Patterns of regional variation of opioid prescribing in primary care in England: a retrospective observational study

Abstract

Background: Opioids are a widely prescribed class of drug with potentially harmful short-term and long-term side effects. There are concerns about the amounts of these drugs being prescribed in England given that they are increasingly considered ineffective in the context of long-term non-cancer pain, which is one of the major reasons for their prescription.

Aim: To assess the amount and type of opioids prescribed in primary care in England, and patterns of regional variation in prescribing.

Design and setting: Retrospective observational study using publicly available government data from various sources pertaining to opioids prescribed in primary practice in England and Indices of Social Deprivation.

Method: Official government data were analysed for opioid prescriptions from August 2010 to February 2014. The total amount of opioid prescribed was calculated and standardised to allow for geographical comparisons.

Results: The total amount of opioid prescribed, in equivalent milligrams of morphine, increased (r = 0.48) over the study period. More opioids were prescribed in the north than in the south of England (r = 0.66, P<0.0001), and more opioids were prescribed in areas of greater social deprivation (r = 0.56, P<0.0001).

Conclusion: Long-term opioid prescribing is increasing despite poor efficacy for non-cancer pain, potential harm, and incompatibility with best practice. Questions of equality of care arise from higher prescription rates in the north of England and in areas of greater social deprivation. A national registry of patients with high opioid use would improve patient safety for this high-risk demographic, as well as provide more focused epidemiological data regarding patterns of prescribing.

Keywords: chronic pain; observational study; opioid prescribing; primary care; regional variation; social deprivation.

Figure 1.

Percentage of each opioid prescribed in equivalent mg morphine in England from August 2010 to February 2014.

Figure 2.

Total opioids prescribed in equivalent grams of morphine in England per month from August 2010 to February 2014 (r = 0.48, r² = 0.23).

Figure 3.

Variation in English CCGs in opioid prescribing in equivalent mg of morphine from August 2010 to February 2014. CCG = clinical commissioning group.

Figure 4.

Relationship between amount of opioid prescribed, in equivalent mg morphine, and latitude of clinical commissioning group (r² = 0.36). CCG = clinical commissioning group.

Figure 5.

Relationship between the amount of opioid prescribed, in equivalent mg morphine, and social deprivation index of CCGs from August 2010 to February 2014 (r² = 0.28). CCG = clinical commissioning group.