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Trends and factors associated with prescription opioid utilisation, dependence and deaths in patients with rheumatic and musculoskeletal diseases

Safe People

Organisation name

University of Manchester

Organisation sector

Academic Institute

Applicant name(s)

Meghna Jani - Chief Investigator - University of ManchesterMeghna Jani - Corresponding Applicant - University of ManchesterBelay Yimer - Collaborator - University of ManchesterDAVID JENKINS - Collaborator - University of ManchesterMark Lunt - Collaborator - University of ManchesterNiels Peek - Collaborator - University of ManchesterWilliam Dixon - Collaborator - University of Manchester

Safe Projects

Project ID

CPRD885

Lay summary

Opioid drugs (such as codeine and tramadol) for chronic pain have increased considerably in the US, UK and Europe. Pain due to musculoskeletal (MSK) conditions is one of the common reasons for prescribing opioids. MSK patients may be particularly susceptible to opioid-related harms due to older age, other existing health-conditions and drug-interactions. However, there are limited alternative options for painkillers. Therefore, depriving everyone of opioids is not a solution. Recognising risk-factors and patient subgroups where harms outweigh the benefits is imperative for informed decision-making and safe prescribing. We will focus on people with MSK conditions starting opioids for the first-time to address (i) the current national trends of opioid prescribing in the UK over the last 14 years (ii) how many people/year get admitted to hospital for opioid-related harms, develop opioid-dependence, or die because of the drug? (iii) what risk factors in individual patients predispose to opioid-dependence and deaths?(iv) can we predict individual risk before prescribing an opioid and what subgroups of people should not be prescribed an opioid due to a high risk of death? A better understanding of individual risk of opioid-related harms before starting opioids, would enable patients to make more informed decisions. By determining patient subgroups most vulnerable to opioid-related harms we can develop targeted interventions for safer future clinical care, whilst avoiding depriving the entire population of this class of painkillers that may be safe and effective for some.

Technical summary

Rising opioid use has been associated with an alarming rise in opioid-related harms, dependence and mortality in North America. However, fewer data are available in Europe. RMDs are one of the most common indications for prescribing opioids. These patients may already be at high-risk of opioid-related morbidity/mortality due to multimorbidity, immunosuppression and polypharmacy.

Latest approval date

06/01/2021

Safe Data

Dataset(s) name

CHESS (Hospitalisation in England Surveillance System)

HES Accident and Emergency

HES Admitted Patient Care

ONS Death Registration Data

Patient Level Index of Multiple Deprivation

Safe Setting

Access type

Release