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Opioid prescribing for chronic musculoskeletal pain in UK primary care : results from a cohort analysis of the COPERS trial
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Ashaye, Tomi, Hounsome, Natalia, Carnes, Dawn, Taylor, Stephanie J. C., Homer, Kate, Eldridge, Sandra, Spencer, Anne, Rahman, Anisur, Foell, Jens and Underwood, Martin (2018) Opioid prescribing for chronic musculoskeletal pain in UK primary care : results from a cohort analysis of the COPERS trial. BMJ Open, 8 (6). e019491. doi:10.1136/bmjopen-2017-019491 ISSN 2044-6055.
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Official URL: http://dx.doi.org/10.1136/bmjopen-2017-019491
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.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RC Internal medicine | ||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Chronic pain -- Treatment, Musculoskeletal system -- Diseases -- Treatment, Opioids -- Therapeutic use, Drugs -- Prescribing | ||||||
Journal or Publication Title: | BMJ Open | ||||||
Publisher: | BMJ | ||||||
ISSN: | 2044-6055 | ||||||
Official Date: | 6 June 2018 | ||||||
Dates: |
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Volume: | 8 | ||||||
Number: | 6 | ||||||
Article Number: | e019491 | ||||||
DOI: | 10.1136/bmjopen-2017-019491 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 13 July 2018 | ||||||
Date of first compliant Open Access: | 13 July 2018 | ||||||
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