In 2019, Public Health England published an evidence review, which included dependence and withdrawal associated with opioids for chronic non-cancer pain. Since then, there has been a flurry of government and NHS reports that have highlighted the risks of opioid dependency and made recommendations to reduce them. Indeed, the number of opioids dispensed in the community in England has fallen from a peak in 2016. However, this overall decrease disguises an increase or plateauing of prescribing for some opioids, and an increase in long-term prescribing.
Increase in long-term opioid use
Data from the NHS Business Services Authority’s medication safety indicators dashboard show that the number of adults taking oral or transdermal opioids for longer than three months in the community in England has been rising steadily for years, increasing by 54% between 2015 and 2021. However, despite the government’s renewed focus on reducing opioids, this increase appears to have accelerated dramatically since 2019, rising by 28% between October and December in 2019 (Q3 2019/2020) and the same period in 2021 (Q3 2021/2022), compared with 10% between 2017 (Q3 2017/2018) and 2019 (Q3 2019/2020). Some experts put this change down to the COVID-19 pandemic, which brought fewer opportunities for face-to-face medication reviews.
Hospitalisations following suit
The number of patients taking long-term opioids admitted to hospital with respiratory depression, accidental overdose or confusion has also accelerated over the same period, but to a lesser extent, staying the same between October and December in 2017 (Q3 2017/2018) and the same period in 2019 (Q3 2019/2020) but then increasing by 13% between 2019 (Q3 2019/2020) and 2021 (Q3 2021/2022).
Use of some opioids going up
Despite a slight fall in the number of opioids dispensed in the community in England overall, analysis of data for individual drugs shows that use of some opioids continues to increase.
Use of oxycodone has risen by 73% between 2011 and 2021, similar to the increase seen for morphine, despite an initial assumption that oxycodone would replace morphine. However, use of both has slowed considerably in the past few years, with oxycodone rising by only 0.1% between 2020 and 2021, and morphine falling by 2%.
Although the increase in codeine use is slowing, it continues its upward trajectory, with a 55% rise in the number of items dispensed over the same ten-year period and a 1% rise between 2020 and 2021. Buprenorphine use has also risen, increasing by 77% between 2011 and 2021, and 1% between 2020 and 2021.
Deaths continue to rise
Overall deaths from prescription and illicit opioids have been steadily rising since 2012. Morphine and heroin together are responsible for the highest number of opioid-related deaths in England, at 1,264 deaths in 2020 (latest data available).
Deaths from codeine increased substantially between 2019 and 2020, from 160 to 207. However, buprenorphine saw the largest percentage rise in deaths during that period, from 29 to 39, an increase of 34%.