A new study published in BMJ Open suggests strong opioids may be overprescribed in more than a quarter of primary care patients with chronic musculoskeletal pain.
The finding is based on analyses of data from the randomised controlled COPERS trial which examined the effectiveness of group self-management course and usual care against relaxation and usual care for patients with chronic musculoskeletal pain recruited from 25 general practices and 2 community musculoskeletal services.
Of the 703 trial participants, 413 (59%) were prescribed opioids. In total, 3319 opioid prescriptions were issued over the study period, of which 53% were for strong opioids (tramadol, buprenorphine, morphine, oxycodone, fentanyl and tapentadol). Among those prescribed an opioid, the number of opioid prescriptions varied from 1 to 52 per year. The mean number of opioid prescriptions per patient was 8.0.
A third of patients were prescribed more than one type of opioid. The most frequent combinations were codeine plus tramadol and codeine plus morphine.
The cost of opioid prescriptions per patient per year varied from £3 to £4844. The average annual prescription cost was £24 for patients prescribed weak opioids and £174 for patients prescribed strong opioids. Approximately 40% of patients received at least 3 prescriptions of strong opioids per year, with an annual cost of £236 per person.
According to national guidelines on chronic pain management for people with low back pain and osteoarthritis, strong opioids are only to be prescribed in unremitting cases for short-term use, stepping down to weaker opioids, or removing altogether if not effective. The authors say the COPERS data suggesting a high rate of overprescribing based on current guidelines.