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Health economics
Research
Opioid prescribing for chronic musculoskeletal pain in UK primary care: results from a cohort analysis of the COPERS trial
  1. Tomi Ashaye1,
  2. Natalia Hounsome2,
  3. Dawn Carnes2,
  4. Stephanie J C Taylor2,
  5. Kate Homer2,
  6. Sandra Eldridge2,
  7. Anne Spencer3,
  8. Anisur Rahman4,
  9. Jens Foell2,
  10. Martin R Underwood5
  11. on behalf of the COPERS Study Team (ISRCTN 24426731).
  1. 1 Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  2. 2 Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
  3. 3 Exeter Medical School, University of Exeter, Exeter, Devon, UK
  4. 4 Centre for Rheumatology Research, University College London, London, UK
  5. 5 Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Dr. Natalia Hounsome; n.hounsome{at}bsms.ac.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.

  • opioids
  • prescribing
  • chronic pain
  • primary care
  • cost

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-019491

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    Footnotes

    • Contributors TA and NH jointly conducted data analysis, wrote the first draft and integrated comments from the coauthors. DC, SJCT, KH, SE, AS, AR, JF and MRU critically revised the manuscript and provided methodological input. NH led data analyses and manuscript production. MRU and SJCT were the principal investigators on the COPERS project. DC, SE, AS and AR were coapplicants on the funding application. All coauthors contributed to the concept of the paper.

    • Funding This paper presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10189).

    • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

    • 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.

    • Patient consent Not required.

    • Ethics approval Cambridgeshire Ethics Committee provided a favourable ethical review for this study (Ref 11/EE/046).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data available.