Opioid prescribing in general practice: use of a two-stage review tool to identify and assess high-dose prescribing

Ponton, Rhys; Sawyer, Richard

doi:10.1177/2049463717742420

Cited by 7 publications

(9 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This made Taiwan different from some of other countries where opioids were mostly prescribed by clinic physicians. 10,15,17,24 This difference may be attributed to differences in healthcare models.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of opioid prescriptions in Taiwan (2008–2018)

Wang

Chu

Teng

et al. 2022

Journal of the Chinese Medical Association

View full text Add to dashboard Cite

Background: Opioids are effective for severe pain; however, the safety issue is also a primary concern. To better understand the opioid use in Taiwan, we conducted this study. Methods: Data on patients with opioid prescriptions, including morphine, fentanyl, pethidine, codeine, oxycodone, hydromorphone, and buprenorphine were collected using the Taiwan National Health Insurance Database (NHID). Results: Our analysis of opioid prescriptions from 2008 to 2018 in Taiwan indicated that (1) A slow increase in prevalence of opioid prescription was found during the study period. Among the drugs studied, morphine accounted for the majority of the prescriptions written, with a gradual increase annually. Pethidine prescriptions showed a significant and rapid decline over the years; (2) medical centers prescribed the largest number of opioids, followed by regional hospitals, local hospitals, and clinics; (3) the number of prescriptions per year per capita in cancer group was much higher than that in noncancer group. In noncancer group, most of the prescriptions were used in acute pain service (98.7%); and (4) use of opioids increased with age in both cancer and noncancer patients. Conclusion:The total number of opioid prescriptions in Taiwan gradually increased annually, among which morphine was the most commonly used opioid. Cancer patients consumed more opioid prescriptions than noncancer patients and most of the prescriptions in noncancer patients were used in acute pain service. The number of prescriptions increased with the age of the patients in both cancer and noncancer patients. The low prescription rate of opioids in chronic pain in Taiwan is not similar as those in high opioid-consuming countries, such as United States.

show abstract

Section: Discussionmentioning

confidence: 99%

“…In those countries, most of the opioid prescriptions were used in noncancer chronic pain. 9–16 The low prescription rate is common seen in Asian countries and may be due to differences in Eastern and Western cultures and concerns about the use of opioids. 13,25–29…”

Section: Discussionmentioning

confidence: 99%

Prevalence of opioid prescriptions in Taiwan (2008–2018)

Wang

Chu

Teng

et al. 2022

Journal of the Chinese Medical Association

View full text Add to dashboard Cite

show abstract

“…In a preventive perspective, improving PO practices for pain management is necessary [ 37 ]. Evidence suggests that most PO are prescribed in primary-care settings and the management of these prescriptions can become an issue for some primary-care physicians [ 50 , 51 ]. GPs, with their wealth of information about their patients and their background [ 52 ] have an important role to play in prevention, by identifying patients with CNCP associated with p-OUD [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Analgesic Opioid Misuse and Opioid Use Disorder among Patients with Chronic Non-Cancer Pain and Prescribed Opioids in a Pain Centre in France

Guillou-Landréat

Quinio²,

Reste³

et al. 2021

IJERPH

View full text Add to dashboard Cite

(1) Background: Chronic non-cancer pain (CNCP) remains a public health challenge around the world. Opioids (PO) have been increasingly used in the treatment of CNCP in the last 20 years. This study aimed to assess the prevalence of opioid misuse and prescribed-opioid use disorder (p-OUD) among patients with CNCP in a pain centre in France, and to analyse risk factors for moderate or severe p-OUD. (2) Method: A cross-sectional study was conducted, including patients consulting for pain management in the pain centre of Brest University Hospital. A self-questionnaire was administered (sociodemographic data, medical data, PO misuse, and p-OUD according the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) criteria). Descriptive, univariate, and multivariate analyses were conducted, together with a principal component analysis, in order to identify factors associated with p-OUD. (3) Results: In total, 115 patients were included, the majority of whom were women, with a mean age of 52 years old [18–82]; 64.3% (n = 74) had a current prescription for opioid analgesics (weak or strong). In this group, 56.7% (n = 42) had no or only mild p-OUD and 43.3% (n = 32) had current moderate or severe p-OUD. Patients with moderate or severe p-OUD were more likely to have a current antidepressant prescription, to have had psychotherapy, to currently use strong opioids and oxycodone, and to report taking more frequent doses than prescribed and feeling dependent. (4) Conclusions: We showed that the prevalence of current moderate/severe p-OUD concerned 43.3% of the patients with a CNCP seeking treatment in a pain centre. According to these results, several measures are relevant in managing p-OUD among patients with CNCP.

show abstract

“…Primary care prescribers should thus carefully consider whether to continue prescribing this combination of drugs and, when the combination is deemed necessary, should discourage continuous benzodiazepine treatment lasting two or more months and marked dose increases [45]. Efforts have been made to audit the number of people taking high doses of opioids in primary care [46,47]. Providers should extend this audit to include co-prescribed benzodiazepines using real-time audit and feedback tools [48].…”

Section: Implications For Practice and Policymentioning

confidence: 99%

Factors associated with the prescribing of high-dose opioids in primary care: a systematic review and meta-analysis

Richards

Mahtani

Muthee

et al. 2020

BMC Med

View full text Add to dashboard Cite

Background: The risks of harms from opioids increase substantially at high doses, and high-dose prescribing has increased in primary care. However, little is known about what leads to high-dose prescribing, and studies exploring this have not been synthesized. We, therefore, systematically synthesized factors associated with the prescribing of high-dose opioids in primary care. Methods:We conducted a systematic review of observational studies in high-income countries that used patientlevel primary care data and explored any factor(s) in people for whom opioids were prescribed, stratified by oral morphine equivalents (OME). We defined high doses as ≥ 90 OME mg/day. We searched MEDLINE, Embase, Web of Science, reference lists, forward citations, and conference proceedings from database inception to 5 April 2019. Two investigators independently screened studies, extracted data, and appraised the quality of included studies using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. We pooled data on factors using random effects meta-analyses and reported relative risks (RR) or mean differences with 95% confidence intervals (CI) where appropriate. We also performed a number needed to harm (NNT H ) calculation on factors when applicable. Results:We included six studies with a total of 4,248,119 participants taking opioids, of whom 3.64% (n = 154,749) were taking high doses. The majority of included studies (n = 4) were conducted in the USA, one in Australia and one in the UK. The largest study (n = 4,046,275) was from the USA. Included studies were graded as having fair to good quality evidence. The co-prescription of benzodiazepines (RR 3.27, 95% CI 1.32 to 8.13, I 2 = 99.9%), depression (RR 1.38, 95% CI 1.27 to 1.51, I 2 = 0%), emergency department visits (RR 1.53, 95% CI 1.46 to 1.61, I 2 = 0%, NNT H 15, 95% CI 12 to 20), unemployment (RR 1.44, 95% CI 1.27 to 1.63, I 2 = 0%), and male gender (RR 1.21, 95% CI 1.14 to 1.28, I 2 = 78.6%) were significantly associated with the prescribing of high-dose opioids in primary care.Conclusions: High doses of opioids are associated with greater risks of harms. Associated factors such as the coprescription of benzodiazepines and depression identify priority areas that should be considered when selecting, identifying, and managing people taking high-dose opioids in primary care. Coordinated strategies and services that promote the safe prescribing of opioids are needed. Study registration: PROSPERO, CRD42018088057

show abstract

Opioid prescribing in general practice: use of a two-stage review tool to identify and assess high-dose prescribing

Cited by 7 publications

References 32 publications

Prevalence of opioid prescriptions in Taiwan (2008–2018)

Prevalence of opioid prescriptions in Taiwan (2008–2018)

Analgesic Opioid Misuse and Opioid Use Disorder among Patients with Chronic Non-Cancer Pain and Prescribed Opioids in a Pain Centre in France

Factors associated with the prescribing of high-dose opioids in primary care: a systematic review and meta-analysis

Contact Info

Product

Resources

About