-harm, alcohol abuse, and major surgery were associated with long-term opioid use.
  • After accounting for individual patient factors, the North West, Yorkshire and the Humber, and South West regions of England were associated with a higher risk of long-term opioid use.
  • Whilst there were only 3.5% of prescribers who had significantly higher prescribing practices leading to long-term use after adjustment of patient factors, where they did, rates were up to 3.5 times higher than the population average.

What do these findings mean?

  • Clinicians should take care in prescribing high dose opioids at initiation and closely monitor those with the above individual factors for long-term use.
  • The variation observed across regions, practices, and prescribers after adjustment for patient factors supports calls for action to reduce such variation and harmonise prescribing practices.
Item Type
Publication Type
International, Open Access, Article
Drug Type
Opioid, Prescription/Over the counter
Intervention Type
Drug therapy
October 2020
Identification #
Page Range

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