Factors associated with long-term opioid therapy discontinuation for people with chronic non-cancer pain in UK primary care: a population-based retrospective cohort study

Abstract

Background: Understanding the characteristics linked to long-term opioid therapy (L-TOT) discontinuation may inform safer and personalised discontinuation strategies. This study aimed to identify factors associated with L-TOT discontinuation in people with chronic non-cancer pain (CNCP) in UK primary care.

Methods: A retrospective cohort study using the Clinical Practice Research Datalink Aurum data (2000-2020) was conducted. Adults with CNCP receiving L-TOT (three or more opioid prescriptions within 90 days or ≥90 days' supply within the first year, excluding the first 30 days) were included. Discontinuation was defined as opioid-free for ≥180 days after an L-TOT. Mixed-effects logistic models with a random intercept for general practice were used to identify sociodemographic, comorbidities, lifestyle, and pharmacological factors associated with L-TOT discontinuation.

Results: Among 573 639 L-TOT users, 5.2% (n=29 589) discontinued within the first year. Discontinuation was more likely among Asians (adjusted odds ratio [aOR], 1.31; 95% confidence interval [CI], 1.23-1.39; P<0.001), Blacks (aOR, 1.21; 95% CI, 1.13-1.31; P<0.001), non-smokers (aOR, 1.09; 95% CI, 1.05-1.12; P<0.001), those living in the least deprived area (aOR, 1.09; 95% CI, 1.04-1.14; P<0.001), those using weak and short-acting opioids (aOR, 1.50; 95% CI, 1.39-1.61), those with co-existing osteoarthritis (aOR, 1.06; 95% CI, 1.02-1.11; P=0.003), those with anxiety (aOR, 1.04; 95% CI, 1.01-1.07; P=0.003), or those co-using non-steroidal anti-inflammatory drugs (aOR, 1.06; 95% CI, 1.03-1.09; P<0.001) or benzodiazepines (aOR, 1.08; 95% CI, 1.05-1.11; P<0.001).

Conclusions: This study identified key characteristics of people with CNCP who are more likely to discontinue L-TOT. This may help to inform the development of tailored interventions to promote safe opioid discontinuation in primary care.

Keywords: UK primary care; chronic non-cancer pain; discontinuation; general practice; long-term opioid therapy; mixed-effect logistic regression; retrospective cohort study.