Changes in opioid prescribing during the COVID-19 pandemic in England

Background

The COVID-19 pandemic disrupted healthcare delivery, including difficulty accessing in-person care, which may have increased the need for strong pharmacological pain relief.

Methods

With NHS England approval, we used routine clinical data from >20 million general practice adult patients in OpenSAFELY-TPP. Using interrupted time series analysis, we quantified prevalent and new opioid prescribing prior to the COVID-19 pandemic (January 2018-February 2020), and during lockdown (March 2020-March 2021) and recovery periods (April 2021-June 2022), overall and stratified by demographics (age, sex, deprivation, ethnicity, geographic region) and to people in care homes identified via an address-matching algorithm.

Outcomes

There was little change in prevalent prescribing during the pandemic, except for a temporary increase in March 2020. We observed a 9.8% (95%CI -14.5%, -6.5%) reduction in new opioid prescribing from March 2020, sustained to June 2022 for all demographic groups except people 80+ years. Among care home residents, in April 2020 new opioid prescribing increased by 112.5% (95%CI 92.2%, 134.9%) and parenteral opioid prescribing increased by 186.3% (95%CI 153.1%, 223.9%).

Interpretation

Prevalent opioid prescribing increased temporarily among older people and care home residents, likely reflecting use to treat end-of-life COVID-19 symptoms. However, new opioid prescribing decreased among most other groups. Further research is needed to understand what is driving the reduction in new opioid prescribing and its relation to changes to health care provision during the pandemic.