Opioid prescribing is rising in many countries

Smith, Blair H.; Fletcher, Emma; Colvin, Lesley

doi:10.1136/bmj.l5823

Cited by 13 publications

(12 citation statements)

References 9 publications

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“…Individuals are prescribed opioids for acute pain, cancer pain and chronic non cancer pain (CNCP); for the management for dependence on illicit opioids; and for palliative care [4]. Opioids can effectively manage acute and cancer pain but there is limited evidence of their efficacy in CNCP [5], with studies finding variable quality evidence of short to mediumterm analgesic benefits. Studies have highlighted an increased risk of harm directly related to opioid prescribing [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Quantifying prescribed high dose opioids in the community and risk of overdose

et al. 2021

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Background Opioid prescribing for a range of health issues is increasing globally. The risk of fatal and non-fatal overdose is increased among people prescribed strong opioids: in high doses in the context of polypharmacy (the use of multiple medications at the same time), especially with other sedatives; and among people with multiple morbidities including cardiorespiratory, hepatic and renal conditions. This study described and quantified the prescribing of strong opioids, comorbidities and other overdose risk factors among those prescribed strong opioids, and factors associated with high/very high opioid dosage in a regional health authority in Scotland as part of a wider service improvement exercise. Methods Participating practices ran searches to identify patients prescribed strong opioids and their characteristics, polypharmacy, and other overdose risk factors. Data were anonymised before being analysed at practice and patient-level. Morphine Equivalent Doses were calculated for patients based on drug/dose information and classed as Low/Medium/High/Very High. Descriptive statistics were generated on the strong opioid patient population and overdose risk factors. The relationship between the prescribing of strong opioids and practice/patient-level factors was investigated using linear and logistic regression models. Results Eighty-five percent (46/54) of GP practices participated. 12.4% (42,382/341,240) of individuals in participating practices were prescribed opioids and, of these, one third (14,079/42,382) were prescribed strong opioids. The most common comorbidities and overdose risk factors among strong opioid recipients were pain (67.2%), cardiovascular disease (43.2%), and mental health problems (39.3%). There was a positive significant relationship between level of social deprivation among practice caseload and level of strong opioid prescribing (p < 0.001). People prescribed strong opioids tended to be older (mean 59.7 years) and female (8638, 61.4%) and, among a subset of patients, age, gender and opioid drug class were significantly associated with prescribing of High/Very High doses. Conclusions Our findings have identified a large population at potential risk of prescription opioid overdose. There is a need to explore pragmatic models of tailored interventions which may reduce the risk of overdose within this group and clinical practice may need to be tightened to minimise overdose risk for individuals prescribed high dose opioids.

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Section: Introductionmentioning

confidence: 99%

Quantifying prescribed high dose opioids in the community and risk of overdose

et al. 2021

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“…In particular, the increase in prescribing of opioids in the USA from the late 1990s to the early 2010s has been well documented (Centers for Disease Control and Prevention (CDC), 2011), with 9.9 million people aged 12 years or over reported to have misused prescription opioids (United Nations, 2020). There are a number of possible explanations for this increase in opioid use, including an ageing population at greater risk of developing chronic pain conditions, changes in prescribing recommendations with increased use for chronic non-cancer pain and more effective marketing from pharmaceutical companies (Smith et al, 2019). This increase in opioid use has given rise to the “opioid epidemic” in the USA and there are concerns a similar situation could be happening in Scotland (Dhalla et al, 2011, Kimber et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Assessing the impact of a national clinical guideline for the management of chronic pain on opioid prescribing rates: A controlled interrupted time series analysis

Hébert

Moralès

Torrance

et al. 2021

Preprint

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Background: Opioids are used to treat patients with chronic pain, but their long-term use is associated with harms. In December 2013, SIGN 136 was published, providing a comprehensive evidence-based guideline for the assessment and management of chronic pain in Scotland. Aims: This study aimed to examine the impact of SIGN 136 on opioid prescribing trends and costs across the whole of Scotland. Methods: Opioid prescribing data and average cost per item were obtained from Public Health Scotland. An interrupted time series analysis examined the effects of SIGN 136 publication on the number of items prescribed per 1,000 population per quarter for 29 opioids (or opioid-containing combinations) from 2005 to 2019 inclusive. Exploratory analysis was conducted in NHS Tayside and NHS Fife combined and then up-scaled to all 14 NHS Scotland health boards. A similar approach was also used to assess the effect of SIGN 136 on estimated gross ingredient costs per quarter. Results: At six years post-intervention there was a relative reduction in opioid prescribing of 18.8% (95% CI: 16.0-21.7) across Scotland. There was also a relative reduction of 22.8% (95%: 14.9-30.1) in gross ingredient cost nationally. Opioid prescribing increased significantly pre-intervention across all 14 NHS Scotland health boards (2.19 items per 1000 population per quarter), followed by a non-significant change in level and a significant negative change in trend post-intervention (-2.69 items per 1000 population per quarter). Similar findings were observed locally in NHS Tayside and NHS Fife. Conclusions: The publication of SIGN 136 coincided with a statistically significant reduction in opioid prescribing rates in Scotland and suggests that changes in clinical policy are having a positive effect on prescribing practices in primary care. These prescribing trends appear to be in contrast to the UK as a whole.

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“…1 Furthermore, prescription opioids are implicated in the so-called opioid epidemic experienced most keenly in North America 2 but now also seen increasingly elsewhere. 3 Although the causes of the opioid crisis are complex, changes in perioperative prescribing practices with newer formulations of synthetic opioid analgesics are partly to blame. Approximately 5% of patients prescribed opioids will go on to become dependent on them.…”

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confidence: 99%

Commentary: Enhanced recovery and postoperative opioid use: Good for the patient, good for society?

Batchelor

2021

The Journal of Thoracic and Cardiovascular Surgery

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Perioperative lung resection outcomes after implementation of a multidisciplinary, evidence-based thoracic ERAS program. Ann Surg. December 5, 2019 [Epub ahead of print]. 4. Nelson DB, Mehran RJ, Mitchell KG, Correa AM, Sepesi B, Antonoff MB, et al.Enhanced recovery after thoracic surgery is associated with improved adjuvant chemotherapy completion for non-small cell lung cancer. J Thorac Cardiovasc Surg. 2019;158:279-86.e1. 5. Antonoff MB. Commentary: predicting patients at risk for complications after thoracic surgery-application in the era of enhanced recovery.

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Opioid prescribing is rising in many countries

Abstract: Chronic pain strategies must be embedded within broader efforts to tackle deprivation

Cited by 13 publications

References 9 publications

Quantifying prescribed high dose opioids in the community and risk of overdose

Quantifying prescribed high dose opioids in the community and risk of overdose

Assessing the impact of a national clinical guideline for the management of chronic pain on opioid prescribing rates: A controlled interrupted time series analysis

Commentary: Enhanced recovery and postoperative opioid use: Good for the patient, good for society?

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