Trends in Opioid Prescribing and Associated resource utilisation in Wales (TOPAS)

Emma Davies, Swansea University

Research Hypotheses 

  • That opioid utilisation has increased in Wales in the last 10 years and varies between different Health Boards, population demographic and type of prescriber 
  • That there is association between individual patients’ use of opioids and their use of health care resources and that this relationship can be determined by the opioid being used, persistence of use and the doses prescribed 

Research Aims 

This study aims to: 

  • Describe the trends in opioid prescribing in the Welsh Primary Care Population, over a 10 year period (2005 – 2015) 
  • Determine any causal or potential association between opioid use, non-pain morbidities and the utilisation of other health care services, in primary, community or acute care settings 
  • Develop an economic model that enables the full costs of opioid use in chronic, non-cancer pain to be more accurately determined, in order to inform the development of more effective services for pain management and improved use of medicines 

Research objectives 

To describe the trends in opioid prescribing 

1. Opioid utilisation and prescribing patterns evaluation

  • To evaluate the prescribing data of opioid prescriptions and to explore the type of prescriber (medical or non-medical), geographic (Health Board), patient age and deprivation level variation
  • To investigate the impact of major clinical guidance and recent legislative changes on opioid prescribing patterns

2. Opioid prescribing persistence in chronic, non-malignant pain management 

  • To determine the persistence of opioid prescribing and assess whether the persistence and pattern of prescribing can be a proxy for measuring adherence, drug diversion and misuse
  • To determine the potential factors contributing to persistence of long-term opioid prescribing including the nature of Chronic Pain (CP) being treated

3. Clinical outcomes related to long-term opioid utilisation 

  • To assess adverse effects which are associated with short-term and long-term opioid use
  • To compare the mortality rate between opioid and non-opioid users in patients with chronic, non-malignant pain conditions 

To determine associations between opioid use, morbidity and health care utilisation: 

4. Association between opioid use and health care utilisation 

  • To assess the frequency of primary and secondary healthcare referral or attendance by patients on long-term opioids therapy compared to the general population (patients not receiving opioids or who have a pain diagnosis on record)
  • To assess if any association is determined by the type of opioid medication (e.g. weak or strong opioid) being prescribed, the doses administered or the duration of use 

To evaluate the cost of opioid use in chronic, non-cancer pain: 

5. Estimation of the ‘true cost’ of opioid prescribing 

  • To develop economic descriptions of the impact of health care utilisation associated with long-term opioid therapy which may then be used in the development of strategies to change how opioid prescribing is used in CP

This project is running from October 2016 to February 2020.