What is the prevalence of opioid and antidepressant co-prescribing in primary care in England?

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

1B.1

Presenter:

Ruth H Jack

Twitter:

@DrRuthHJack

Co-authors:

Jake Butler, Rebecca M Joseph, Carol Coupland, Roger Knaggs, Debbie Butler, Dave Waldram, Louisa Gerrard, Tony Avery, Chris Hollis, Richard Morriss

Author institutions:

University of Nottingham

Problem

Opioids are medicines that are prescribed to relieve pain, and antidepressants are medicines that are given for several reasons, including depression, anxiety, and other mental health conditions, as well as for pain relief. Taking antidepressants and opioids at the same time (called co-prescribing) might lead to some problems - for example, the medicines may not work as well together and there may be more side effects. However, little is known about the scale of co-prescription for these medicines. We wanted to find out how often people have overlapping opioid and antidepressant prescriptions in primary care, describing the medicines and length of co-prescribing, and which groups are more affected.

Approach

The original idea for the study came from public contributors. They were taking multiple different medicines and were concerned that they and their prescribers did not have much information to base their prescribing decisions on, such as what to do if their pain or depression became worse. Three public contributors were part of the project team and provided insights on study design, methods, and interpretation.We used anonymised routinely collected primary care data from the Clinical Practice Research Datalink (CPRD) to describe the extent of opioid and antidepressant co-prescribing in over 4.3 million adults in England. We identified all primary care prescriptions of opioids and antidepressants between 2010 and 2019 and counted if an opioid and antidepressant prescription overlapped, and if so, how long for. People were censored at the first date of a record of cancer, terminal illness, heart failure or opioid misuse.

Findings

We found that 304,029 (7%) people had an opioid and antidepressant co-prescribed at least once during the study period. Women, older people, White people and people living in more deprived areas were more likely to be co-prescribed opioids and antidepressants. Of people co-prescribed, prescriptions overlapped for at least 14 days for 273,361 (90%) people and at least 28 days for 204,565 (67%) people. The median length of co-prescription was 29 days (interquartile range: 17-51 days). The most commonly co-prescribed medicines were codeine and amitriptyline, co-prescribed 358,395 times to 104,579 people (including combinations with other opioids and antidepressants) and 235,017 times to 87,274 people without other opioids or antidepressants.

Consequences

There is a substantial group of people co-prescribed opioids and antidepressants in England. This information will be useful to help GPs, policymakers and other researchers understand how many people in the UK may be at risk of harm from using both types of medicines at the same time, and which groups are particularly affected. It will also help researchers design studies about the safety of using these two medicines at the same time. Future research should determine whether there are higher risks of adverse events in these co-prescribed groups.

Submitted by:

Ruth Jack

Funding acknowledgement:

This project is funded by the NIHR Applied Research Collaboration East Midlands (ARC EM). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.