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GP prescribing of strong opioids up by more than a fifth in two years

The amount of strong opioid drugs prescribed by GPs increased over 20% between 2013 and 2015, an analysis of official prescribing data for England and Wales has revealed.

The increase comes after GPs were told they may soon be barred from prescribing strong opioids for low back pain under planned changes to NICE guidelines

GP experts said the pattern was concerning in light of the potential risks of addiction and overdose, but warned GPs needed better access to pain clinics to be able to offer patients alternatives to prescribing.

The analysis, by the research division of Pulse’s publisher, Cogora, showed that the number of strong opioid analgesics capsules prescribed by GPs – including buprenorphine, fentanyl, morphine and oxycodone – increased by 10% from 2014 to 2015, continuing a trend seen the year before when it rose by 12%.

By comparison, the amount of weaker opioid analgesics including codeine and tramadol prescribed by GPs has seen a net increase of just 1% over the two-year period.

The report suggested concerns around other analgesics was leading GPs to turn more to opioids, as well as lack of time for assessments and pain referral services, and patients wanting their pain completely eradicated.   

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, told Pulse the rise in strong opioid use raised concerns the UK was following trends seen in the USA, where ‘we have seen big increases in the prescribing of opioids in non-cancer pain… and a significant increase in deaths there from overdoses’.

Dr Green added that ‘it would be tragic if we were to follow their lead’, but warned that ‘CCG decommissioning of clinics for long-term pain from secondary care and moving them into community settings with, in general, less qualified staff, has meant that fewer options are available for these patients, and this can lead to a remorseless ascent of the analgesic “ladder”’.

Dr Ollie Hart, a GP and clinical lead for musculoskeletal commissioning in Sheffield, said GPs had previously been given the message that they could use stronger opioids for chronic pain, and that ‘there is always a bit of a lag in changing practice’ - but agreed a lack of ‘non-prescribing’ alternatives was contributing to the problem.

He said: ‘Pain clinics, and community support for chronic pain is not widely available – certainly not to the scale we know people have chronic pain – and these kinds of management approaches are quite difficult to talk people through, so prescribing is sometimes the easier thing to do.’

The GPC is currently working with the BMA Science Committee on guidance on addictive analgesics, including strong opioids, after doctors demanded action at last year’s annual BMA conference.

The Cogora report also found a large increase for a second year running in the total spend on prescriptions for nutritional supplements and milk intolerance in children, which went up by 13% from 2014 to 2015. 

Readers' comments (12)

  • Vinci Ho

    The irony is if the latest NICE guidance on back pain would eventually slag off most options of treatment : opioids as well as non-opiod methods, even the pain clinic will be thrown into limbo!

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  • There's needs to be adequate funding for alternatives. Currently my local pain clinic has lost funding from the CCG. Even when they did see them, they seemed to just offer a different opiod to what they were taking

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  • Harley Thespaniel

    Yes, cos they're great!

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  • Bob Hodges

    Erm, our workload has gone up by about a fifth in the past 2 years.

    What's the point here?

    Hospitals and specialists don't prescribe things anymore. Longer waits for orthopaedics also means longer periods of time on opiates for many. GPs are also taking on more and more community palliative care. Opiates are issued 'in anticipation' for the dying should they be required, and often they are not and have to be destroyed.

    Oh, and they work. That might be another reason why.

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  • Bob Hodges

    Oh, and paracetamol is now apparently in the same circle of hell as Satan's seed according to Nice.

    Where do you go from there when NSAIDs are also guidelined out of the picture?

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  • 2 reasons 1) Ageing population and 2) Diminishing resilience of society as a whole, underpinned by increasing unhappiness and loss of direction of humankind. Need to externalise all ills and to apportion blame and not accept that sometimes things just are.

    "A tablet will make me happier and I'll keep looking until I find the right one".

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  • Dear All
    third reason, EOLC. The drugs named are all used extensively in palliative care and demanded, advised, recommended, suggested or insisted by various of the noctors that dwell in that place. Then add in the quantities prescribed to cover weekends ect and its no wonder that the amount prescribed and issued has gone up. WHen a patient in a nursing home goes onto the expected to die soon they get issued with a small hoard of "anticipatory" narcotics that more often than not are never administered.
    These and many others have not quite grasped the fact that because a computer or the PPA says Dr Cundy issued a script for X or Y on a date it does not mean it was actually given or taken. I'd bet there is now more diamorphine flushed down loos than there is actually administered to patients.
    Regards
    Paul C

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  • Good to see all that money spent on marketing has not gone to waste; but there are still plenty of Grannies with achy knees out there who are not addicted yet, so no time to relax.

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  • (1) poor access to pain services (2) increased multimorbidity folk with high expectations surviving longer (3) increased community palliative care and "just in case meds" (4) Increased "rationing" i.e. folk with high BMIs not receiving THR/other pain relieving procedures (5) Lack of time in consultations to explore and mould patient expectation (6) efficacy (7) VERY OFTEN NO BLINKING ALTERNATIVES

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  • Maybe we should send them all to homeopaths (ha ha ha)

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