No increase to opioid prescribing during the COVID-19 pandemic in England

Opioids are useful for treating some types of pain, but they’re over-used - which can lead to dependence, tolerance, and even death. Governments around the world are facing the same problem, and taking action: reducing unnecessary opioid prescribing is a major policy focus in the UK and internationally.

The COVID-19 pandemic changed how people accessed healthcare. For people experiencing pain, this might mean that they were less likely to be able to access non-pharmaceutical treatments, like physical therapy. Waiting list times for elective procedures also increased, so people with painful conditions were waiting longer to receive treatment.

This didn’t affect everyone equally. People living in more deprived areas, women, and older people were more affected by COVID-19 restrictions. And these are the same people who have the highest rates of opioid prescribing.

That’s why there were concerns that during the pandemic, opioid prescribing may have increased, reversing recent declines. We wanted to check this, so we conducted a study of over 20 million primary care patients, to find out how opioid prescribing changed since the start of the pandemic, and how this varied in different populations.

What did we find?

  • For most people, opioid prescribing did not increase;
  • There was a dramatic, but temporary, increase in prescribing of opioids to treat end-of-life symptoms to people living in care homes in March-May 2020, coinciding with the peak in COVID-19 morbidity and mortality;
  • There were substantial disparities in opioid prescribing by sex, deprivation, and region, but they did not widen further during the pandemic;
  • There was a decrease in new opioid prescribing - that is, to people who hadn’t been prescribed an opioid at any time in the past year.

What do these findings mean?

Research in OpenSAFELY has previously found potentially harmful changes to health care delivery during the pandemic, such as:

So it’s encouraging that we saw no evidence of an inappropriate increase in opioid prescribing, either overall or in high risk populations, in this study.

The reduction in new opioid prescribing may be explained by fewer interactions with healthcare providers during lockdown, or that prescribers were less comfortable prescribing opioids to people who had not used them before in a remote setting.

Generally speaking, opioid prescribing is still high, and there’s still a lot we don’t know about the causes of long-term use and dependence.

Further reading

See our previous work on geographic variation in opioid prescribing in England (1998-2018), or on changes to antipsychotic prescribing to high risk populations during the pandemic.