Marked rise in opioid prescribing

Opioid prescribing more than doubled in England between 1998 and 2016, and varies considerably across the country, according to a new analysis in Lancet Psychiatry.

Between 1998 and 2016, the number of opioid prescriptions increased by 34 per cent from 568 to 761 per 1,000 of the population. Based on total oral morphine equivalency, prescribing more than doubled (127 per cent increase) from 190,000mg to 431,000mg per 1,000 of the population. The volume of high-dose (120mg or greater morphine equivalency), long-acting opioid prescriptions increased almost six-fold from three to 23 per 1,000 of the population during this time.

Based on total oral morphine equivalency, prescribing rose five-fold (457 per cent increase) from 17,800mg to 99,300mg per 1,000 of the population. Prescriptions declined from 2016 to 2017, largely due to a reduction in morphine use.

Opioid prescribing varied widely between CCGs. Based on data collected between March and August 2018, total oral morphine equivalency differed almost eight-fold (52,700mg to 416,000mg per 1,000 of the population). The total number of items prescribed varied about six-fold (119 to 727 items). The change in prescribing between 2016 and 2017 based on oral morphine equivalency varied from a 10.5 per cent decline to an increase of 3.5 per cent.

GP practices with the largest lists were 53 per cent more likely than smaller practices to prescribe high-dose opioids. Practices in “urban with major conurbation” areas were 23 per cent less likely to prescribe high-dose opioids than those in “mainly rural” parts of the country. Practices in the most deprived areas were 24 per cent more likely to prescribe high-dose opioids than those in the least deprived areas.

The authors suggest that the “findings support calls for greater action to promote best practice in chronic pain prescribing and to reduce geographical variation”.

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