POS1075 CLINICAL INDICATIONS ASSOCIATED WITH NEW OPIOID USE FOR PAIN MANAGEMENT IN THE UNITED KINGDOM: USING NATIONAL PRIMARY CARE DATA
Authors: C. R. Ramirez Medina, M. Lyon, E. Davies, V. Reid, A. Khanna, D. Mccarthy, S. Ling, M. Jani
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Prescription opioids for non-cancer pain in the UK have increased considerably over the past two decades, alongside a rise in associated harms. Despite the high prevalence of opioid use, there are limited data on the specific indications for prescribing opioids for non-cancer pain. By understanding the reasons for opioid initiation and relative contribution of systems and specific conditions, the opioid burden in patient subgroups can be assessed to develop tailored interventions, policies, and additional support as appropriate. <h3>Objectives:</h3> The main aim of this study was to evaluate clinical indications associated with new opioid initiation in non-cancer pain using UK large-scale data. <h3>Methods:</h3> UK national primary care electronic health records from 01/01/2006 to 31/09/2021 were used from the Clinical Research Practice Datalink. Patients ≥18 years who were new users of opioids were included. Exclusion criteria included a cancer diagnosis five years prior to first opioid prescription. A comprehensive list of 53 clinical indications for opioid use and relevant SNOMED-CT code lists were compiled in consultation with UK-based clinicians with expertise in pain management. Indications were organised into ten distinct medical systems to facilitate the analysis (i.e., Musculoskeletal, Respiratory, Infections, Trauma/Injury, Neurology, Major Surgery, Gynaecological reasons, Gastrointestinal, Dental and Haematological). These were applied to a period one-year prior to index date for surgical indication and five years prior for chronic conditions. For each clinical indication system, we defined demographic and prescription characteristics at initiation, including age, ethnicity, social deprivation, the daily dose dispensed in milligram morphine equivalents (MMEs) and opioid prescribed. Descriptive statistics were used to analyse the data using STATA v13.1, allowing for overlap between indications. <h3>Results:</h3> A total of 3,031,950 new opioid users (2,028,356 unique adult patients) were identified over ~15-year study window. Opioids were initiated more commonly in women (60.7%), people aged 45-64 (40.0%), ≥65 years (37.0%), and with a low (&lt;50) MME dose at initiation (99.6%). Ten systems associated with opioid-initiation were identified. The most common were musculoskeletal (84.8%), respiratory (57.6%), infections (30.4%), trauma/injury (20.4%), neurology (19.8%), gastrointestinal (5.2%) within five years prior to the opioid prescription date and post-surgical within one-year prior (5.5%). Musculoskeletal conditions most frequently associated with opioid use were osteoarthritis (n=1,231,972 unique patients, 60.7%), low back pain (n= 831,983, 41.0%), other non-inflammatory musculoskeletal conditions (n=292,755, 11.4%), osteoporosis (n=96,903, 4.8%) and gout (n=87,440, n=4.31%). Post-surgical indications were associated with 5.5% of all prescriptions, with orthopaedic surgeries being the most common: 43.3% of all post-surgical indications (Table 1). This included total knee replacements (n= 30,930; 27.8%) and total hip replacements (n=17,313; 15.5%). The clinical systems with the highest MME mean dose at initiation were haematological, major surgery, and dental. <h3>Conclusion:</h3> This is the first study in the UK evaluating large scale national data to assess indications associated with opioid initiation. More than three quarters of the new prescriptions of opioids for non-cancer pain were in people with a diagnosis of a musculoskeletal condition. Orthopaedic surgeries contributed to a third of all post-surgical indications. These findings could help inform prioritisation of targeted interventions in opioid de-prescribing, clinical vigilance, and policy development to support non-pharmacological interventions in patients with musculoskeletal conditions. <h3>REFERENCES:</h3> <b>NIL.</b> <b>Table 1.</b> Clinical indications of opioids for new opioid patients with different look back periods (overlapping totals). <h3>Acknowledgements:</h3> MJ is supported by an NIHR Advanced Fellowship [NIHR301413]. <h3>Disclosure of Interests:</h3> <b>None declared.</b>