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Opioid analgesics

Big increase in opioid prescriptions and related hospital admissions since 2000

Looking at primary care data, researchers have found that opioids were over twice as likely to be prescribed as benzodiazepines or GABAergic medicines.

opioids us medicine bottles ss 17


Researchers have analysed primary care prescribing data and found that in 2015, opioids were twice as likely to be prescribed as benzodiazepines, Z-drugs or GABAergic medicines

The proportion of patients prescribed opioids and Z-drugs doubled between 2000 and 2012, according to the results of a study into prescribing patterns in dependence-forming medicines, by the Public Health Research Consortium (PHRC)[1].

Looking at primary care prescribing data from the Clinical Practice Research Datalink, the researchers found that in 2015, opioids were over twice as likely to be prescribed as benzodiazepines, Z-drugs, or GABAergic medicines. Opioids were issued to 1 patient in 20 whereas benzodiazepines, Z-drugs and GABAergic medicines were each prescribed to around 1 patient in 50.

As well as the numbers of prescriptions, there has also been an upward trend in the length of continuous prescribing periods, especially for opioids which increased from 64 days in 2000, to a peak of 102 days in 2013 and 2014.

Neil Smith, research director at the National Centre for Social Research who conducted the study on behalf of the PHRC, said the report highlights the fact that a balance needs to be struck between ensuring proper access to medicines to relieve suffering and avoiding prescribing that might cause harm such as dependence.

“Clinical guidance recommending more cautious and time limited prescribing of benzodiazepines may well have been effective in changing practice, with reductions in the extent and length of benzodiazepine prescribing,” he said.

“Trends in the extent and duration of opioid prescribing however, needs ongoing monitoring.”

Roger Knaggs, a pharmacist specialising in anaesthesia and pain management said that if analgesic medicines were likely to be of benefit for a patient, some improvement in pain and function would usually be apparent within a few weeks.

“If there is no benefit within a couple of months, it is unlikely to be effective and the dose should be tapered and not increased,” he explained.

“Over recent years, opioid medicines have been prescribed more commonly for other types of long-term pain such as back pain, arthritis or nerve pain. However, there is no evidence that they are effective in the longer term (over one year) for these types of pain.”

In addition to this report, data from NHS Digital, published on 31 August 2017, showed that in England the number of patients admitted to hospital for overdosing on opioid painkillers almost doubled in the last decade, from 4,312 in 2005–2006 to 8,219 in 2016. Poisoning from other synthetic narcotics also increased more than four-fold from 579 in 2005–2006 to 2,780 in 2016–2017.

Knaggs said that there were probably many reasons for this finding.

“This is most likely to be associated with a large increase in prescribing since 2005 (more than 100%) and people may have been obtaining these medicines from sources other than their GP, such as family or friends, illicit sources or over the internet,” he said.

“Also, more patients are being discharged earlier after surgery with supplies of opioids, and prescription is continued in the community without regular review.”

He added that managing pain was complex and medicines formed just a small part of the overall treatment plan for a patient.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20203590

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