Managing addiction to prescribed opioids: the job of general practice?

Leach, Jack M

doi:10.3399/bjgp18x698597

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…One study suggests that 0.8% of people aged 15–64 in England are dependent on illicit opioids 4 , corresponding to approximately 300,000 individuals. There have also been growing concerns about dependence on prescription opioids, although the scale of this problem remains unclear 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

Healthcare use by people who use illicit opioids (HUPIO): development of a cohort based on electronic primary care records in England

et al. 2020

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Background: People who use illicit opioids such as heroin have substantial health needs, but there are few longitudinal studies of general health and healthcare in this population. Most research to date has focused on a narrow set of outcomes, including overdoses and HIV or hepatitis infections. We developed and validated a cohort using UK primary care electronic health records (Clinical Practice Research Datalink GOLD and AURUM databases) to facilitate research into healthcare use by people who use illicit opioid use (HUPIO). Methods: Participants are patients in England with primary care records indicating a history of illicit opioid use. We identified codes including prescriptions of opioid agonist therapies (methadone and buprenorphine) and clinical observations such as ‘heroin dependence’. We constructed a cohort of patients with at least one of these codes and aged 18-64 at cohort entry, with follow-up between January 1997 and March 2020. We validated the cohort by comparing patient characteristics and mortality rates to other cohorts of people who use illicit opioids, with different recruitment methods. Results: Up to March 2020, the HUPIO cohort included 138,761 patients with a history of illicit opioid use. Demographic characteristics and all-cause mortality were similar to existing cohorts: 69% were male; the median age at index for patients in CPRD AURUM (the database with more included participants) was 35.3 (IQR 29.1-42.6); the average age of new cohort entrants increased over time; 76% had records indicating current tobacco smoking; patients disproportionately lived in deprived neighbourhoods; and all-cause mortality risk was 5.4 (95% CI 5.3-5.5) times the general population of England. Conclusions: Primary care data offer new opportunities to study holistic health outcomes and healthcare of this population. The large sample enables investigation of rare outcomes, whilst the availability of linkage to external datasets allows investigation of hospital use, cancer treatment, and mortality.

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Section: Introductionmentioning

confidence: 99%

Healthcare use by people who use illicit opioids (HUPIO): development of a cohort based on electronic primary care records in England

et al. 2020

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“…Evidence suggests that most PO are prescribed in primary-care settings and the management of these prescriptions can become an issue for some primary-care physicians [ 50 , 51 ]. GPs, with their wealth of information about their patients and their background [ 52 ] have an important role to play in prevention, by identifying patients with CNCP associated with p-OUD [ 53 ]. We have shown that moderate/severe prescribed OUD was associated with three factors.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Opioid Misuse and Opioid Use Disorder among Patients with Chronic Non-Cancer Pain and Prescribed Opioids in a Pain Centre in France

Guillou-Landréat

Quinio²,

Reste³

et al. 2021

IJERPH

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(1) Background: Chronic non-cancer pain (CNCP) remains a public health challenge around the world. Opioids (PO) have been increasingly used in the treatment of CNCP in the last 20 years. This study aimed to assess the prevalence of opioid misuse and prescribed-opioid use disorder (p-OUD) among patients with CNCP in a pain centre in France, and to analyse risk factors for moderate or severe p-OUD. (2) Method: A cross-sectional study was conducted, including patients consulting for pain management in the pain centre of Brest University Hospital. A self-questionnaire was administered (sociodemographic data, medical data, PO misuse, and p-OUD according the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) criteria). Descriptive, univariate, and multivariate analyses were conducted, together with a principal component analysis, in order to identify factors associated with p-OUD. (3) Results: In total, 115 patients were included, the majority of whom were women, with a mean age of 52 years old [18–82]; 64.3% (n = 74) had a current prescription for opioid analgesics (weak or strong). In this group, 56.7% (n = 42) had no or only mild p-OUD and 43.3% (n = 32) had current moderate or severe p-OUD. Patients with moderate or severe p-OUD were more likely to have a current antidepressant prescription, to have had psychotherapy, to currently use strong opioids and oxycodone, and to report taking more frequent doses than prescribed and feeling dependent. (4) Conclusions: We showed that the prevalence of current moderate/severe p-OUD concerned 43.3% of the patients with a CNCP seeking treatment in a pain centre. According to these results, several measures are relevant in managing p-OUD among patients with CNCP.

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“…67 Primary care is believed to be an ideal place for managing patients with prescription opioid dependence. 65,68 Furthermore, GPs are generally supportive of the recommendation to provide separate services for the treatment of prescription opioid dependence, and recognise that they have an important role to play in identifying and treating these patients. 38 Efforts to improve prescribing appropriateness have been called for.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Acceptability of a primary care-based opioid and pain review service: a mixed-methods evaluation in England

et al. 2019

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BackgroundPrimary care opioid prescribing to treat chronic non-cancer pain (CNCP) has progressively increased despite a lack of evidence for long-term safety and effectiveness. Developing primary care interventions to reduce opioid dependence in patients with CNCP is a public health priority.AimTo report the acceptability of the South Gloucestershire pain and opioid review service for patients with CNCP, which aimed to help patients understand their relationship with prescribed opioids and support non-drug-based pain management strategies.Design and settingA mixed-methods evaluation was performed on the service, which was based in two GP practices in South Gloucestershire, England, and delivered by project workers.MethodDescriptive data were collected on delivered-within-service and community-based interventions. Twenty-five semi-structured interviews (n = 18 patients, n = 7 service providers) explored experiences of the service.ResultsThe enrolment process, person-centred primary care-based delivery, and service content focused on psychological issues underlying CNCP were found to be acceptable to patients and service providers. Patients welcomed having time to discuss their pain, its management, and related psychological issues. Maintaining a long-term approach was desired as CNCP is a complex issue that takes time to address. GPs recommended that funding was needed to ensure they have dedicated time to support a similar service and to ensure that project workers received adequate clinical supervision.ConclusionThis service model was acceptable and may be a useful means to manage patients with CNCP who develop opioid dependence after long-term use of opioids. A randomised controlled trial is needed to formally test the effectiveness of the service.

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Managing addiction to prescribed opioids: the job of general practice?

Cited by 4 publications

References 4 publications

Healthcare use by people who use illicit opioids (HUPIO): development of a cohort based on electronic primary care records in England

Healthcare use by people who use illicit opioids (HUPIO): development of a cohort based on electronic primary care records in England

Analgesic Opioid Misuse and Opioid Use Disorder among Patients with Chronic Non-Cancer Pain and Prescribed Opioids in a Pain Centre in France

Acceptability of a primary care-based opioid and pain review service: a mixed-methods evaluation in England

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