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. 2014 Oct;18(9):1343-51.
doi: 10.1002/j.1532-2149.2014.496.x. Epub 2014 Apr 22.

Changes in trends and pattern of strong opioid prescribing in primary care

C S Zin  1 , L C Chen, R D Knaggs
Affiliations

Changes in trends and pattern of strong opioid prescribing in primary care

C S Zin et al. Eur J Pain. 2014 Oct.

Abstract

Background: This study evaluated the prescribing trends of four commonly prescribed strong opioids in primary care and explored utilization in non-cancer and cancer users.

Methods: This cross-sectional study was conducted from 2000 to 2010 using the UK Clinical Practice Research Datalink. Prescriptions of buprenorphine, fentanyl, morphine and oxycodone issued to adult patients were included in this study. Opioid prescriptions issued after patients had cancer medical codes were defined as cancer-related use; otherwise, they were considered non-cancer use. Annual number of prescriptions and patients, defined daily dose (DDD/1000 inhabitants/day) and oral morphine equivalent (OMEQ) dose were measured in repeat cross-sectional estimates.

Results: In total, there were 2,672,022 prescriptions (87.8% for non-cancer) of strong opioids for 178,692 users (59.9% female, 83.9% non-cancer, mean age 67.1 ± 17.0 years) during the study period. The mean annual (DDD/1000 inhabitants/day) was higher in the non-cancer group than in the cancer group for all four opioids; morphine (0.73 ± 0.28 vs. 0.12 ± 0.04), fentanyl (0.46 ± 0.29 vs. 0.06 ± 0.24), oxycodone (0.24 ± 0.19 vs. 0.038 ± 0.028) and buprenorphine (0.23 ± 0.15 vs. 0.008 ± 0.006). The highest proportion of patients were prescribed low opioid doses (OMEQ ≤ 50 mg/day) in both non-cancer (50.3%) and cancer (39.9%) groups, followed by the dose ranks of 51-100 mg/day (26.2% vs. 28.7%), 101-200 mg/day (15.1% vs. 19.2%) and >200 mg/day (8.25% vs. 12.1%).

Conclusions: There has been a huge increase in strong opioid prescribing in the United Kingdom, with the majority of prescriptions for non-cancer pain. Morphine was the most frequently prescribed, but the utilization of oxycodone, buprenorphine and fentanyl increased markedly over time.

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Figures

Figure 1
Figure 1
Number of strong opioid prescriptions and users in non-cancer and cancer groups.
Figure 2
Figure 2
Number of prescriptions for each strong opioid in non-cancer and cancer groups.
Figure 3
Figure 3
Number of defined daily dose (DDD)/1000 inhabitants/day for each strong opioid in non-cancer and cancer groups.
Figure 4
Figure 4
Number of patients stratified by four dose ranks for annual oral morphine equivalent (OMEQ) dose per patient per day.
Figure 5
Figure 5
Annual oral morphine equivalent (OMEQ) dose per patient per day in all patients, non-cancer and cancer groups.
Figure 6
Figure 6
Proportion of opioids contributing to each rank of oral morphine equivalent (OMEQ) calculation between cancer and non-cancer patients.
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