Opioids Aware: a general practice audit of high-dose opioid prescribing NHS England Midlands and East.

Ruth Bastable,Sarah Rann

doi:10.3399/bjgpopen18x101642

Abstract

There has been a marked increase in the number of patients in the UK taking opioids from 2.5% in 2000 to 5% in 2015.1 More patients are taking opioids at higher doses for chronic pain,2,3 for which there is limited evidence of effectiveness. A public facing4 audit with educational resources of high-dose opioids (≥120 mg oral morphine equivalent [OME]) prescribed for chronic pain was carried out in 74 general practices in the East of England, representing 663 418 patients. The dose of ≥120 mg OME was chosen as doses above this are not associated with increased benefit but are associated with increased harms.2 The aim of this study was to quantify: This study also aimed to record practice reflections and plans on their results. In total, 517 practices throughout NHS England Midland and East (East) were emailed (January 2018), inviting participation in an audit of high-dose opioids prescribed for chronic pain. Downloadable searches were provided. It was suggested that …

Highlights

1022 patients were identified as being prescribed high-dose opioids
Almost all were for chronic pain (894/1022 = 87%, prevalence 0.13%)
There was considerable variation in the number and percentage of patients prescribed high-dose opioids by practice and the indication for the prescribing of opioids was unclear in 31.1%

Summary

Introduction

There has been a marked increase in the number of patients in the UK taking opioids from 2.5% in 2000 to 5% in 2015.1 More patients are taking opioids at higher doses for chronic pain,[2,3] for which there is limited evidence of effectiveness.A public facing[4] audit with educational resources of high-dose opioids (≥120 mg oral morphine equivalent [OME]) prescribed for chronic pain was carried out in 74 general practices in the East of England, representing 663 418 patients.The dose of ≥120 mg OME was chosen as doses above this are not associated with increased benefit but are associated with increased harms.[2]The aim of this study was to quantify:• the prevalence of high-dose (≥120 mg OME per day) opioid prescribing for chronic pain in general practices in the East of England;• markers of prescribing quality (clear dose and frequency; clear indication; and review within the last 3 months);• evidence of possible misuse or overuse; and • co-prescribing of other potentially dependence-forming medications (DFMs)[1] (such as, benzodiazepines, z drugs, gabapentin, and pregabalin).

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Conclusion