Opioid drugs: a high risk prescribing area?

This month's research roundup will evaluate some recent research around prescribing opioid medications across various settings.

There has been concern over prescribing of opioids and the high risk of harm associated with their use for many years now. This is an area of active research and controversial opinions which has attracted much public and media attention. There are many emerging studies looking at how, why and how long opioids are prescribed. In this roundup, we will look at four different aspects of opioid prescribing practices in the UK that have had publications around them in the last few months.

Richards et al (2020) start this paper by looking at the current picture of prescribing of opioids in a primary care setting. They acknowledge that research shows that an increase in opioid prescribing for long-term pain conditions has led to more people taking opioids and taking these at higher doses that has been seen before. Supporting literature presented here reveals that high doses of opioids are associated with greater morbidity, mortality and cost. Despite this, the prescribing of high-dose opioids remains relatively common in high-income countries. The authors, to investigate the phenomenon, conducted a systematic review of observational studies into opioid use in high income countries up to and including April 2019. Searching and quality appraisal of articles led to inclusion of six studies form the USA, Australia and the UK. These papers presented information on over four million opioid users. They reported findings in the form of factors commonly associated with high dose opioid prescription in primary care. These ranged from concurrent prescription of benzodiazepines, depressive symptoms, increased visits to accident and emergency departments, unemployment and being male. All these factors came out as significant in the literature included. They conclude that patients prescribed high doses of opioids have a greater risk of harm. They identify key factors such as the co-prescription of benzodiazepines and the presence of depressive symptoms as a priority for consideration when managing people on high-dose opioids in primary care. They recommend that coordinated approaches to promote and monitor prescribing are necessary for safe prescribing practice.