England has hugely varying rates of opioid prescribing across its regions, researchers say today.
Opioid prescribing patterns in the areas of greatest deprivation in the north of England are more than three times higher than those in the most deprived parts of London, according to the new study.
Researchers from the University of Manchester analysed general practice data from 2018-2019 and examined prescribing patterns across the country at local level to see if there were links with deprivation, as measured by the 2019 Index of Multiple Deprivation.
They focused on data from Clinical Commissioning Groups (CCGs) and found that higher prescribing rates were associated with a higher prevalence of rheumatoid arthritis in local populations, urban areas and higher levels of socioeconomic deprivation.
They found that in 2018-1029, 624, 411,164 doses of opioids were prescribed every day in England, averaging more than 30 doses per 1000 people every day.
Writing in the Journal of Epidemiology & Community Health, they said local area rates varied from 1.7 to 121.04 daily doses per 1000 people per day, with higher prescribing in the Midlands, the North, Cornwall and the coastal areas.
Although the research team found that prescribing in the most deprived areas of England was on average 9.7 doses per 1000 people per day higher than it was in the least deprived areas, it was not consistent between or within CCGs.
They identified that in the CCGs with the greatest socioeconomic inequalities, the prescribing rate in the most deprived areas was twice that of the least deprived.
However, in some CCGs opioid prescribing was higher in the more affluent areas than in the most deprived ones, while in others, on average, more than 40 doses per 1000 people per day were prescribed in the most deprived compared to more affluent areas.
Prescribing in the most deprived local areas in the North of England was 20% higher than the national average for areas with similar deprivation levels, and more than three times higher than in the most deprived areas of London.
The authors say they did not have data on the number of prescriptions for people living in each local area nor information on the dose or duration of treatment in some regions but conclude: “Our study provides evidence that levels of opioid prescribing differ significantly across small geographical areas in England, even after adjusting for population structure.”
They write that their data “highlights that some geographical areas experience vastly different levels of opioid prescribing even with similar deprivation levels. This suggests that the relationship between socioeconomic deprivation, as measured by Index of Multiple Deprivation, and opioid prescribing is not uniform across the country”.
Nowakowska N, Zghebi S, Perisi R et al. Association of socioeconomic deprivation with opioid prescribing in primary care in England: a spatial analysis. Journal of Epidemiology & Community Health 15 December 2020; doi 10.1136/jech-2020-214676
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