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Opioid prescribing in primary care on the rise in England

GP opioid prescribing has ‘significantly’ increased in England in the past five years, a new study has found.

Researchers found the prescription of gabapentin, pregabalin and oxycodone had increased consecutively over the past five years.

It follows a Public Health England review this month that found one in four adults are prescribed addictive medicines. 

The study, published in BJGP Open, revealed the CCGs that prescribed the highest volumes of these opioids were in the northern and eastern regions of England.

The research analysed aggregate data of prescribing trends at GP practice and CCG level from April 2013 up to March 2018.

The paper highlighted the concerns of ‘substantial’ increase in prescriptions since 2013.

Results showed the median rate of opioid prescriptions per 1,000 population in England increased each year, but the largest increase between 2013 and 2017 was from pregabalin.

In 2013/2014, the median number of pregabalin prescriptions was 66 per 1,000 population. In 2017/2018, it was 119 per 1000 population.

Researchers also found out of the three drugs, gabapentin was the most prescribed drug per 1,000 population.

The CCGs with the highest total number of opioid prescriptions of the three drugs varied according to the deprivation of the area. In 2017/18, 13 of the 15 CCGs with the highest opioid prescription rates were in the north of England. Sunderland CCG was in the top five of each of the three drugs.

Researchers said: 'Geographical variation in CCGs with the highest average rate of prescribing for gabapentin appears primarily to be within northern and eastern areas of the country.

'Rates of pregabalin prescribing that exceed 1.5 times the national mean also occur in the northern and eastern regions of England. This pattern is largely mirrored in oxycodone, with the addition of high rates of prescribing along the south-east coastline.'

However, the study highlighted that GPs are limited with options for chronic pain treatment. 

It added: 'Pressures on specialist pain management and mental health teams means that access to programmes is often restricted.'

The report concluded: 'There have been significant increases in annual prescriptions of gabapentin, pregabalin, and oxycodone per capita in English primary care. The scale of the increases in prescribing of these medications may be driving increased harm in the form of drug-related mortality and morbidity.

'The experience of the prescription drug misuse epidemic in the US should serve as an early warning to England’s NHS and prompt action to better understand the underlying explanations for the increases in prescribing, and the variation in prescribing rates between GPs and between CCGs.'

 

Readers' comments (8)

  • Paragraph 10, line 2- depravity? WTF use of English is this?

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  • Azeem Majeed

    Is it possible to add the link to the BJGP Open article?

    https://bjgpopen.org/content/early/2019/09/16/bjgpopen19X101662

    Thanks

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  • Looks to be a good time to be a Medical Negligence lawyer.

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  • Vinci Ho

    Would like to similar study on Tramadol prescribing.

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  • Vinci Ho

    In 2013/2014, the median number of pregabalin prescriptions was 66 per 1,000 population. In 2017/2018, it was 119 per 1000 population.

    The number was almost doubled in only four years . Is there a trend going further up ?
    If the fundamental argument is that GPs are not well equipped to manage these patients on these drugs , am I right to infer that the currently available specialist services where GPs are supposed to seek help , are failing us, GPs , then ?

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  • This is because:
    1) Hospital waiting lists too long, and people in pain;
    2) Hospital doctors initiating prescribing and recommending these drugs;
    3) Psychiatry Consultants starting people on and recommending these drugs;
    4) Prisons starting people on and recommending these drugs;
    5) Media and Internernet starting people on and recommending these drugs;
    6) GPs aren't allowed to prescribe 'normal' strong painkillers like MST and Co0Codamol any more!

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  • perhaps more prescriptions for shorter intervals?

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  • will get worse as continuity breaks down . If private introduced worse still as people lose ability to say no.

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