There are fears of a codeine addiction crisis after prescriptions for opioids have soared across the UK.
A new study found orders for the medication increased between 2006 and 2017, with 14% of patients becoming long-term users.
The researchers analysed data from 1,968,742 new opioid users to find prescribing trends and understand the risk factors.
They found opioid prescriptions, especially for codeine, morphine, and oxycodone, all increased substantially during the course of the study.
And older age, social deprivation, and a history of self-harm or substance abuse are believed to be associated with increased risk of long-term opioid use.
Researchers are calling for action for safer and more consistent opioid prescription practices in the UK, to avoid the addiction epidemic seen in many other countries such as the US.
Dr Meghna Jani from the University of Manchester, who worked on the study published in the PLOS Medicine journal, said: ‘Given the potential harms of these drugs, we think it is imperative to promote safe practices in prescribing opioids and reduce the variability we observed between regions, practices and prescriber.
‘One way to do this would be to harmonise prescribing practices across regions through future well-researched policies.
‘The other would be developing targeted interventions in high risk groups including areas of social deprivation and for those undergoing major surgery.’
The results indicate that overall, 14.6% of patients with new opioid prescriptions became long-term users starting in their first year.
It was also discovered a small percentage of physicians were what researchers called high-risk prescribers – whose patients were 3.5 times more likely to use the drugs continually.
The retrospective cohort study was carried out using UK primary care electronic health records from the Clinical Practice Research Datalink.
They found that the most commonly used opioids were codeine, dihydrocodeine, and tramadol.
Over a 12-year period, 2006-2017, codeine use increased from 484 to 2,456 prescriptions per 10,000 population per year.
Dihydrocodeine, tramadol, and fentanyl prescriptions increased between 2006 and 2012, and plateaued thereafter until the end of 2017.
Within the strong opioids group, oxycodone prescribing rose approximately from five to 169 prescriptions per 10,000 population per year over 12 years.
While morphine prescriptions also rose, from 18 to 422 prescriptions per 10,000 population per year between 2006 and 2017.
The authors point out a number of limitations to their study. They said it was limited to patients prescribed opioids in primary care and did not include opioids available over the counter, or prescribed in hospitals or drug treatment centres.
Because the data captures electronic prescription information from primary care physicians, the findings likely underrepresent overall drug utilisation of weaker opioids.
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Another limitation is that in 2014 tramadol was reclassified as a schedule 3 drug, and prescriptions longer than one month were prohibited at any one time.
Therefore the rise in prescriptions may reflect shorter prescriptions for certain medications.
The researchers addedd: ‘Treatments for opioid addiction are mainly prescribed through specialist addiction centres in the UK, rather than through primary care, and are thus not available in the dataset.
‘We were therefore not able to account for these in the analysis.’
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