Opioids are strong medicines that are prescribed to relieve pain, and antidepressants are medicines that are prescribed for several reasons, including depression, anxiety, other mental health conditions and pain relief. Taking antidepressants and opioids at the same time can have some negative outcomes, for example the treatments may not work as well and there may be more side effects. This study will look at adults prescribed both opioids and antidepressants between 2010 and 2019.
We want to find out how often opioid and antidepressant prescriptions from GPs overlapped, whether this has changed over time, and if this happens more often in different groups of people. This information will be useful to help GPs, policymakers and other researchers understand how many people in the UK may be at risk of harm from using both types of medicines at the same time. It will also help researchers design future studies about the safety of using these two medicines at the same time.
We aim to describe the co-prescribing (defined as overlapping prescriptions) of opioids for non cancer pain and antidepressants in primary care, describe how this has changed over time and whether there is any variation by sociodemographic and clinical characteristics.
We will examine adults aged over 18 years who were prescribed opioids and antidepressants between 2010 and 2019 in CPRD GOLD after at least one year of follow-up in CPRD GOLD. We will exclude people with a prior record of cancer, terminal illness (defined as people on the palliative care pathway), and substance use disorder. We will examine rates of co-prescribing in the general population. In the subgroup of people prescribed opioids, we will compare characteristics of people who were and were not prescribed antidepressants. For this analysis, we will also exclude people who have a record of surgery up to six months before the first opioid prescription, using information from hospital episode statistics.
Our project includes a longitudinal study describing rates of opioid and antidepressant co prescribing and a cohort study examining sociodemographic and clinical factors associated with this co prescribing in people prescribed opioids for non-cancer pain. In the cohort study, we will perform Cox regression to test the association between covariates and being co prescribed antidepressants in people prescribed opioids. Where appropriate, covariates will be included as time-varying variables to allow for changes in health between starting opioids and starting antidepressants (or the end of follow-up). We will account for clustering at general practice level.
Results of the study will be of interest to prescribers, policymakers and other researchers, as they will provide a useful description of the extent of opioid and antidepressant co prescribing in the UK. Any variation or trends identified could lead to future work examining why such differences exist.
Co-prescribing (defined as overlapping prescriptions) of opioids for non-cancer pain and antidepressants.
Ruth Jack - Chief Investigator - University of Nottingham
Ruth Jack - Corresponding Applicant - University of Nottingham
Anthony Avery - Collaborator - University of Nottingham
Carol Coupland - Collaborator - University of Nottingham
Chris Hollis - Collaborator - University of Nottingham
Debbie Butler - Collaborator - University of Nottingham
Jake Butler - Collaborator - University of Nottingham
Rebecca Joseph - Collaborator - University of Nottingham
Richard Morriss - Collaborator - University of Nottingham
Roger Knaggs - Collaborator - University of Nottingham
Yana Vinogradova - Collaborator - University of Nottingham
HES Admitted Patient Care;Patient Level Townsend Index;Practice Level Townsend Index