In the U.K., new prescriptions for multiple opioids have risen steadily in recent years, leading to concerning rates of long-term use, especially in older, socially deprived patients. Dr Meghna Jani at the University of Manchester and colleagues report these findings in a new study published October 15 in PLOS Medicine.
In the U.S., Canada and several European countries, a sharp increase in prescription opioid use for non-cancer patients has sparked concerns that a similar epidemic might occur in the U.K. To evaluate prescribing trends and understand the risk factors for long-term opioid use in the U.K., Jani and colleagues performed a study of 1,968,742 new opioid users. Their analysis showed that opioid prescriptions, especially codeine, morphine, and oxycodone, all increased substantially during the course of the study, from 2006 to 2017. Overall, 14.6% of patients with new opioid prescriptions became long-term users starting in their first year. A small percentage of physicians were "high-risk prescribers" whose patients were 3.5 times more likely to use the drugs continually. People were more likely to become long-term users if they were older, experiencing social deprivation, had a history of self-harm, suicide attempts, or substance or alcohol abuse, or suffering from fibromyalgia or rheumatological diseases.
The study's findings support the call for action for safer and more consistent opioid prescription practices in the U.K., to avoid the addiction epidemic seen in many other countries. The authors recommend that physicians should take care when prescribing high initial doses of opioids and should closely monitor patients with risk factors for long-term use. They point out that identifying general practices with abnormally high prescription rates through audit and feedback tools could help drive safer prescribing practices.
"Given the potential harms of these drugs, we think it is imperative to promote safe practices in prescribing opioids and reduce the variability we observed between in regions, practices and prescribers," said Dr. Jani. "One way to do this would be to harmonise prescribing practices across regions through future well-researched policies. The other would be developing targeted interventions in high risk groups including areas of social deprivation and for those undergoing major surgery."
Peer reviewed; Observational study; Humans
In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003270
Funding: The authors received no specific funding for this work. The work is supported by the Versus Arthritis Centre for Epidemiology, the authors' host institution (grant number 20380; WGD Principal Investigator). MJ's work was supported by an NIHR academic clinical lecturership and a Presidential Fellowship. The funders listed had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: MJ is a member of the Medicines and Healthcare products Regulatory Agency (MHRA) Opioids Expert Working Group. WGD has received consultancy fees from Google and Bayer, unrelated to this work.
Citation: Jani M, Birlie Yimer B, Sheppard T, Lunt M, Dixon WG (2020) Time trends and prescribing patterns of opioid drugs in UK primary care patients with non-cancer pain: A retrospective cohort study. PLoS Med 17(10): e1003270. https://doi.org/10.1371/journal.pmed.1003270