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Prescription opioids: regional variation and socioeconomic status: evidence from primary care in England

Chen, Teng-Chou; Chen, Li-Chia; Kerry, Miriam; Knaggs, Roger D.


Teng-Chou Chen

Li-Chia Chen

Miriam Kerry


Background: This study aimed to quantify dispensed opioid prescriptions among primary care practices throughout England and investigate its association with socioeconomic status (SES).
Methods: This cross-sectional study used publicly available data in 2015, including practice-level dispensing data and characteristics of registrants from the United Kingdom (UK) National Health Service Digital, and Index of Multiple Deprivation (IMD) data from Department of Communities and Local Government. Practices in England which had opioid prescriptions that could be assigned a defined daily dose (DDD) in the claim-based dispensing database were included. The total amount of dispensed opioid prescriptions (DDD/1000 registrants/day) was calculated for each practice. The association between dispensed opioid prescriptions and IMD was analyzed by multi-level regression and adjusted for registrants' characteristics and the clustered effect of Clinical Commissioning Groups. Subgroup analysis was conducted for practices in London, Birmingham, Manchester and Newcastle.
Results: Of the 7856 included practices in England, the median and interquartile range (IQR) of prescription opioids dispensed was 36.9 (IQR: 23.1, 52.5) DDD/1000 registrants/day. The median opioid utilization (DDD/1000 registrants/day) amongst practices varied between Manchester (53.1; IQR: 36.8, 71.4), Newcastle (48.9; IQR: 38.8, 60.1), Birmingham (35.3; IQR: 23.1, 49.4) and London (13.9; IQR: 8.1, 18.8). Lower SES, increased prevalence of patients aged more than 65 years, female gender, smoking, obesity and depression were significantly associated with increased dispensed opioid prescriptions. For every decrease in IMD decile (lower SES), there was a significant increase of opioid utilization by 1.0 (95% confidence interval: 0.89, 1.2, P less than 0.001) DDD/1000 registrants/day.
Conclusion: There was a variation in prescription opioids dispensed among practices from Northern and Eastern England to Southern England. A significant association between increased opioid prescriptions and greater deprivation at a population level was observed. Further longitudinal studies using individual patient data are needed to validate this association and identify the potential mechanisms.


Chen, T., Chen, L., Kerry, M., & Knaggs, R. D. (2019). Prescription opioids: regional variation and socioeconomic status: evidence from primary care in England. International Journal of Drug Policy, 64, 87-94.

Journal Article Type Article
Acceptance Date Nov 6, 2018
Online Publication Date Jan 12, 2019
Publication Date Feb 25, 2019
Deposit Date Nov 30, 2018
Publicly Available Date Jan 13, 2020
Journal International Journal of Drug Policy
Print ISSN 0955-3959
Electronic ISSN 1873-4758
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 64
Pages 87-94
Public URL
Publisher URL
Additional Information This article is maintained by: Elsevier; Article Title: Prescription opioids: Regional variation and socioeconomic status – evidence from primary care in England; Journal Title: International Journal of Drug Policy; CrossRef DOI link to publisher maintained version:; Content Type: article; Copyright: © 2018 Elsevier B.V. All rights reserved.


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