Clinical Indications Associated with New Opioid Use for Pain Management in the United Kingdom: Using National Primary Care Data

Prescription opioids for non-cancer pain in the UK have increased over the past two decades, alongside associated harms. Policies addressing opioid prescribing must be tailored to individual patient needs with specific disease systems. This study aimed to evaluate clinical conditions associated with new opioid initiation in non-cancer pain using nationally representative UK data.
Primary care electronic health records from 01/01/2006 to 31/09/2021 were used from the Clinical Research Practice Datalink to identify incident opioid prescriptions. Patient histories were reviewed using codelists for opioid-related conditions with a five-year look-back for chronic conditions and a one-year look-back for surgical indications before opioid initiation.
3,030,077 new opioid users were identified, with 61% being women, 77% aged ≥45, and 48% from the highest deprivation quintile. Ten systems associated with opioid initiation were identified, which were not mutually exclusive, as patients could have opioids prescribed for multiple indications. The most common were musculoskeletal (80.8%), respiratory (57.6%), infections (30.4%), trauma/injury (20.4%), neurology (19.9%), and post-surgical indications (5.5%). Osteoarthritis (60.7%) and low back pain (41.0%) were the most frequent musculoskeletal conditions. Orthopaedic surgeries accounted for 41.2% of all post-surgical indications.
This is the first study in the UK evaluating large-scale national data to assess indications associated with opioid initiation. Nearly three quarters of new opioid prescriptions for non-cancer pain were in patients with musculoskeletal conditions, often for conditions with limited evidence for opioid efficacy. These findings could inform targeted interventions and future policies to support non-pharmacological interventions in the most common conditions where opioid harms outweigh benefits.