North-south divide in England revealed as prescription of opioid drugs rise

February 13, 2018, University College London
Credit: University College London

The prescription of opioid drugs by GPs in England is steadily rising, especially in more deprived communities, even though they can cause complications and adverse effects and have not been proven to work for chronic pain, finds a new study led by UCL and UCLH.

The study, published in the British Journal of General Practice, found that over a 43 month period between 2010 and 2014 there was a rise in opioid prescribing.

It also revealed a north-south divide with nine out of ten of the highest prescribing areas located in the north of England.

"We feel that the most important finding is the extremely strong association between the amount of opioid prescribed and lower socio-economic status. The variation across the country is undeniable and, given the morbidity and mortality associated with this class of drugs, unacceptable," said lead author Dr Luke Mordecai (UCLH and UCL Institute of Epidemiology & Health Care).

He said that opioids were rightly given to people to cope with cancer and short-lived acute pain. However, the widespread prescribing of opioids for people with long-term pain was not adequately supported by evidence because opioids have not been shown to be effective in most beyond modest, short-term effects.

Opioids are also potentially dangerous, particularly with long term use and larger regular doses, leading to problems such as addiction and abuse, hyperalgesia, gastrointestinal disturbance, immunological dysfunction, risk of fracture in older people and increased mortality.

The US has seen a stark rise in the rate of opioid prescriptions over recent years with tripling in the last decade. In England, Scotland and Wales, deaths attributed to opioids have also increased with nearly 900 in 2001 compared with 500 in 2011.

Even weak opioids such as codeine and dihydrocodeine carried risks with deaths related to codeine up from 73 in 2012 to 130 in 2013 and dihydrocodeine accounting for 103 and 102 deaths over the same years.

Despite the risks and evidence that they do not work, the study found that many GPs prescribed them because they thought it was unethical to refuse their patients painkillers. The study looks at the total amount in grams of each of eight commonly prescribed opioid drugs and found a rise in six of them.

The most prescribed in England over the 43 months of the study, from August 2010 to February 2014, was tramadol. It is not as weak as over-the-counter codeine but does not have the stigma of the powerful morphine.

The authors call on policymakers to identify the reasons for the variation to enable avoidable harm to be addressed.

They also say there is not enough capacity in the specialist pain service with as few as one in five people with problematic pain having access to specialist pain services, and that only 40% of those services offer best practice in the form of multidisciplinary team assessment and treatment. They argue that good practice needs now to be extended from specialist to primary care.

"This study highlights the lack of access to specialist pain services which practise pain self-management techniques and opioid reduction programmes, which demonstrate far better outcomes than opioid prescriptions," said Dr Mordecai.

Guidelines from the British Pain Society and Map of Medicine aim at standardising care for the most common forms of pain, which, if followed could lead to a reduction in opioid prescriptions and an improvement in the care of those suffering pain.

"A national database of high opioid users is essential to identify this incredibly high risk patient population and ensure that they are known to specialist pain services in an attempt to minimise avoidable harm and on-going potentially avoidable escalations in doses," said Dr Mordecai.

Explore further: How to avoid opioid addiction after surgery

More information: Patterns of regional variation of opioid prescribing in primary care in England: a retrospective observational study. Br J Gen Pract; bjgp18X695057. DOI:

Related Stories

How to avoid opioid addiction after surgery

January 30, 2018
(HealthDay)—Following surgery, many patients head home with prescriptions for 30 or more opioid painkillers—enough to trigger addiction, warns a leading group of anesthesiologists.

Long-term opioid use has dropped among US military veterans

January 30, 2018
A new study in the Journal of General Internal Medicine, published by Springer, shows that opioid prescribing has dropped after a peak in 2012. Lead author Katherine Hadlandsmyth of the Iowa City VA Healthcare System and ...

Plastic surgeons get tips on managing opioid addiction risk

October 2, 2017
Opioid medications prescribed for pain management after plastic surgery may contribute to the ongoing opioid epidemic, according to a special topic paper in the October issue of Plastic and Reconstructive Surgery, the official ...

Gabapentin co-use may increase risk of fatal opioid overdose

October 3, 2017
Co-prescription of the anticonvulsant gabapentin is associated with an increased risk of opioid-related death in people who are prescribed opioid painkillers, according to a new study published in PLOS Medicine.

Long-term opioid use does not increase risk of Alzheimer 's disease

October 24, 2017
Opioid use is not associated with an increased risk of Alzheimer's disease, shows a recent study from the University of Eastern Finland. Researchers did not find any risk neither for long-term use nor for higher cumulative ...

Drugstore pain pills as effective as opioids in ER patients

November 7, 2017
Emergency rooms are where many patients are first introduced to powerful opioid painkillers, but what if doctors offered over-the-counter pills instead? A new study tested that approach on patients with broken bones and sprains ...

Recommended for you

Medicating distress: Risky sedative prescriptions for older adults vary widely

October 18, 2018
Despite years of warnings that older adults shouldn't take sedative drugs that put them at risk of injury and death, a new study reveals how many primary care doctors are still prescribing them, how often, and exactly where.

Medical management of opioid-induced constipation differs from other forms of condition

October 17, 2018
Traditional laxatives are recommended as first-line agents to treat patients with a confirmed diagnosis of opioid-induced constipation (OIC), according to a new guideline from the American Gastroenterological Association ...

Research assesses geographic distribution of new antibiotics following market introduction

October 16, 2018
There is a growing need for new antibiotics to help combat the looming threat of antimicrobial resistance. According to a new study conducted by researchers at the Center for Disease Dynamics, Economics & Policy (CDDEP) with ...

Health insurer policies may discourage use of non-opioid alternatives for lower back pain

October 5, 2018
Public and private health insurance policies in the U.S. are missing important opportunities to encourage the use of physical therapy, psychological counseling and other non-drug alternatives to opioid medication for treating ...

Opioid overdoses, depression linked

October 3, 2018
The link between mental health disorders and substance abuse is well-documented. Nearly one in 12 adults in the U.S is depressed, and opioid-related deaths are skyrocketing. As these numbers continue to climb, some mental ...

Do price spikes on some generic drugs indicate problems in the market?

October 1, 2018
A new USC study reports that sudden price spikes for some generic drugs—such as the recently reported increases of a decades-old generic heart medication and an antibiotic—are becoming more common.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.