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Research

Long-term, high-dose opioid prescribing for chronic non-cancer pain in primary care

John Bailey, Simon Gill and Rob Poole
BJGP Open 21 June 2022; BJGPO.2021.0217. DOI: https://doi.org/10.3399/BJGPO.2021.0217
John Bailey
1 Centre for Mental Health and Society, Bangor University Wrexham Academic Unit, Technology Park Wrexham, Wrexham, UK
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Simon Gill
2 Betsi Cadwaladr University Health Board, North Wales, UK
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Rob Poole
3 Centre for Mental Health and Society, Bangor University, Bangor, UK
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Abstract

Background Opioid prescriptions for chronic pain have risen sharply over the last 25 years; harms associated with these drugs are related to dose and length of use.

Aim The main aim of this study was to identify patients prescribed long-term, high doses of opioids in the community and to assess the prevalence of such use.

Design & setting An observational study of opioid prescribing in two demographically dissimilar GP practices was carried out.

Method Details of opioid prescriptions were collected for 22,841 patients, of whom 1,488 (6.5%) were being prescribed opioids on the census date. Exhaustive examination of the data identified all patients who were prescribed oral morphine equivalent doses of 120 mg/day or more for one year or longer.

Results All these patients were being prescribed ≥120 mg/day as a single drug; morphine, oxycodone, fentanyl or buprenorphine, irrespective of opioid polypharmacy. Across both practices, 1.71/1000 patients were identified as long-term, high-dose users of opioid medication for chronic non-cancer pain. Prevalence was similar in the two practices. Repetition of the process until January 2021 showed no change in the pattern.

Conclusion This study offers confirmation that a significant group of patients are prescribed long-term opioid medication for chronic pain at doses which are unlikely to be effective in reducing pain but are likely to have harmful consequences. The findings offer a simple, reliable and practical method of data extraction to identify these patients individually from routinely collected prescribing data, which will help in monitoring and treating individuals and establishing the problem prevalence.

  • Opioid analgesics
  • Chronic pain
  • Drug presciptions
  • Received November 12, 2021.
  • Revision received May 23, 2022.
  • Accepted June 16, 2022.
  • Copyright © 2022, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Accepted Manuscript
Long-term, high-dose opioid prescribing for chronic non-cancer pain in primary care
John Bailey, Simon Gill, Rob Poole
BJGP Open 21 June 2022; BJGPO.2021.0217. DOI: 10.3399/BJGPO.2021.0217

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Accepted Manuscript
Long-term, high-dose opioid prescribing for chronic non-cancer pain in primary care
John Bailey, Simon Gill, Rob Poole
BJGP Open 21 June 2022; BJGPO.2021.0217. DOI: 10.3399/BJGPO.2021.0217
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Keywords

  • Opioid analgesics
  • Chronic pain
  • Drug presciptions

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