Abstract
Long-term opioids may benefit patients with chronic pain but have also been linked to harmful outcomes. In the United Kingdom, the predominant source of opioids is primary care prescription. The objective was to examine changes in the incidence, length, and opioid potency of long-term prescribing episodes for musculoskeletal conditions in UK primary care (2002-2013). This was an observational database study (Clinical Practice Research Datalink, 190 practices). Participants (≥18 years) were prescribed an opioid for a musculoskeletal condition (no opioid prescribed in previous 6 months), and issued ≥2 opioid prescriptions within 90 days (long-term episode). Opioids were divided into short- and long-acting noncontrolled and controlled drugs. Annual incidence of long-term opioid episodes was determined, and for those still in a long-term episode, the percentage of patients prescribed each type 1 to 2 years, and >2 years after initiation. Annual denominator population varied from 1.25 to 1.38 m. A total of 76,416 patients started 1 long-term episode. Annual long-term episode incidence increased (2002-2009) by 38% (42.4-58.3 per 10,000 person-years), remaining stable to 2011, then decreasing slightly to 55.8/10,000 (2013). Patients prescribed long-acting controlled opioids within the first 90 days of long-term use increased from 2002 to 2013 (2.3%-9.9%). In those still in a long-term opioid episode (>2 years), long-acting controlled opioid prescribing increased from 3.5% to 22.6%. This study has uniquely shown an increase in prescribing long-term opioids to 2009, gradually decreasing from 2011 in the United Kingdom. The trend was towards increased prescribing of controlled long-acting opioids and earlier use. Further research into the risks and benefits of opioids is required.
Highlights
Over 20% of adults in the United Kingdom present to primary care with a musculoskeletal (MSK) condition each year.[21]
In England, 98% of the population are registered with a general practice,[18,33] and it is in primary care that 90% of all National Health Service (NHS) contacts occur.[15]
Including practices that joined or left Clinical Practice Research Datalink (CPRD) during the study period (n 5 360) in the analysis gave similar trends to the analysis restricted to those practices continuously contributing to CPRD
Summary
Over 20% of adults in the United Kingdom present to primary care with a musculoskeletal (MSK) condition each year.[21] Guidance from the World Health Organisation and the UK National Institute for Health and Care Excellence (NICE) suggest using opioids as part of a stepped approach to controlling MSK pain.[16,30] This advice advocates incremental increases from analgesics such as paracetamol to stronger analgesics such as opioids. Previous studies suggest that approximately 50% of patients consulting with MSK pain will be Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. A Institute for Primary Care and Health Sciences, Staffordshire, United Kingdom, b Research Department of Primary Care and Population Health, UCL, London, United Kingdom
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