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GP prescribing of opioids is still rising

Study calls for national registry of patients with high opioid use

Adrian O'Dowd

Tuesday, 13 February 2018

Prescribing of opioids by GPs in England is rising despite long-standing concerns over these drugs’ effectiveness and drawbacks such as possible addiction, according to a study* published today in the British Journal of General Practice.

The UK study’s authors are calling for a national database of patients taking large amounts of opioids to be set up to monitor their appropriate use.

Chronic, non-cancer pain is common, but treatment is often unsatisfactory, and potent analgesics, such as opioids, are often not effective.

Despite this, there appears to be an ongoing rise in their prescription for non-cancer chronic pain, with the potential for dependence, addiction, abuse and multiple serious side-effects.

A team of researchers from University College London and the London School of Hygiene and Tropical Medicine used data from the Health and Social Care Information Centre (now called NHS Digital) and the Office for National Statistics to examine trends in opioid prescribing in England between August 2010 to February 2014.

The results showed there has been a continuing, often steep, rise in the prescription of eight opioid drugs including buprenorphine, codeine, morphine, and tramadol.

Tramadol was the most prescribed, followed by buprenorphine and methadone. Fentanyl was the least prescribed drug.

The researchers found that opioids were more often prescribed in the north than in the south of England and more often in places with greater social deprivation.

They also noted that only a fifth of people with problematic pain had access to specialist services, and as few as 40% of those services offered best practice in the form of multidisciplinary team assessment and treatment.

To address the overall trend, they called for GPs to contribute data towards a new national database of patients taking large amounts of opioids, which could help avoid further escalations of doses, attempt to help patients with specialist opioid reduction programmes, and provide data to help clarify distribution of high opioid use and target areas for future research.

The authors concluded: “This study exposes increasing rates of prescription of a class of drugs whose use for chronic pain is controversial, with potential for abuse, and an association with serious adverse effects and premature death.

“The authors call on policymakers to identify the reasons for this variation to enable avoidable harm to be addressed.”

The Royal College of General Practitioners (RCGP) said GPs were trying to limit opioid use for patients but needed access to alternative treatments.

College chair Professor Helen Stokes-Lampard said: “Addiction to any substance can have a potentially life-changing effect on a person’s health and wellbeing, which is why GPs will carefully consider the risks of a drug before prescribing it to a patient.

“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.

“However, most patients don’t want to be on long-term prescriptions and, where possible, GPs will always try to explore non-pharmacological treatments – but 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.”

*Mordecai, L; Reynolds, C; Donaldson, L; and de C Williams, A. Patterns of regional variation of opioid prescribing in primary care in England: a retrospective observational study. Br J Gen Pract 2018. DOI:10.3399/bjgp18X695057.

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