The number of adults prescribed an opioid for more than three months in England increased sharply during the COVID-19 pandemic, figures analysed by The Pharmaceutical Journal have shown.
NHS Business Services Authority (NHSBSA) data, described by experts as “worrying”, show that 3,055 per 10,000 patients were prescribed opioids for longer than three months between October and December 2019. However, the latest available data show that this rose by 28% to 3,918 per 10,000 patients between October and December 2021.
The chronic use of opioids, defined by NHSBSA as use for three months or longer, is associated with an increased risk of adverse events and admission to hospital with respiratory depression, accidental overdose or confusion.
Long-term opioid prescribing rates have been slowly rising since 2015, but the latest figures reveal a more dramatic escalation. NHSBSA data show there was a 10% rise between October to December 2017 and October to December 2019, from 2,782 per 10,000 patients to 3,055.
The number of patients prescribed an opioid for more than three months, who were subsequently admitted to hospital with respiratory depression, accidental overdose or confusion, also increased, but to a lesser extent. Between October and December 2019, 16 per 10,000 patients who were prescribed an opioid for longer than three months were admitted to hospital, compared with 18 per 10,000 patients for the same period in 2021.
According to the British Pain Society, patients who may benefit from opioids in the long term will demonstrate a favourable response within two to four weeks, and those who do not are unlikely to gain benefit when taking the drugs for longer periods. However, it also says that short-term efficacy does not guarantee long-term efficacy.
Roger Knaggs, a specialist pharmacist and president elect of the British Pain Society, said it was “difficult” to provide a precise explanation as to why opioid prescribing had increased over the pandemic, but said it was known that during that period there were an increasing number of people waiting longer periods for surgery.
“Evidence from Scotland suggests that people on waiting lists for primary hip and knee arthroplasty, as of September 2020, were more likely to be prescribed opioids than historical controls,” he said.
“There may have been lack of access to other treatment options during the pandemic as well.”
He reiterated that opioids were most effective for acute pain and pain at the end of life.
“There is no evidence for benefit in non-cancer conditions in studies longer than three months. Opioids should be prescribed for an initial trial period and if there is no benefit or intolerable side effects after several weeks then the dose should be tapered and discontinued.
“This does require regular review to ensure that they continue to be effective and providing ongoing benefit.”
Duncan Hill, a specialist pharmacist in substance misuse at NHS Lanarkshire, said that the acceleration seen in the number of opioids being prescribed long term during the pandemic was a “significant jump”.
“The worry is that the jump hasn’t stopped … more medication reviews are needed to check whether or not an opioid is still of value and is not causing harm,” he said.
Jane Quinlan, a consultant in anaesthetics and pain management at Oxford University Hospitals, who has a specific interest in prescribed opioid dependence, said that the move to online or telephone consultations may be a factor.
“For a lot of chronic pain patients, [remote consultations are] much easier than getting in a car and driving half an hour with back pain, but you don’t get that kind of personal interaction in the same way as you do face to face.
“I suspect, when GPs were overwhelmed, addressing some of the opioid use was just put on hold,” she said.
Since 1 April 2022, primary care networks (PCNs) are being paid for delivering structured medicine reviews (SMRs) to patients in priority cohorts, such as those prescribed an oral or transdermal opioid with more than 120mg oral morphine equivalent.
NHS England and NHS Improvement have recommended that, “where possible”, practices should involve practice-based clinical pharmacists and local community pharmacists in their quality improvement plans.
NHS England did not respond to a request for comment.
Read more: In figures: the rise in long-term opioid use