Research in context
Evidence before this study
Concerns have been raised about the use of strong opioids and at high doses, especially in management of chronic pain; better monitoring and audit has been advocated. We reviewed the literature published in English on PubMed describing the trends and variation in opioid prescribing for chronic non-cancer pain in the UK since Jan 1, 2010, onwards. We screened abstracts for relevance after using combinations of the search terms “opioid” AND/OR “opiate”, “prescribing”, “chronic pain”, and “NHS” AND/OR “UK”. We also reviewed relevant reports from public bodies. The consensus is for an increase in prescribing of opioids in primary care in England, but most data are several years out of date at publication and very few correct for opioid strength or analyse high-dose prescriptions separately. Few publications cover the entire country or contain robust statistical analyses. None provides detailed data or tools to allow readers to investigate detailed prescribing information for their local area.
Added value of this study
There has been a substantial increase in opioid prescribing in the National Health Service (NHS) in England between 1998 and 2016; failing to account for the different potencies of opioid being prescribed would underestimate this increase by a factor of 3·7. We provide detailed prescribing data at the individual practice level, available to all through an interactive online tool at OpenPrescribing.net.
Implications of all the available evidence
Our study provides a framework for monitoring of primary care opioid prescribing in routinely available data and provides a tool for anyone to use for further research, such as local audits and improvement projects. Future work with patient-level data could reveal more detailed high-dose opioid prescribing patterns.