Curtis Helen J, Croker Richard, Walker Alex J, Richards Georgia C, Quinlan Jane, Goldacre Ben
The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK.
Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK.
Lancet Psychiatry. 2019 Feb;6(2):140-150. doi: 10.1016/S2215-0366(18)30471-1. Epub 2018 Dec 20.
There is a call for greater monitoring of opioid prescribing in the UK, particularly of strong opioids in chronic pain, for which there is little evidence of clinical benefit. We aimed to comprehensively assess trends and variation in opioid prescribing in primary care in England, from 1998 to 2018, and to assess factors associated with high-dose opioid prescribing behaviour in general practices.
We did a retrospective database study using open data sources on prescribing for all general practices in England. For all standard opioids we calculated the number of items prescribed, costs, and oral morphine equivalency to account for variation in strength. We assessed long-term prescribing trends from 1998 to 2017, patterns of geographical variation for 2018, and investigated practice factors associated with higher opioid prescribing. We also analysed prescriptions for long-acting opioids at high doses.
Between 1998 and 2016, opioid prescriptions increased by 34% in England (from 568 per 1000 patients to 761 per 1000). After correcting for total oral morphine equivalency, the increase was 127% (from 190 000 mg to 431 000 mg per 1000 population). There was a decline in prescriptions from 2016 to 2017. If every practice prescribed high-dose opioids at the lowest decile rate, 543 000 fewer high-dose prescriptions could have been issued over a period of 6 months. Larger practice list size, ruralness, and deprivation were associated with greater high-dose prescribing rates. The clinical commissioning group to which a practice belongs accounted for 11·7% of the variation in high-dose prescribing. We have developed a publicly available interactive online tool, OpenPrescribing.net, which displays all primary care opioid prescribing data in England down to the individual practice level.
Failing to account for opioid strength would substantially underestimate the true increase in opioid prescribing in the National Health Service (NHS) in England. Our findings support calls for greater action to promote best practice in chronic pain prescribing and to reduce geographical variation. This study provides a model for routine monitoring of opioid prescribing to aid targeting of interventions to reduce high-dose prescribing.
National Institute for Health Research (NIHR) School of Primary Care Research, NIHR Biomedical Research Centre Oxford, NHS England.
英国需要加强对阿片类药物处方的监测，尤其是慢性疼痛中强效阿片类药物的处方，目前几乎没有临床获益的证据。我们旨在全面评估1998年至2018年英格兰初级医疗中阿片类药物处方的趋势和差异，并评估与全科医疗中高剂量阿片类药物处方行为相关的因素。
我们使用英格兰所有全科医疗处方的公开数据源进行了一项回顾性数据库研究。对于所有标准阿片类药物，我们计算了处方数量、成本以及口服吗啡当量，以考虑强度差异。我们评估了1998年至2017年的长期处方趋势、2018年的地理差异模式，并调查了与较高阿片类药物处方相关的医疗因素。我们还分析了高剂量长效阿片类药物的处方。
1998年至2016年期间，英格兰的阿片类药物处方增加了34%（从每1000名患者568张增加到每1000名患者761张）。校正总口服吗啡当量后，增加了127%（从每1000人口190000毫克增加到431000毫克）。2016年至2017年处方量有所下降。如果每个医疗机构以最低十分位数的速率开具高剂量阿片类药物处方，那么在6个月的时间里，高剂量处方可能会减少543000张。更大的医疗机构名单规模、地处农村和贫困与更高的高剂量处方率相关。医疗机构所属的临床委托小组占高剂量处方差异的11.7%。我们开发了一个公开可用的交互式在线工具OpenPrescribing.net，它展示了英格兰所有初级医疗阿片类药物处方数据，直至个体医疗机构层面。
未考虑阿片类药物强度会大幅低估英格兰国民医疗服务体系（NHS）中阿片类药物处方的实际增加量。我们的研究结果支持呼吁采取更多行动，以促进慢性疼痛处方的最佳实践并减少地理差异。本研究为阿片类药物处方的常规监测提供了一个模型，有助于针对减少高剂量处方的干预措施进行精准定位。
国家卫生研究院（NIHR）初级医疗研究学院、NIHR牛津生物医学研究中心、英格兰国民医疗服务体系。
