Abstract
BackgroundOpioid prescribing for a range of health issues is increasing globally. The risk of fatal and non-fatal overdose is increased among people prescribed strong opioids: in high doses in the context of polypharmacy (the use of multiple medications at the same time), especially with other sedatives; and among people with multiple morbidities including cardiorespiratory, hepatic and renal conditions. This study described and quantified the prescribing of strong opioids, comorbidities and other overdose risk factors among those prescribed strong opioids, and factors associated with high/very high opioid dosage in a regional health authority in Scotland as part of a wider service improvement exercise.MethodsParticipating practices ran searches to identify patients prescribed strong opioids and their characteristics, polypharmacy, and other overdose risk factors. Data were anonymised before being analysed at practice and patient-level. Morphine Equivalent Doses were calculated for patients based on drug/dose information and classed as Low/Medium/High/Very High. Descriptive statistics were generated on the strong opioid patient population and overdose risk factors. The relationship between the prescribing of strong opioids and practice/patient-level factors was investigated using linear and logistic regression models.ResultsEighty-five percent (46/54) of GP practices participated. 12.4% (42,382/341,240) of individuals in participating practices were prescribed opioids and, of these, one third (14,079/42,382) were prescribed strong opioids. The most common comorbidities and overdose risk factors among strong opioid recipients were pain (67.2%), cardiovascular disease (43.2%), and mental health problems (39.3%). There was a positive significant relationship between level of social deprivation among practice caseload and level of strong opioid prescribing (p < 0.001). People prescribed strong opioids tended to be older (mean 59.7 years) and female (8638, 61.4%) and, among a subset of patients, age, gender and opioid drug class were significantly associated with prescribing of High/Very High doses.ConclusionsOur findings have identified a large population at potential risk of prescription opioid overdose. There is a need to explore pragmatic models of tailored interventions which may reduce the risk of overdose within this group and clinical practice may need to be tightened to minimise overdose risk for individuals prescribed high dose opioids.
Highlights
Opioid prescribing for a range of health issues is increasing globally
Scotland has one of the highest rates of opioid-related overdose mortality in Europe, with the rates of fatal overdose continuing to increase [1]. These overdoses mainly occur among users of illicit opioids such as heroin, or opioids prescribed for dependence such as methadone and buprenorphine [1]
Some countries, including the United States of America (USA) and Canada, have responded to these concerns through increased monitoring or regulation of these prescriptions, these measures have been associated with some unwelcome, unintended consequences such as increased use of illicit opioids [15, 16, 17]
Summary
Opioid prescribing for a range of health issues is increasing globally. The risk of fatal and non-fatal overdose is increased among people prescribed strong opioids: in high doses in the context of polypharmacy (the use of multiple medications at the same time), especially with other sedatives; and among people with multiple morbidities including cardiorespiratory, hepatic and renal conditions. In the last 20 years, there have been considerable increases in the prescription of opioids for CNCP, predominantly in high-income countries including the USA, Canada and Australia This increase is perceived to be caused by several interrelated systematic, political, economic, prescribing and governance developments and issues that syndemically created a large population of people prescribed opioids, with questionable benefits [9,10,11]. This may have contributed to increasing or persistent expectations by patients for the unqualified continuation of these prescriptions [12, 13]. Some countries, including the USA and Canada, have responded to these concerns through increased monitoring or regulation of these prescriptions, these measures have been associated with some unwelcome, unintended consequences such as increased use of illicit opioids [15, 16, 17]
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