Meta-analysis examines high-dose opioid prescribing in primary care

  • Richards GC & al.
  • BMC Med
  • 30.03.2020

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Prescription of high-dose opioids in primary care settings is associated with an increased likelihood of benzodiazepine coprescription, depression, and more visits to emergency departments.
  • These results are from a meta-analysis of studies from the United Kingdom, United States, and Australia.

Why this matters

  • This study is the first meta-analysis to examine factors associated with high-dose opioid use by primary care patients.
  • It highlights issues primary care clinicians should consider when formulating pain management strategies.

Study design

  • A meta-analysis of 6 studies including 4,248,119 patients (aged ≥18 years) who had been prescribed opioids.
  • Funding: National Institute for Health Research School for Primary Care.

Key results

  • Total, 3.64% of patients were using high-dose opioids.
  • Prescription of high-dose vs low-dose opioids was significantly associated (relative risk; 95% CI) with:
    • Coprescription of benzodiazepines: 3.27 (1.32-8.13; I2=99.9%).
    • Depression: 1.38 (1.27-1.51; I2=0%).
    • Emergency department visits: 1.53 (1.46-1.61; I2=0%).
    • Unemployment: 1.44 (1.27-1.63; I2=0%).
    • Male sex: 1.21 (1.14-1.28; I2=78.6%).
  • Number needed to harm: 15 (95% CI, 12-20).

Limitations

  • Included data from observational studies.
  • Included only a small number of studies.

Coauthored with Vijay Rathod, PhD