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BMJ Open. 2018 Jun 6;8(6):e019491. doi: 10.1136/bmjopen-2017-019491.

Opioid prescribing for chronic musculoskeletal pain in UK primary care: results from a cohort analysis of the COPERS trial.

Author information

1
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
2
Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
3
Exeter Medical School, University of Exeter, Exeter, Devon, UK.
4
Centre for Rheumatology Research, University College London, London, UK.
5
Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.

Abstract

OBJECTIVE:

To establish the level of opioid prescribing for patients with chronic musculoskeletal pain in a sample of patients from primary care and to estimate prescription costs.

DESIGN:

Secondary data analyses from a two-arm pragmatic randomised controlled trial (COPERS) testing the effectiveness of group self-management course and usual care against relaxation and usual care for patients with chronic musculoskeletal pain (ISRCTN 24426731).

SETTING:

25 general practices and two community musculoskeletal services in the UK (London and Midlands).

PARTICIPANTS:

703 chronic pain participants; 81% white, 67% female, enrolled in the COPERS trial.

MAIN OUTCOME MEASURES:

Anonymised prescribing data over 12 months extracted from GP electronic records.

RESULTS:

Of the 703 trial participants with chronic musculoskeletal pain, 413 (59%) patients were prescribed opioids. Among those prescribed an opioid, the number of opioid prescriptions varied from 1 to 52 per year. A total of 3319 opioid prescriptions were issued over the study period, of which 53% (1768/3319) were for strong opioids (tramadol, buprenorphine, morphine, oxycodone, fentanyl and tapentadol). The mean number of opioid prescriptions per patient prescribed any opioid was 8.0 (SD=7.9). A third of patients on opioids were prescribed more than one type of opioid; the most frequent combinations were: codeine plus tramadol and codeine plus morphine. The cost of opioid prescriptions per patient per year varied from £3 to £4844. The average annual prescription cost was £24 (SD=29) for patients prescribed weak opioids and £174 (SD=421) for patients prescribed strong opioids. Approximately 40% of patients received >3 prescriptions of strong opioids per year, with an annual cost of £236 per person.

CONCLUSIONS:

Long-term prescribing of opioids for chronic musculoskeletal pain is common in primary care. For over a quarter of patients receiving strong opioids, these drugs may have been overprescribed according to national guidelines.

TRIAL REGISTRATION NUMBER:

ISRCTN24426731; Post-results.

KEYWORDS:

chronic pain; cost; opioids; prescribing; primary care

Conflict of interest statement

Competing interests: TA, NH, DC, SJCT, KH, SE, AS, AR and JF have no competing interests with relation to this paper. MRU is an applicant and coapplicant on multiple studies on pain funded by NIHR and ARUK. These include the I-WOTCH trial of opioid reduction 14/224/04 ISRCTN 49470934. He is an editor for the NIHR journal series for which he receives a fee. He is a director and shareholder of Clinvivo.

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