Opioid prescribing to people on orthopaedic waiting lists during the COVID-19 pandemic in England: a study using OpenSAFELY-TPP

Background: Waiting times for elective procedures increased dramatically during the COVID-19 pandemic. People waiting for orthopaedic procedures often require opioids to manage pain, and longer waiting times may result in a need for more and stronger opioids to treat symptoms.

Methods: With NHS England approval, we used routine clinical data from general practice adult patients in OpenSAFELY-TPP linked with the National Minimum Waiting List Dataset. We identified people on elective waiting lists for inpatient trauma or orthopaedic procedures (May 2021-Apr 2022). We quantified changes in weekly opioid prescribing from 6 months pre-waiting list start date to 1 year after the waiting list end date. We also compared long-term opioid prescribing rates in the 3 months before the waiting list start date and months 4-6 after the waiting list end date. We also stratified analyses by time spent on the waiting list (<=18 weeks, 19-52 weeks, >52 weeks).

Results: Among 63,850 people on elective trauma or orthopaedic waiting lists (median age = 61 years, 54.6% female), 20.5% waited more than 52 weeks. Weekly opioid prescribing rates per 100 waiting list population were relatively stable over time, with peaks immediately post-treatment, and plateauing again after approximately 3 months. Comparing the 3 months before the waiting list start date to months 4-6 after the waiting list end date, changes in the proportion of people with >=3 opioid prescriptions were -1.6% (95%CI -2.2%, -1.0%) for people on the waiting list <=18 weeks, -1.1% (95%CI -1.7%, -0.5%) among people waiting 19-52 weeks, and -0.5% (95%CI -1.4%, 0.4%) among people waiting >52 weeks.

Conclusion: During the COVID-19 pandemic, one in five people waiting for elective orthopaedic procedures waited more than one year. Nearly one in seven were prescribed opioids long-term prior to their referral date, and only small reductions in long-term opioid prescribing was observed post-procedure, regardless of time spent on the waiting list. However, people on waiting lists experienced much longer wait times during the COVID-19 pandemic which also means greater exposure to opioids while awaiting treatment.