PMID- 30641450
OWN - NLM
STAT- MEDLINE
DCOM- 20200226
LR  - 20200226
IS  - 1873-4758 (Electronic)
IS  - 0955-3959 (Linking)
VI  - 64
DP  - 2019 Feb
TI  - Prescription opioids: Regional variation and socioeconomic status - evidence from 
      primary care in England.
PG  - 87-94
LID - S0955-3959(18)30285-8 [pii]
LID - 10.1016/j.drugpo.2018.10.013 [doi]
AB  - BACKGROUND: This study aimed to quantify opioid prescriptions dispensed from 
      primary care practices throughout England and investigate its association with 
      socioeconomic status (SES). METHODS: This cross-sectional study used publicly 
      available data in 2015, including practice-level dispensing data and 
      characteristics of registrants from the United Kingdom (UK) National Health 
      Service Digital, and Index of Multiple Deprivation (IMD) data from Department of 
      Communities and Local Government. Practices in England which issued opioid 
      prescriptions that could be assigned a defined daily dose (DDD) in the 
      claim-based dispensing database were included. The total amount of opioid 
      prescriptions dispensed (DDD/1000 registrants/day) was calculated for each 
      practice. The association between dispensed opioid prescriptions and IMD was 
      analyzed by multi-level regression and adjusted for registrants' characteristics 
      and the clustered effect of Clinical Commissioning Groups. Subgroup analysis was 
      conducted for practices in London, Birmingham, Manchester and Newcastle. RESULTS: 
      Of the 7856 included practices in England, the median and interquartile range 
      (IQR) of prescription opioids dispensed was 36.9 (IQR: 23.1, 52.5) DDD/1000 
      registrants/day. The median opioid utilization (DDD/1000 registrants/day) amongst 
      practices varied between Manchester (53.1; IQR: 36.8, 71.4), Newcastle (48.9; 
      IQR: 38.8, 60.1), Birmingham (35.3; IQR: 23.1, 49.4) and London (13.9; IQR: 8.1, 
      18.8). Lower SES, increased prevalence of patients aged more than 65 years, 
      female gender, smoking, obesity and depression were significantly associated with 
      increased opioid prescriptions. For every decrease in IMD decile (lower SES), 
      there was a significant increase of opioid utilization by 1.0 (95% confidence 
      interval: 0.89, 1.2, P < 0.001) DDD/1000 registrants/day. CONCLUSION: There was 
      substantial variation in opioid prescriptions among practices from Northern and 
      Eastern England to Southern England. A significant association between increased 
      opioid prescriptions and greater deprivation at a population level was observed. 
      Further longitudinal studies using individual patient data are needed to validate 
      this association and identify the potential mechanisms.
CI  - Copyright (c) 2018 Elsevier B.V. All rights reserved.
FAU - Chen, Teng-Chou
AU  - Chen TC
AD  - Division of Pharmacy Practice and Policy, School of Pharmacy, University of 
      Nottingham, East Drive, University Park, Nottingham NG7 2RD, United Kingdom. 
      Electronic address: paxtc4@nottingham.ac.uk.
FAU - Chen, Li-Chia
AU  - Chen LC
AD  - Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and 
      Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, 
      University of Manchester, Manchester Academic Health Science Centre Stopford 
      Building, Oxford Road, Manchester M13 9PT, United Kingdom. Electronic address: 
      li-chia.chen@manchester.ac.uk.
FAU - Kerry, Miriam
AU  - Kerry M
AD  - Division of Pharmacy Practice and Policy, School of Pharmacy, University of 
      Nottingham, East Drive, University Park, Nottingham NG7 2RD, United Kingdom. 
      Electronic address: Miriam.Kerry@btuh.nhs.uk.
FAU - Knaggs, Roger David
AU  - Knaggs RD
AD  - Division of Pharmacy Practice and Policy, School of Pharmacy, University of 
      Nottingham, East Drive, University Park, Nottingham NG7 2RD, United Kingdom; 
      Primary Integrated Community Solutions, Unit 4 Ash Tree Court, Nottingham 
      Business Park, Nottingham NG6 8PY, United Kingdom. Electronic address: 
      roger.knaggs@nottingham.ac.uk.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190112
PL  - Netherlands
TA  - Int J Drug Policy
JT  - The International journal on drug policy
JID - 9014759
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Analgesics, Opioid/*therapeutic use
MH  - Cross-Sectional Studies
MH  - Drug Prescriptions/*standards/*statistics & numerical data
MH  - England
MH  - Female
MH  - Geography, Medical
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Primary Health Care
MH  - Social Class
OTO - NOTNLM
OT  - Dispensed opioid prescriptions
OT  - England
OT  - General practice
OT  - Regional variation
OT  - Socioeconomic status
OT  - Spatial analysis
EDAT- 2019/01/15 06:00
MHDA- 2020/02/27 06:00
CRDT- 2019/01/15 06:00
PHST- 2017/06/23 00:00 [received]
PHST- 2018/09/14 00:00 [revised]
PHST- 2018/10/22 00:00 [accepted]
PHST- 2019/01/15 06:00 [pubmed]
PHST- 2020/02/27 06:00 [medline]
PHST- 2019/01/15 06:00 [entrez]
AID - S0955-3959(18)30285-8 [pii]
AID - 10.1016/j.drugpo.2018.10.013 [doi]
PST - ppublish
SO  - Int J Drug Policy. 2019 Feb;64:87-94. doi: 10.1016/j.drugpo.2018.10.013. Epub 
      2019 Jan 12.