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Amid concerns that the COVID-19 pandemic might have led to increases in opioid prescribing, a new study from researchers at the Bennett Institute for Applied Data Science, University of Oxford, demonstrates how the OpenSAFELY database can be used to conduct detailed analyses of opioid prescribing practices, in line with key recommendations from recent NHS England guidance aimed at preventing and reducing opioid harm.

A large group of prescription medication bottles sit on a table in front of a man who is holding and looking at one of the pill bottles out of focus in the background. The image is photographed with a very shallow depth of field with the focus being on the pill bottles in the foreground.

Opioids are commonly overprescribed for chronic non-cancer pain, despite a lack of evidence for efficacy and potential risks of dependence and other harmful side effects. Policy in recent years has focused on reducing the use of opioids which has resulted in a downward trend in overprescribing since 2016. In 2023 the NHS issued guidance highlighted the need for better use of data to optimise opioid prescribing and ensure these medications are used safely and appropriately.  

In the study published today in the Lancet Public Health, researchers from The Bennett Institute for Applied Data Science in the Nuffield Department of Primary Care Health Sciences, University of Oxford, used the OpenSAFELY research platform to run analyses across the anonymised electronic health records of more than 20 million adult primary care patients to quantify changes in opioid prescribing during the COVID-19 pandemic, from January 2018 to June 2022 

Conducting this study highlights the vital role that robust, near real-time data plays in monitoring and optimising opioid prescribing practices, said Brian MacKenna, Director of NHS Service Analytics at the Bennett Institute for Applied Data Science in NDPCHS. As we continue to navigate evolving pressures on our healthcare system, it's crucial that we use robust data to monitor prescribing practices, identify areas for improvement, and ensure strategies are focused on optimising opioid use and reducing potential harm. OpenSAFELY offers an unprecedented opportunity for the NHS to use national data to facilitate improvements in patient care 

Previously, concerns had been raised that the COVID-19 lockdowns may reverse the progress made in reducing opioid overprescribing since 2016. However, in the study the researchers found that, while there was a temporary increase in prescribing at the start of the first COVID-19 lockdown in March 2020 and an increase for elderly residents in care homes receiving end-of-life care, overall prescribing changed little during the pandemic compared to pre-pandemic trends.  

The study also confirmed that substantial disparities in opioid prescribing identified in previous research still remain. Prescribing varied widely by age, sex, ethnicity and deprivation level and the researchers found that opioid prescribing rates were 2.15 times higher per 1,000 people living in the most deprived areas, compared to the least deprived. Although these disparities weren’t made worse by the pandemic as previously feared, the insights from the OpenSAFELY data show opioid prescribing patterns continue to disproportionally impact specific patient groups. 

Using OpenSAFELY allowed to us to conduct fine grain analysis of opioid prescribing during the pandemic, in line with key recommendations to support NHS England’s ambition on safe opioid use,’ said Dr Andrea Schaffer, Epidemiologist at the NDPCHS, and lead author of the study. Our findings provide important insight into how the COVID-19 pandemic impacted opioid prescribing practices in England and while it's reassuring that we didn't see major changes in prescribing for most of the population, the reduction in new opioid prescriptions and the spike in prescribing to treat end-of-life symptoms in care homes gives valuable insights into the complex ways the pandemic affected pain management and palliative care. 

Building on the need for better data use, the researchers are developing tools to facilitate near real-time audits and feedback, which can include any measures on opioids needed to support the NHS's ambition for safe opioid use. By leveraging the power of OpenSAFELY, the healthcare system can gain valuable insights into prescribing patterns, identify areas of concern, and implement strategies to optimise opioid use and reduce potential harm. 

Read the full paper, 'Changes in opioid prescribing during the COVID-19 pandemic in England' in The Lancet Public Health


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