Examining opioid prescribing trends for non-cancer pain using an estimated oral morphine equivalence measure: a retrospective cohort study between 2005 and 2015.

Emma Davies,Mari Jones,Bernadette Sewell,Ceri J Phillips,Jaynie Y Rance

doi:10.3399/bjgpopen20x101122

Abstract

BackgroundOver the past 20 years prescription of opioid medicines has markedly increased in the UK, despite a lack of supporting evidence for use in commonly occurring, painful conditions. Prescribing is often monitored by counting numbers of prescriptions dispensed, but this may not provide an accurate picture of clinical practice.AimTo use an estimated oral morphine equivalent (OMEQe) dose to describe trends in opioid prescribing in non-cancer pain, and explore if opioid burden differed by deprivation status.Design & settingA retrospective cohort study using cross-sectional and longitudinal trend analyses of opioid prescribing data from Welsh Primary Care General Practices (PCGP) took place. Data were used from the Secure Anonymised Information Linkage (SAIL) databank.MethodAn OMEQe measure was developed and used to describe trends in opioid burden over the study period. OMEQe burden was stratified by eight drug groups, which was based on usage and deprivation.ResultsAn estimated 643 436 843 milligrams (mg) OMEQe was issued during the study. Annual number of prescriptions increased 44% between 2005 and 2015, while total daily OMEQe per 1000 population increased by 95%. The most deprived areas of Wales had 100 711 696 mg more OMEQe prescribed than the least deprived over the study period.ConclusionOver the study period, OMEQe burden nearly doubled, with disproportionate OMEQe prescribed in the most deprived communities. Using OMEQe provides an alternative measure of prescribing and allows easier comparison of the contribution different drugs make to the overall opioid burden.

Highlights

Annual number of prescriptions increased 44% between 2005 and 2015, while total daily oral morphine equivalent (OMEQe) per 1000 population increased by 95%
Using OMEQe provides an alternative measure of prescribing and allows easier comparison of the contribution different drugs make to the overall opioid burden
It is known that opioid prescribing has increased in the UK over the past 20 years

Summary

Introduction

National and international concerns have focused on strong opioids.[12,13,14] dose and duration of use are more likely indicators of harm or potential for dependence than the choice of drug itself.[11,15,16,17,18,19,20] It has been estimated that adverse events occur in as many as 78% of people using opioids over extended periods of time.[11,12,13] Higher doses[14,15,16,17] have been associated with depression and anxiety,[18,19,20] and an increased risk of dependence and misuse.[21,22,23,24] It has been proposed the burden or risk of opioids would be more accurately discussed in mg doses or dose equivalents, rather than number of prescriptions alone.[2,25]. Prescribing is often monitored by counting numbers of prescriptions dispensed, but this may not provide an accurate picture of clinical practice

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