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Opioid analgesics

Opioid prescribing highest in more deprived regions of England, study shows

A study published in the International Journal of Drug Policy has found that opioid prescribing is higher in parts of England with greater levels of social deprivation.

Opiod painkillers spilling out of bottle


Despite high levels of prescribing, opoid analgesics do not work for all people or all types of pain

Opioid prescribing in general practice is highest in North West England and the East Midlands, mirroring general geographical health inequalities, a study published in the International Journal of Drug Policy has found.

The researchers set out to quantify opioid prescriptions dispensed from primary care practices across England and investigate its association with socioeconomic status. They used publicly available data from 2015 to calculate the total amount of opioid prescriptions dispensed for each practice and analysed it alongside data from the Index of Multiple Deprivation (IMD), a UK government qualitative study of deprived areas in England.

Of the 7,856 practices included, the median number of defined daily doses (DDDs) per 1,000 registrants per day was 36.9. Opioid dispensing appeared to be higher in the north of England, with the median number of DDDs per 1,000 registrants varying between 53.1 in Manchester, 48.9 in Newcastle, 35.3 in Birmingham and 13.9 in London.

The three highest areas for GP opioid prescribing were NHS Blackpool clinical commissioning group (CCG), NHS St Helens CCG — both in North West England  — and NHS Lincolnshire East CCG in the East Midlands.

Lower socioeconomic status, smoking, obesity and depression were all found to be significantly associated with increased opioid prescriptions. For every decrease in IMD decile, there was a significant increase in opioid use by 1.0 DDD (95% confidence interval 0.89–1.2; P< 0.001) per 1,000 registrants per day.

“Chronic pain is difficult to manage and, unfortunately, because their workload pressures are so stringent, GPs have limited capacity to counsel patients with persistent pain,” said Li-Chia Chen, lead author of the study.

“Pharmacists could also play a vital role in pain management and, in our view, are an underused resource.”

Roger Knaggs, co-author and associate professor in clinical pharmacy practice at the University of Nottingham, said that while opioids are some of the most potent medicines for pain relief available, they do not work for all types of pain or for everybody.

“We need to understand more about why opioids are prescribed more commonly in areas of greater deprivation and to ensure there is collaboration between different parts of the healthcare system to provide appropriate services and support for people who are prescribed opioids,” he said.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206014

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