A preliminary study of patients on repeat prescriptions of opioid and non-opioid analgesics

Abstract

BACKGROUND: Available literature suggests that problems due to dependence do not result from the use of low doses of low-potency opioids used for short periods of time, but no studies looked at the effect of their long-term use. OBJECTIVES: The main objective of the study was to discover whether those patients on long-term low-potency opioids, and those on non-opioid analgesics, could suffer the problems of tolerance and dependence. The study also explored the validity of applying DCR-10 criteria to a non-problematic population of analgesic users in identifying drug-dependent patients in primary care. METHOD: The prevalence of potential dependence amongst long-term users was assessed by a semi-structured questionnaire applying the DCR-10 criteria for Dependence Syndrome. The sample consisted of 38 randomly selected patients, drawn from four practices in North Cheshire, who had been on continuous repeat prescriptions of low-potency opioids, compound analgesics containing them and non-opioid analgesics (non-steroidal anti-inflammatory drugs - NSAIDs) for a minimum of one year, without any problems becoming apparent either to the patients or to their GPs. RESULTS: Approximately 3.6% of the North Cheshire GP practice population, predominantly elderly people, were shown to be on either opioid and/or non-opioid analgesics continuously for at least one year. An estimated 31% and 40% of patients on NSAIDs and low-potency opioids respectively fulfilled the DCR-10 criteria for Dependence Syndrome. With the exception of the criterion of 'impaired control' (odds ratio 4; P < 0.05), the DCR-10 criteria are equally likely to be reported in both groups. CONCLUSION: An unexpectedly high incidence of dependence was found, not only on opioids but also within the NSAIDs group. The findings may have resulted, at least in part, from an undetermined DCR-10 specificity.

• Long-TERM Prescribing Primary Care Low-POTENCY Opioids Non-STEROIDAL Anti-INFLAMMATORY Drugs Nsaids Repeat Prescriptions Compound Analgesics