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Tables
Study Study period Location Study population Findings NTA (2011)1 1991–2009 England All prescriptions Five-fold increase in prescribing opioids.Regional variations in prescribing. Ruscitto et al (2015)46 1995–2010 Tayside Primary care Increase in opioid prescribing.Larger increase in “strong”a opioid prescribing.Associated factors: polypharmacy, social deprivation. Curtis et al (2019)2 1998–2018 England Primary care Increases in prescribing between 1998 and 2016.Increase in ME amount prescribed much greater.Prescriptions decreased after 2016.Associated factor: geographical variation. Zin et al (2014)13 2000–2010 England Primary care “Huge” increase in “strong”a opioid prescribing.Majority (88%) for non-cancer pain. Cartagena Farias et al (2017)35 2000–2015 England Primary careNon-cancer pain Increasing numbers of people prescribed opioids.Prescribing for longer periods.Associated factors: age, social deprivation, regional variation. Bedson et al (2016)48 2002–2013 England Primary careMusculoskeletal pain Long-term prescribing increased to 2009; slight decrease after 2011.Increased prescribing of long-acting opioids. Green et al (2012)49 2004-2007(?)b North Staffordshire Primary careJoint painAged >50 Factors associated with increased rates of prescription.Factors associated with “strong”a opioid use. Foy et al (2016)33 2005–2012 West Yorkshire Primary careNon-cancer pain Prescribing of weaker opioids doubled.Six-fold increase in “stronger”a opioid prescribing.Patient and prescriber factors associated with stepping up to “stronger” opioids. Davies et al (2019)11 2005–2015 Wales Primary careNon-cancer pain Large increase in prescribing of “strong”a opioids.Associated factors: age, social deprivation, anxiety or depression diagnosis. Jani et al (2020)50 2006–2017 England Primary care Increased prescribing of opioids: codeine, morphine, tramadol, oxycodone.Initiated high doses tend to be maintained.Associated factors: social deprivation, regional variation, polypharmacy. Mordecai et al (2018)34 2010–2014 England Primary care Increase in amount (in ME) prescribed.Associated factors: social deprivation; regional variation. Ponton & Sawyer (2018)36 2012(?)b South East England Primary carePatients prescribed high doses Identified patients prescribed doses ≥120 mg ME of “strong”a opioids as candidates for specialist input. Ashaye et al (2018)51 2011–2012 London and Midlands Primary careMusculoskeletal pain Long-term prescribing common.Possible overprescribing in more than a quarter of patients receiving “strong”a opioids. Public Health England (2019)32 2015–2018 England Primary care Prescriptions and proportion of population prescribed opioids declining from historically high rates.High rates of long-term prescribing.Associated factor: social deprivation, polypharmacy. Bastable & Rann (2019)37 2018 East England Primary carePatients prescribed high doses Identified patients prescribed opioid doses ≥120 mg ME.Co-prescribing of Z-drugs, benzodiazepines, and gabapentinoids. ME = Morphine equivalent..
a Drugs categorised as “strong” vary between studies, but always include morphine, oxycodone, and fentanyl.
b This is estimated from the published text, which does not indicate the data collection period.
Practice A Practice B Both practices Number of patients in practice (all ages) 14 355 8486 22 841 Prescriptions for opioids: including compound drugs 914 734 1648 non-compound drugs 389 275 664 Patients prescribed opioids: including compound drugs 821 (5.7%)a 667 (7.9%)a 1488 (6.5%)a non-compound drugs 337 (2.3%) 246 (2.9%) 583 (2.6%) Patients with estimated daily dose ≥120 mg ME 34b (2.37)c 19 (2.24)c 53 (2.32)c as above + use for more than 1 year 25 (1.74) 14 (1.65) 39 (1.71) Patients with dose ≥60 mg & <120 mg ME in one drug 28d (1.95) 21 (2.47) 49 (2.15) as above + other opioid(s) 15 (1.04) 4 (0.47) 19 (0.83) a% of all practice patients prescribed these drugs. bIn this practice there were an additional 4 patients with a cancer diagnosis. cNumber per thousand patients. dIn this practice there was 1 additional patient with a cancer diagnosis.
Results in bold are the main findings of the study.
2017 2018 2019 2020 2021 Registered patients 14 355 14 584 14 797 15 809 16 140 ≥60<120 mgME 27 (1.88)a 25 (1.71)a 24 (1.62)a 23 (1.45)a 24 (1.49)a ≥120 mgME 34 (2.37)a 37 (2.54)a 37 (2.50)a 36 (2.28)a 36 (2.23)a ≥120 mgME >1 year 25 (1.74)a 28 (1.92)a 30 (2.03)a 32 (2.02)a 31 (1.92)a a n per 1000 registered patients.
- Table 4. Age profile of patients prescribed LTHD opioids in the two practices in the index week 2017
Age, years 0–24 25–34 35–44 45–54 55–64 65–74 75–84 ≥85 Practice A Patients in age group, n 4006 1729 1735 2404 1772 1524 902 283 % of all patients in age group 28 12 12 17 12 11 6 2 Long-term high dose users, n 0 1 2 7 5 3 5 2 n/1000 patients 0 0.58 1.15 2.91 2.82 1.97 5.54 7.07 Practice B Patients in age group, n 2632 1170 1119 1236 972 836 410 106 % of all patients in age group 31 14 13 15 11 10 5 1 Long-term high dose users, n 0 2 4 3 3 0 3 0 n/1000 patients 0 1.71 3.57 2.43 3.09 0 7.32 0 Combined Patients in age group, n 6638 2899 2854 3640 2744 2360 1312 389 % of all patients in age group 29 13 12 16 12 10 6 2 Long-term high dose users, n 0 3 6 10 8 3 8 2 n/1000 patients 0 1.03 2.10 2.75 2.91 1.27 6.10 5.14
Supplementary Data
- Bailey_BJGPO.2021.0217_Supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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Long-term, high-dose opioid prescription for chronic non-cancer pain in primary care: an observational study
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