In the UK, new prescriptions for multiple opioids have risen steadily in recent years, leading to concerning rates of long-term use, especially in older, socially deprived patients. Dr Meghna Jani at the University of Manchester and colleagues report these findings in a new study published in PLOS Medicine.

In the US, Canada, and several European countries, a sharp increase in prescription opioid use for non-cancer patients has sparked concerns that a similar epidemic might occur in the UK. To evaluate prescribing trends and understand the risk factors for long-term opioid use in the UK, Jani and colleagues performed a study of 1,968,742 new opioid users.

Their analysis showed that opioid prescriptions, especially codeine, morphine, and oxycodone, all increased substantially during the course of the study, from 2006 to 2017. Overall, 14.6% of patients with new opioid prescriptions became long-term users starting in their first year. A small percentage of physicians were ‘high-risk prescribers’ whose patients were 3.5 times more likely to use the drugs continually. People were more likely to become long-term users if they were older, experiencing social deprivation, had a history of self-harm, suicide attempts, or substance or alcohol abuse, or suffering from fibromyalgia or rheumatological diseases.

The study’s findings support the call for action for safer and more consistent opioid prescription practices in the UK, to avoid the addiction epidemic seen in many other countries. The authors recommend that physicians should take care when prescribing high initial doses of opioids and should closely monitor patients with risk factors for long-term use. They point out that identifying general practices with abnormally high prescription rates through audit and feedback tools could help drive safer prescribing practices.

‘Given the potential harms of these drugs, we think it is imperative to promote safe practices in prescribing opioids and reduce the variability we observed between in regions, practices and prescribers,’ said Dr Jani. ‘One way to do this would be to harmonise prescribing practices across regions through future well-researched policies. The other would be developing targeted interventions in high-risk groups including areas of social deprivation and for those undergoing major surgery.’