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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.