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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

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



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.


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).


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


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


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


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.


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.


ISRCTN24426731; Post-results.


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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