Analysis of prescribing patterns of prescription opiates across England using CPRD: increasing over 16 years (2000-2015)

First published: 10/05/2019 | Last updated: May 20th, 2019

Background/Aims: Opiates are essential medicines, for relief of pain and other indications. However they also carry dependence potential. Epidemic excessive use of prescription opiates has recently occurred in the US (with four-fold increase in prescription opioid deaths over 15 years), but UK scrutiny is scarce. We report analysis of annual prescription data for England over a 16-year period.

Design/measures: Using CPRD data, we have examined prescription data of approx. 50,000 patients in England to whom GPs have prescribed benzodiazepines, opioids, z-drugs and/or GABAergic drugs (years 2000-2015). In this presentation, we report changes in overall prescribing, individual prescription duration (days) and overall duration of prescribing episode.

Findings:

* Opioids were prescribed to 5% of all patients on CPRD in 2005. (comparators: benzodiazepines 2%, Z-drugs 2%, GABA-ergic medications 2%).

* Patients were mostly female (61-64% annually), with mean age approx. 60, and with >20% living in the most deprived areas (where longer-term prescribing was also more prevalent).

* Average length per prescription remained constant at approx. 24 days, although there was a substantial increase in average length of continuous prescribing periods for opiate/opioid medications from 64 days in 2000, to a peak of 102 days in 2013 and 2014 (declining slightly thereafter).

* The proportion of patients to whom opiate/opioid medications was prescribed doubled between 2000 to 2012 (from 2.5% to 5.4%) but reduced slightly thereafter (see Figure). This was in contrast to the patterns observed for benzodiazepines but with some similarity to proportionate increases seen with z-drugs and with a major increase in prescribing of GABA-ergic drugs (the other potentially dependence-producing medications which we examined).

Figure: Proportion of patients prescribed benzodiazepines, Z-drugs, opioids, GABA-ergics, 2000-15

Conclusions: We find steady substantial increase in opioid prescribing from 2000-2012, but not thereafter. The reasons are not clear and need further investigation. Duration of prescribing per patient also increased, in addition to overall prescribing. With an eye on the extreme opioid epidemic in the US, more attention needs to be paid to study of, and initiatives to address, the increasing opioid prescribing in England.

Declaration of independence of opinions expressed:  This is independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme.  The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health.

Co-Authors

Sally McManus* (co-first author), Senior Research Associate, NatCen (National Centre for Sociual Research), London EC1V 0AX Matthew Hickman, Professor in Public Health and Epidemiology, School of Social & Community Medicine, University of Bristol Neil Smith, Research Director in children, families & work, NatCen (National Centre for Sociual Research) Javiera Cartagena-Farias, Senior Researcher in evaluation, NatCen (National Centre for Sociual Research)


Conflicts of interest:

JS declares that his employer (King’s College London) has received, connected to his work, project grant support and/or honoraria and/or consultancy payments from Department of Health, NTA (National Treatment Agency), PHE (Public Health England), Home Office, NICE (National Institute for Health and Clinical Excellence), and EMCDDA (European Monitoring Centre for Drugs and Drug Addiction) as well as research grants from (last 3 years) NIHR (National Institute on Health Research), MRC (Medical Research Council) and Pilgrim Trust. He has also worked with WHO (World Health Organization), UNODC (United Nations Office on Drugs and Crime), EMCDDA, FDA (US Food and Drug Administration) and NIDA (US National Institute on Drug Abuse) and with other international government agencies. His employer (King’s College London) has registered intellectual property on an innovative buccal naloxone with which JS is involved, and JS has been named in a patent registration by a Pharma company as inventor of a potential concentrated naloxone nasal spray. JS’s employer (King’s College London) has also received, connected to his work, research grant support and/or payment of honoraria, consultancy payments and/or travelling and/or accommodation and/or conference expenses from pharmaceutical companies (including, past 3 years, Martindale, Indivior, MundiPharma, Braeburn) and trial medication supply from iGen and Braeburn and also discussions with various companies about medications potentially applicable in the treatment of addictions and related problems. This includes exploration of the potential for, and consideration of research trials of, improved medications with less abuse liability, longer duration of action (e.g. implant or depot formulations) and also novel non-injectable emergency medications. For updated information see John Strang’s information on the departmental website at http://www.kcl.ac.uk/ioppn/depts/addictions/people/hod.aspx

Professor Mathew Hickman has received honoraria from Gilead, BMS, Janssen for attending expert meetings unrelated to this report. MH is supported by NIHR Health Protection Research Unit in Evaluation and is an NIHR Senior Investigator.

The other authors have no relevant interests to declare.

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