Opioid medicines are being increasingly prescribed for patients with pain for non-cancer conditions. Such drugs have been increasingly linked to a number of serious side effects. However there may be patients where few other alternatives for pain relief exist. Therefore it is essential for both doctors and patients to understand the risk of such drugs compared to one another so that the safest drug is prescribed for patients who may be at the highest risk. This would allow users and their physicians to make informed decisions about the benefits/dangers of such medicines. We will examine how different types and doses of opioid medicines affect a number of potential consequences such as death, heart problems and fractures as part of large international collaboration. Additionally, we will examine if such side effects are more pronounced among patients prescribed specific medications also commonly prescribed with opioids. This work has the potential to benefit a large number of patients, since opioids are prescribed in up to 4% of the adult population. It will help to understand which group of patients are at risk of experiencing serious side-effects/death and eventually improve the quality of prescribing and care for patients with chronic pain.
Opioid use for non-cancer pain has increased significantly over the last 30 years. It has become increasingly apparent that opioids are associated with considerable risks and uncertain benefits. A number of safety outcomes have been associated with opioid use, however little is known about the comparative safety of opioids. Few studies have robustly assessed the effect of opioids on long-term outcomes, the effect of dose, potency, duration, and interactions with other commonly prescribed potentially harmful drugs. A retrospective cohort analysis will be conducted internationally across three countries for all new-users of opioids prescribed for non-malignant pain between 2006-2016, including the UK through CPRD. Descriptive analyses of opioid prescribing trends in each cohort will be followed by modelling of the associations of prescribed opioids with core safety outcomes of (i) all-cause mortality, (ii) cardiovascular outcomes (iii) fractures. Additionally gastrointestinal outcomes and road traffic accidents will be assessed within CPRD. This work will help clinicians and patients understand better the risk profile of opioids to allow informed decision making, based on the resulting insights about potential deleterious effects to patients. Additionally, it will allow improved understanding of the effects of dose, treatment duration, and interactions with other common co-medications such as benzodiazepines.
Primary outcomes: All-cause mortality. Secondary outcomes: Cause-specific mortality; Fractures: hip, pelvis, wrist, humerus, vertebral, rib, lower limb; Cardiovascular: myocardial infarction, stroke/TIA; Gastrointestinal: constipation, bowel obstruction; Road Traffic Accidents.
Meghna Jani - Chief Investigator - University of Manchester
Meghna Jani - Corresponding Applicant - University of Manchester
David Jenkins - Collaborator - University of Manchester
Mark Lunt - Collaborator - University of Manchester
Michal Abrahamowicz - Collaborator - McGill University
Rikesh Patel - Collaborator - University of Manchester
Therese Sheppard - Collaborator - University of Manchester
William Dixon - Collaborator - University of Manchester
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Patient Level Townsend Score