Opioids and Gabapentinoids Utilisation and Their Related-Mortality Trends in the United Kingdom Primary Care Setting, 2010–2019: A Cross-National, Population-Based Comparison Study

Abstract

Background: There is growing concern over the increasing utilisation trends of opioids and gabapentinoids across but there is lack of data assessing and comparing the utilisation trends across the four United Kingdom countries. We assessed/compared opioids and gabapentinoids utilisation trends across the four United Kingdom countries then evaluated the correlation between their utilisation with related mortality.Methods: This repeated cross-national study used Prescription Cost Analysis (PCA) datasets (2010–2019). Opioids and gabapentinoids utilisation were measured using number of items dispensed/1,000 inhabitants and defined daily doses (DDDs)/1,000 inhabitant/day. Number of Opioids and gabapentinoids-related mortality were extracted from the United Kingdom Office for National Statistics (2010–2018). Data were analysed using descriptive statistics including linear trend analysis; correlation between the Opioids and gabapentinoids utilisation and their related mortality using Pearson correlation coefficient.Results: The results illustrated an overall significant increasing trend in the utilisation of opioids (12.5–14%) and gabapentinoids (205–207%) with substantial variations among the four United Kingdom countries. For opioids, Scotland had the highest level of number of items dispensed/1,000 inhabitant (156.6% higher compared to the lowest level in England), whereas in terms of DDD/1,000 inhabitant/day, NI had the highest level. Utilisation trends increased significantly across the four countries ranging from 7.7% in Scotland to 20.5% in NI (p < 0.001). Similarly, for gabapentinoids, there were significant increasing trends ranging from 126.5 to 114.9% in NI to 285.8–299.6% in Wales (p < 0.001) for number of items/1,000 inhabitants and DDD/1,000 inhabitant/day, respectively. Although the utilisation trends levelled off after 2016, this was not translated into comparable reduction in opioids and gabapentinoids-related mortality as the latter continued to increase with the highest level in Scotland (3.5 times more deaths in 2018 compared to England- 280.1 vs. 79.3 deaths/million inhabitants). There were significant moderate-strong positive correlations between opioids and gabapentinoids utilisation trends and their related mortality.Conclusion: The utilisation trends of opioids and gabapentinoids have increased significantly with substantial variations among the four United Kingdom countries. This coincided with significant increase in their related mortality. Our findings support the call for immediate actions including radical changes in official United Kingdom policies on drug use and effective strategies to promote best clinical practice in opioids and gabapentinoids prescribing.

Rise of Pregabalin Poisoning and Abuse Cases in Serbia: A Ten-Year Retrospective Study

“… 1 In many countries, the prescribing and overall consumption of gabapentinoids has increased sharply. 2 , 3 A significant part of this trend is attributed to the common off-label use of gabapentinoids and the ongoing efforts of clinicians not to rely on opioids in the treatment of various pain conditions. 4 In Serbia, gabapentinoids are approved for the treatment of neuropathic pain and as adjunctive therapy for focal seizures in patients with epilepsy, while pregabalin has an additional indication for the treatment of generalized anxiety disorder.…”

Feasibility and Acceptability of an Overdose Prevention Intervention Delivered by Community Pharmacists for Patients Prescribed Opioids for Chronic Non-Cancer Pain

“…Instead, non-pharmacological treatments, such as group exercise programmes or psychological therapy, should be offered first to help manage pain [ 1 ]. Opioids are associated with central nervous system depression, dependence, and possibly an increase in all-cause mortality [ 10 , 11 , 12 ]. In the UK, the Medications and Healthcare products Regulatory Agency now recommend that overdose risk should be communicated to all patients prescribed opioids for chronic pain [ 13 ].…”

“…Coffin et al also identified that reduced access to prescribed opioids amongst patients previously reliant on their prescription was related to an increased use of non-prescription opioid analgesia [ 17 ]. In the CNCP population, polypharmacy (the use of multiple medications at the same time, including the co-prescribing of other central nervous system depressants), high dose opioids (≥50 morphine milligram equivalent per day), histories of non-prescription substance use, and co-morbid mental and physical health conditions are all risk factors for opioid-related harms, including overdose [ 6 , 10 , 18 ]. Additionally, CNCP is over-represented in people who use non-prescription substances [ 19 , 20 ], and this has also been found in the Scottish context [ 21 ].…”

“…Opioids are associated with central nervous system depression, dependence, and possibly an increase in all-cause mortality [10][11][12]. In the UK, the Medications and Healthcare products Regulatory Agency now recommend that overdose risk should be communicated to all patients prescribed opioids for chronic pain [13].…”

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

“…In addition to inadequate pain relief, the use of opioids for pain management is challenged by significant adverse effects including physical dependence, tolerance, sedation, dizziness, constipation, nausea, vomiting, and respiratory depression ( 3 ). Trends in opioid prescription and the associated mortality continue to be problematic not only in the US, but also in other countries ( 4 , 5 ). Multimodal approaches for pain management such as combination therapy with both nonpharmacological means in addition to traditional pharmacological therapeutics can be effective in achieving optimal control of pain ( 6 , 7 ).…”