Changes in Opioid and Other Analgesic Use 1995-2010: Repeated Cross-Sectional Analysis of Dispensed Prescribing for a Large Geographical Population in Scotland

Eur J Pain. 2015 Jan;19(1):59-66. doi: 10.1002/ejp.520. Epub 2014 May 8.

Abstract

Background: Despite recent concerns about increasing rates of analgesic prescribing, detailed epidemiological studies are lacking. We identified and described changes in the pattern of community-dispensed prescriptions to the Tayside population, Scotland, between 31st March 1995 (n = 301,020) and 31st March 2010 (n = 311,881).

Methods: Repeated cross-sectional analysis of patient-level population data on dispensed analgesics, stratified by sociodemographic variables; logistic regression to identify factors associated with strong opioid dispensing in 2010.

Results: The proportion of people currently dispensed any analgesic increased in 2010 (17.9%) compared with 1995 (15.7%). This increase was not equal across drug classes, with paracetamol, opioids and gabapentin/pregabalin showing an increase, but others showing a decrease. Weak opioids were less commonly dispensed in 2010 (8.2% vs. 8.4%) but dispensing of strong opioids increased 18-fold (3.6% vs. 0.2%), including a five-fold increase of morphine, fentanyl or oxycodone (0.75% vs. 0.15%). People receiving more non-analgesic drugs (odds ratio 20.7 if dispensed >14 non-analgesic medications vs. those dispensed <4) and those living in more deprived areas (OR 1.63 most deprived vs. most affluent) were more likely to receive a strong opioid in 2010.

Conclusions: Analgesic use rose modestly between 1995 and 2010, but with larger changes within individual classes, only partly reflecting evidence-based guidance. Dispensing of strong opioids increased dramatically, largely driven by tramadol, although other strong opioids tripled. Polypharmacy and socio-economic deprivation were strongly associated with strong opioid use. Research is needed to establish the causes, benefits and harms of the increase in analgesic, and especially strong opioid use.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics / therapeutic use*
  • Analgesics, Opioid / therapeutic use*
  • Cross-Sectional Studies
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain / drug therapy
  • Practice Patterns, Physicians' / trends*
  • Scotland
  • Young Adult

Substances

  • Analgesics
  • Analgesics, Opioid