Trends in Opioid Prescribing for Non-Cancer pain and Associated Resource Utilisation in Wales

Abstract

Background:Opioid prescribing in the UK has increased significantly since the start of the millennium and has been associated with a rise in chronic pain reporting. In Wales, despite concern about rising rates of opioid analgesic prescribing, no detailed examination of the data had been undertaken to assess the changes in prescribing and its consequent impact on the population. Methods:In this study, anonymised, individual level data of people diagnosed with non-cancer pain in Wales was extracted from the Secure Anonymised Information Linkage (SAIL) Databank and used to scrutinise opioid analgesic prescribing trends in people aged 18 years and over, establish whether legislation or clinical guidance impacted on those trends and examine associations with increased healthcare use. The study was conducted in two phases. Phase 1 included a retrospective, repeated cross-sectional analysis of opioid analgesics issued from Primary Care, stratified by gender, age and socioeconomic status. Phase 2 of the study evaluated differences in healthcare service use and costs between individuals receiving opioids for defined non-cancer pain-related diagnoses and matched patients not receiving opioids. Results:Total opioid prescribing increased by 43.6% and strong opioids by 306.2% between 2005 and 2015. Women received 1.5 times more prescriptions than men. Increasing age was associated with higher prescribing rates. People in the most deprived areas received 2.4 times more prescriptions than in least deprived. People receiving opioid prescriptions accessed primary care four times more frequently than controls and had twice the number of hospital admissions. Opioid prescription was associated with 41% higher healthcare costs than noted in controls. Conclusion:This research highlights the need to develop a national strategy to address pain management and opioid stewardship in Wales. We must consider how to address the wide variability observed, particularly between areas of differing socioeconomic status. Further research should investigate what underlies continued opioid prescribing and how alternative strategies can be implemented in practice to reduce population harm and optimise the use of limited healthcare resources.