Campaign to Reduce Opioid Prescribing

Problem

Management of chronic pain in general practice is problematic. The World Health Organisation (WHO) ‘analgesic ladder’ was originally developed for cancer pain but its use has spread to chronic, non-cancer pain. There are growing concerns that: (1) patients are being moved up this ladder towards potent opioids inappropriately and without considering other drug and non-drug aspects of care; and (2) the potential social and medical harms of opioids have been significantly underestimated. A recent study showed that opioid prescribing in Leeds and Bradford increased greatly in the period 2005 to 2012. Prescriptions for weak opioids doubled in this time and prescriptions for strong opioids increased over six-fold. There was also a 10-fold variation between practices that could not be explained away by many patient or practice factors (such as deprivation).

Approach

A time-series analysis of centrally-held anonymised computerised general practice records covering the majority of practices in West Yorkshire.The Campaign to Reduce Opioid Prescribing (CROP) is an audit and feedback intervention designed in conjunction the ten Clinical Commissioning Groups (CCGs) of West Yorkshire. Each practice will receive a bimonthly enhanced audit & feedback report on their opioid prescribing that will be tailored to include behavioural change techniques to help GPs reduce prescribing. We shall examine associations between long term opioid prescribing and practice and patient characteristics (e.g. coded diagnoses and demographics) and the impact of CROP. We shall also examine temporal trends in prescribing.

Findings

This study is ongoing. The data will be analysed as an interrupted time series analysis. We will look for evidence that CROP has had an effect over time, indicated by a statistically significant result. We will also examine for decay or sustainability in change in prescribing after the intervention has finished. A further adjusted model will examine for potential impact of both practice and aggregated patient level factors.Trends in prescribing nationally at CCG level will be compared for those CCGs targeted by CROP and thosewho were not to see if the underlying national trend was changed by the intervention.Initial data will be presented at this meeting as the campaign is due to finish April 2017.

Consequences

The current rate of annual growth in opioid prescriptions is approximately £26,000 per 100,000 population. For West Yorkshire (population 2.161 million) the equivalent figure is £510,000 per annum. Stopping a further rise in growth would be expected to prevent the West Yorkshire CCGs spending a further £500,000 per annum. Current CCG prescribing data is predicting a £400,000 underspend in opioid prescribing compared to the previous year. If a change in the underlying increasing trend for opioid prescribing in primary care is achieved, the relatively low cost audit and feedback intervention can be rolled out across UK general practice.