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Opioid prescribing and social deprivation: A retrospective analysis of prescribing for CNCP in Liverpool CCG

Begley, E, Poole, H, Sumnall, H, Frank, B and Montgomery, C (2023) Opioid prescribing and social deprivation: A retrospective analysis of prescribing for CNCP in Liverpool CCG. PLoS One, 18 (3). ISSN 1932-6203

Opioid prescribing and social deprivation A retrospective analysis of prescribing for CNCP in Liverpool CCG.pdf - Published Version
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Open Access URL: https://doi.org/10.1371/journal.pone.0280958 (Published version)


Background: Treating Chronic Non-Cancer Pain (CNCP) with long-term, high dose and more potent opioids puts patients at increased risk of harm, whilst providing limited pain relief. Socially deprived areas mapped from Index of Multiple Deprivation (IMD) scores show higher rates of high dose, strong opioid prescribing compared to more affluent areas.
Objective: To explore if opioid prescribing is higher in more deprived areas of Liverpool (UK) and assess the incidence of high dose prescribing to improve clinical pathways for opioid weaning.
Design and setting: This retrospective observational study used primary care practice and patient level opioid prescribing data for N = 30,474 CNCP patients across Liverpool Clinical Commissioning Group (LCCG) between August 2016 and August 2018.
Method: A Defined Daily Dose (DDD) was calculated for each patient prescribed opioids. DDD was converted into a Morphine Equivalent Dose (MED) and patients stratified according to high (≥120mg) MED cut off. The association between prescribing and deprivation was analysed by linking GP practice codes and IMD scores across LCCG.
Results: 3.5% of patients were prescribed an average dose above 120mg MED/day. Patients prescribed long-term, high dose, strong opioids were more likely to be female, aged 60+, prescribed three opioids and reside in the North of Liverpool where there is a higher density of areas in the IMD most deprived deciles.
Conclusion: A small but significant proportion of CNCP patients across Liverpool are currently prescribed opioids above the recommended dose threshold of 120mg MED. Identification of fentanyl as a contributor to high dose prescribing resulted in changes to prescribing practice, and reports from NHS pain clinics that fewer patients require tapering from fentanyl. In conclusion, higher rates of high dose opioid prescribing continue to be evident in more socially deprived areas further increasing health inequalities.

Item Type: Article
Uncontrolled Keywords: General Science & Technology
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RS Pharmacy and materia medica
Divisions: Psychology (from Sep 2019)
Public Health Institute
Publisher: Public Library of Science
SWORD Depositor: A Symplectic
Date Deposited: 09 Mar 2023 11:47
Last Modified: 09 Mar 2023 11:47
DOI or ID number: 10.1371/journal.pone.0280958
URI: https://researchonline.ljmu.ac.uk/id/eprint/19056
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