Private prescribing of controlled opioids in England, 2014-2021: a retrospective observational study
Authors: Martus Isabella , MacKenna Brian , Rial William , Hayhurst Jon , Richards Georgia C. 
Published: February 2023

Background

Trends of opioid prescribing in the NHS has been well published, yet trends for the same in private prescribing have not been widely established.

Aim

To assess trends and geographical variation of controlled opioids prescribed by private prescribers in England.

Design and setting

A retrospective observational study in English primary healthcare.

Methods

Data on Schedule 2 and 3 controlled opioids (“controlled opioids”) was obtained from the NHS Business Services Authority (BSA) using freedom of information (FOI) requests between 01 January 2014 and 30 November 2021. Absolute counts and rates of the number of items dispensed per cumulative number of registered private prescribers were calculated and stratified over time, by opioid type, and geographical region.

Results

128,341 items controlled opioids were prescribed by private prescribers in England between January 2014 and November 2021, which decreased by 50% from 23,339 items (4.09 items/prescriber) in 2014 to 11,573 items (1.49 items/prescriber) in 2020. Methadone (36%) was the most common controlled opioid prescribed privately, followed by morphine (18%), buprenorphine (16%), and oxycodone (12%). Prescriptions were highest in London (74%), followed by the South-East of England (7%). A proportion of items (n=462, 0.35%) were prescribed by “unidentified doctors” where the prescription is not readily attributable to an individual prescriber by the BSA.

Conclusions

Controlled opioids prescribed by private prescribers in England decreased and were primarily prescribed in London. To ensure patient safety, the monitoring and surveillance of controlled opioids dispensed privately should continue and items linked to “unidentified doctors” should be addressed further.

How this fits in

There are concerns over the long-term, high-dose use of opioids in people with chronic pain – trends for which have been described using English NHS prescription data. However, opioids can also be acquired from outside of NHS services, including private prescribers, over-the-counter (e.g. co-codamol), and through online healthcare services and pharmacies or the “dark web”. Without exploring non-NHS data, the full picture of opioid use in England cannot be understood. This study sought to fill this gap by investigating opioids in the private sector. We found that the number of controlled opioid items prescribed by private prescribers in England halved between January 2014 and November 2021, and that most prescribing occurred from prescribers in London. There were also controlled opioid items dispensed by “unidentified doctors”, which must be addressed to ensure patient safety. While there is monitoring of controlled drug prescribing by NHS England Controlled Drug Accountable Officers, expanding access to such data to allow for a greater visibility and wider analysis of non-NHS data, including the private prescribing of controlled opioids, will allow policymakers and clinicians to further assess the implementation of pain guidelines and identify harms that can be addressed to improve patient safety.