Examining opioid prescribing trends for non-cancer pain using an estimated oral morphine equivalence measure: a retrospective cohort study between 2005 and 2015

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Abstract

Background

Over the past 20 years prescription of opioid medicines has markedly increased in the UK, despite a lack of supporting evidence for use in commonly occurring, painful conditions. Prescribing is often monitored by counting numbers of prescriptions dispensed, but this may not provide an accurate picture of clinical practice.

Aim

To use an estimated oral morphine equivalent (OMEQ _e) dose to describe trends in opioid prescribing in non-cancer pain, and explore if opioid burden differed by deprivation status.

Design & setting

A retrospective cohort study using cross-sectional and longitudinal trend analyses of opioid prescribing data from Welsh Primary Care General Practices (PCGP) took place. Data were used from the Secure Anonymised Information Linkage (SAIL) databank.

Method

An OMEQ _e measure was developed and used to describe trends in opioid burden over the study period. OMEQ _e burden was stratified by eight drug groups, which was based on usage and deprivation.

Results

An estimated 643 436 843 milligrams (mg) OMEQ _e was issued during the study. Annual number of prescriptions increased 44% between 2005 and 2015, while total daily OMEQ _e per 1000 population increased by 95%. The most deprived areas of Wales had 100 711 696 mg more OMEQ _e prescribed than the least deprived over the study period.

Conclusion

Over the study period, OMEQ _e burden nearly doubled, with disproportionate OMEQ _e prescribed in the most deprived communities. Using OMEQ _e provides an alternative measure of prescribing and allows easier comparison of the contribution different drugs make to the overall opioid burden.

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Most cited references 64

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Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects.

Andrea D Furlan, Juan Sandoval, Angela Mailis-Gagnon … (2006)

Chronic noncancer pain (CNCP) is a major health problem, for which opioids provide one treatment option. However, evidence is needed about side effects, efficacy, and risk of misuse or addiction. This meta-analysis was carried out with these objectives: to compare the efficacy of opioids for CNCP with other drugs and placebo; to identify types of CNCP that respond better to opioids; and to determine the most common side effects of opioids. We searched MEDLINE, EMBASE, CENTRAL (up to May 2005) and reference lists for randomized controlled trials of any opioid administered by oral or transdermal routes or rectal suppositories for CNCP (defined as pain for longer than 6 mo). Extracted outcomes included pain, function or side effects. Methodological quality was assessed with the Jadad instrument; analyses were conducted with Revman 4.2.7. Included were 41 randomized trials involving 6019 patients: 80% of the patients had nociceptive pain (osteoarthritis, rheumatoid arthritis or back pain); 12%, neuropathic pain (postherpetic neuralgia, diabetic neuropathy or phantom limb pain); 7%, fibromyalgia; and 1%, mixed pain. The methodological quality of 87% of the studies was high. The opioids studied were classified as weak (tramadol, propoxyphene, codeine) or strong (morphine, oxycodone). Average duration of treatment was 5 (range 1-16) weeks. Dropout rates averaged 33% in the opioid groups and 38% in the placebo groups. Opioids were more effective than placebo for both pain and functional outcomes in patients with nociceptive or neuropathic pain or fibromyalgia. Strong, but not weak, opioids were significantly superior to naproxen and nortriptyline, and only for pain relief. Among the side effects of opioids, only constipation and nausea were clinically and statistically significant. Weak and strong opioids outperformed placebo for pain and function in all types of CNCP. Other drugs produced better functional outcomes than opioids, whereas for pain relief they were outperformed only by strong opioids. Despite the relative shortness of the trials, more than one-third of the participants abandoned treatment.

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Fair society, healthy lives

M. Marmot, R. Bell (2012)

The final report of the World Health Organization Commission on the Social Determinants of Health (CSDH), published in 2008, affirmed that social injustice was killing on a grand scale, with a toxic combination of 'poor social policies and programmes, unfair economic arrangements, and bad politics' being responsible for producing and reinforcing health inequalities. It provided a comprehensive evidence-based discussion of pervasive inequalities of health in many countries, demonstrating the presence of a social gradient in health outcomes associated with the unfair distribution of the social determinants of health. The social determinants of health include the conditions in which people are born, grow, live, work and age, and the fundamental drivers of these conditions: the distribution of power; money; and resources. Following publication of the CSDH report and recommendations for action, the UK Government commissioned a Strategic Review of Health Inequalities in England. This article provides an overview and reflection on the findings from the CSDH and the Strategic Review of Health Inequalities in England, reviewing the case for putting fairness at the heart of all policy making. In the process, it highlights the need for action on the social determinants of health in order to address health inequalities and the social gradient in health outcomes. Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

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The SAIL databank: linking multiple health and social care datasets

Ronan Lyons, Kerina Jones, Gareth John … (2009)

Background Vast amounts of data are collected about patients and service users in the course of health and social care service delivery. Electronic data systems for patient records have the potential to revolutionise service delivery and research. But in order to achieve this, it is essential that the ability to link the data at the individual record level be retained whilst adhering to the principles of information governance. The SAIL (Secure Anonymised Information Linkage) databank has been established using disparate datasets, and over 500 million records from multiple health and social care service providers have been loaded to date, with further growth in progress. Methods Having established the infrastructure of the databank, the aim of this work was to develop and implement an accurate matching process to enable the assignment of a unique Anonymous Linking Field (ALF) to person-based records to make the databank ready for record-linkage research studies. An SQL-based matching algorithm (MACRAL, Matching Algorithm for Consistent Results in Anonymised Linkage) was developed for this purpose. Firstly the suitability of using a valid NHS number as the basis of a unique identifier was assessed using MACRAL. Secondly, MACRAL was applied in turn to match primary care, secondary care and social services datasets to the NHS Administrative Register (NHSAR), to assess the efficacy of this process, and the optimum matching technique. Results The validation of using the NHS number yielded specificity values > 99.8% and sensitivity values > 94.6% using probabilistic record linkage (PRL) at the 50% threshold, and error rates were < 0.2%. A range of techniques for matching datasets to the NHSAR were applied and the optimum technique resulted in sensitivity values of: 99.9% for a GP dataset from primary care, 99.3% for a PEDW dataset from secondary care and 95.2% for the PARIS database from social care. Conclusion With the infrastructure that has been put in place, the reliable matching process that has been developed enables an ALF to be consistently allocated to records in the databank. The SAIL databank represents a research-ready platform for record-linkage studies.

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Author and article information

Journal

Journal ID (nlm-ta): BJGP Open

Journal ID (iso-abbrev): BJGP Open

Journal ID (publisher-id): bjgpoa

Journal ID (hwp): bjgpoa

Title: BJGP Open

Publisher: Royal College of General Practitioners

ISSN (Electronic): 2398-3795

Publication date Collection: January 2021

Publication date (Electronic, pub): 02 December 2020

Publication date PMC-release: 02 December 2020

Volume: 5

Issue: 1

Electronic Location Identifier: bjgpopen20X101122

Affiliations

[1 ] PhD Research Fellow, College of Human and Health Sciences, Swansea University , Swansea, UK

[2 ] Advanced Pharmacist Practitioner in Pain Management, Pharmacy and Medicines Management, Cwm Taf Morgannwg University Health Board , Abercynon, UK

[3 ] Senior Lecturer in Health Economics, Swansea Centre for Health Economics, Swansea University , Swansea, UK

[4 ] Research Officer, Swansea Centre for Health Economics, Swansea University , Swansea, UK

[5 ] Professor of Health Economics, College of Human and Health Sciences, Swansea University , Swansea, UK

[6 ] Professor of Public Health, Policy and Social Sciences, College of Human and Health Sciences, Swansea University , Swansea, UK

Author notes

*For correspondence: Emma Davies, 878970@ 123456swansea.ac.uk

Author information

Emma Davies https://orcid.org/0000-0003-1171-3201

Mari Jones http://orcid.org/0000-0001-9661-4899

Article

Publisher ID: 01122

DOI: 10.3399/bjgpopen20X101122

PMC ID: 7960521

PubMed ID: 33172848

SO-VID: 3aee6b49-5536-49e9-a6d8-acb6ecc415f9

License:

This article is Open Access: CC BY license ( https://creativecommons.org/licenses/by/4.0/)

Examining opioid prescribing trends for non-cancer pain using an estimated oral morphine equivalence measure: a retrospective cohort study between 2005 and 2015

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Most cited references 64

Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects.

Fair society, healthy lives

The SAIL databank: linking multiple health and social care datasets

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