The epidemiology and healthcare burden of opioid therapy in the United Kingdom

Date of Approval: 
2018-04-30 00:00:00
Lay Summary: 
Opioids, such as codeine and tramadol, are a type of painkilling drug used commonly in the UK. At one time, the stronger opioids, such as morphine, were used mainly to relieve moderate to severe pain that was either short-term or associated with cancer, but there is evidence that doctors are now prescribing opioids more frequently for long-term, non-cancer pain. However, opioids can have unpleasant side effects such as nausea and constipation, which can impair the patient's quality of life and make care and pain relief more difficult. The purpose of our study is to describe how, over time, patients have been treated with opioids - for how long, in what combination and for what reason; how often side effects occur and how these are managed; patients' use of healthcare services while being prescribed opioids; and circumstances associated with higher usage and costs. This will provide valuable information about trends in the use of prescribed opioids in the UK and the effects of these trends and of different patient characteristics and treatment experiences on healthcare burden.
Technical Summary: 
Recent years have seen a significant increase in opioid prescribing in the UK and elsewhere, with consequent concerns about healthcare burden. We wish to profile the prescribing of weak and strong opioids in UK primary care 1998-2016 and to examine the impact of treatment patterns, indications and adverse events on healthcare resource use and associated cost. Episodes of opioid treatment will be identified from prescription data and characterized by their indications, component opioid class(es), duration, medical possession ratio, number of treatment changes, adverse events commonly associated with opioids, and the stability of the treatments for those adverse events. We will report the annual incidence and prevalence of opioid therapy and calculate the frequency and associated costs of healthcare use in the course of the episode, comparing these with usage and costs in the 12 months prior to initiation using the Wilcoxon signed-rank testPoisson regression models, and stratifying the results by the episode characteristics described above. Main analyses will consider primary-care data from CPRD alone, with sensitivity analyses performed with the addition of linked inpatient and outpatient data in patients eligible for linkage.
Health Outcomes to be Measured: 
Treatment patterns of opioid therapy in primary care - Demographic and clinical characteristics of patients exposed to opioid therapy - Patient-level and treatment characteristics that may modify healthcare resource use and cost - Annual incidence and prevalence of opioid therapy - Number and financial costs of primary and secondary healthcare contacts and prescribed medications while exposed to opioid therapy - Adverse events associated with opioid exposure and their treatment
Application Number: 
18_069
Collaborators: 

Craig Currie - Chief Investigator - Pharmatelligence Limited
Sara Jenkins-Jones - Corresponding Applicant - Pharmatelligence Limited
Christopher Morgan - Collaborator - Pharmatelligence Limited
Ellen Berni - Collaborator - Pharmatelligence Limited
Sarah Holden - Collaborator - Pharmatelligence Limited

Linkages: 
HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation