Regional variation in longitudinal trajectories of primary care opioids prescribing across Health Boards in Scotland: a population-based study

ABSTRACT

Background

This study aims to describe the longitudinal trajectory of opioid prescribing at the practice level and assess associated factors, including Health Boards and socioeconomic status.

Research design and methods

This drug utilization research used practice-level dispensing data from 2016 to 2018. Practice-level prescription opioids dispensed were quantified by the defined daily doses (DDDs) per 1000 registrants. Group-based trajectory models were used to identify groups of practices with similar trajectories based on the difference in monthly opioid utilization. Characteristics of registrants were associated with the trajectory by a conditional logistic regression and the prescription opioids dispensed by a random-effect regression model.

Results

Of the 798 practices, 29.5% increased opioid prescription by an additional 100 DDDs/1000 registrants/month during 2017 and 2018. Practice in southwest Scotland tended to be categorized into the group with increasing opioid utilization. Deprived socioeconomic status was associated with increasing opioid utilization (odds ratio: 2.2; 95% confidence interval: 1.5, 3.2) or higher annual opioid utilization (coefficient: 358.2; 95% confidence interval: 327.6, 388.8).

Conclusions

Increasing opioid utilization over time was related to deprived socioeconomic status associated with chronic pain conditions and inequality in pain services. Further strategies to balance inequality are needed, which needs further investigation.

KEYWORDS:

• Longitudinal trajectory
• opioid analgesics
• primary health care
• Scotland
• socioeconomic factors
• spatial mapping

Author contributions

T-C Chen proposed the concept and study design, accessed, analyzed the research data, and drafted the manuscript. T-L Su performed the geographical analysis and contributed to the manuscript review. A Kurdi contributed to the study design, interpretation of the results and manuscript revision. L-C Chen led the research project, study design, interpretation of results, and manuscript revision.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics approval

This study used aggregate-level data that are publicly available and do not require ethical approval.

Data availability statement

This study used publicly available data from the NHS National Services Scotland.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17512433.2022.2102972