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.

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