(330) Analgesia Dispensing in Primary Care in Ireland and England - A Repeated Cross-Sectional Study

Background: Pain is a major public health issue and the main reason people seek medical care. The pharmacological treatment depends on the type of pain and includes opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and paracetamol. Opioid analgesics are a particularly high-risk group of medications and internationally, use of these medications has been steadily rising, along with associated morbidity and mortality.

Objectives: The aim of this study is to examine trends in analgesic prescribing in Ireland and England between 2014 and 2022.

Methods: For Ireland, monthly data on medicines prescribed and dispensed in primary care on the General Medical Services (GMS) scheme was used. Eligibility for the GMS scheme is based on age and income and covers approximately 32% of the population. For England, monthly data from the NHS Digital platform on prescribed medications aggregated at the general practice level for all practices in England was used. Outcomes of volume of prescribed analgesic use, including rates of dispensings, costs, and standard doses (including oral morphine equivalents (OMEs) for opioids) per 1,000 population, were summarised per year for each drug class and drug in both countries.

Results: In Ireland, the rate of analgesia dispensings increased between 2014 and 2022 for most drugs. Opioid dispensings increased from 979 to 1,220 per 1,000 population, while paracetamol increased from 1,295 to 1,824. Systemic NSAIDs decreased from 781 to 734. In England, most analgesia dispensing rates decreased, with opioids decreasing from 721 per 1,000 population to 585, paracetamol from 734 to 484, and systemic NSAIDs from 259 to 167. The rate ratio (RR) for opioid dispensing for Ireland compared to England ranged from 1.36 in 2014 to 2.09 in 2022. Paracetamol dispensing rate rate increased from 1.76 to 3.77 and for NSAIDs from 3.02 to 4.39. Similar patterns were seen for rates of defined daily doses and OMEs. Most opioids had higher rates of dispensings in Ireland compared to England. The rate of hydromorphone dispensings was 14.99 times higher in Ireland compared to England in 2022, and the rate of tapentadol 26.03 times higher. The percentage share of individuals opioids was similar in Ireland and England, with some exceptions; notedly morphine dispensing made up 13% of opioid prescribing in England compared to 3% in Ireland.

Conclusions: Rates of analgesic use are increasing in Ireland, except for systemic NSAIDs, while in England rates of all classes are declining over time. Rates were comparatively higher in Ireland, potentially due to older age and lower incomes of GMS patients. Further research to understand drivers for this higher volume of use is required.