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a white pills imageFebruary 14 2018

GPs have increased long-term opioid prescribing for non-cancer pain against guidelines, an observational study has found. 

Analysis of prescription data for all opioids indicates the amounts prescribed has increased, and that there are regional variations. “More opioids were prescribed in the north than in the south of England (r = 0.66, P<0.0001), and more opioids were prescribed in areas of greater social deprivation (r = 0.56, P<0.0001),” the University of London researchers found.

Data from England was analysed for prescribing of eight opioids from August 2010 to February 2014. “Over the 43-month study, an overall increase in opioid prescribing was found, specifically of buprenorphine, codeine, morphine, oxycodone, and tramadol, which was the most prescribed opioid in England,” said the researchers.

“A north–south gradient in opioid usage was also found, with nine out of ten of the highest prescribing areas located in the north of the country, and there was an association between social deprivation and higher opioid prescription.”

The study suggests an increase in tramadol prescribing has resulted from the withdrawal of co-proxamol in the mid-2000s, but also as it is an alternative to non-steroidal inflammatory drugs. It also notes: “Many practitioners routinely prescribe opioids for chronic non-cancer pain because they believe it is unethical to withhold analgesia, regardless of the aetiology of pain, yet opioids are ineffective in much chronic pain beyond modest effects in the short term.”

Responding to the study, Professor Helen Stokes-Lampard, RCGP Chair, said: “While some prescribed medication has been shown to be addictive, many of these drugs, when used appropriately and in conjunction with established clinical guidelines, are safe to use and can, most importantly, help relieve patients from debilitating and painful symptoms.

“Patients are also made aware of any potential risks and side effects of taking any new medication – regardless of whether it is a known addictive drug or not – and consulted about if they think it is right for them. Additionally, all medication newly issued to a patient should have an information leaflet provided by the dispensing pharmacist.”

While the study has demonstrated an increase in opioid prescribing for non-cancer pain, she said that “most patients don’t want to be on long-term prescriptions and, where possible, GPs will always try to explore non-pharmacological treatments.” However, “these are often hard to come by at a community level, leaving family doctors with few alternatives that are still of equal benefit to the patient.”

Prof Stoke-Lampard called on GPs and their teams to encourage patients to attend regular medication reviews and urged doctors to ensure “these drugs are only prescribed for the shortest amount of time, which is tailored to the individual.”

Links:
L Mordecai et al. ‘Patterns of regional variation of opioid prescribing in primary care in England: a retrospective observational study’. Br J Gen Pract. Published 12 February 2018.       
RCGP comment           

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