BackgroundOpioids can be effective analgesics, but long-term use may be associated with harms. In 2013, the first national, comprehensive, evidence-based pain management guideline was published, from the Scottish Intercollegiate Guideline Network (SIGN 136: Management of Chronic Pain) with key recommendations on analgesic prescribing. This study aimed to examine the potential impact on national opioid prescribing rates in Scotland.
MethodsTrends in national and regional community opioid prescribing data for Scotland were analysed from quarter one (Q1) 2005 to Q2 2020. Interrupted time series regression examined the association of SIGN 136 publication with prescribing rates for opioid-containing drugs. Gabapentinoid prescribing was used as an outcome control.
ResultsAfter a positive prescribing trend pre-publication, the timing of SIGN 136 publication was associated with a negative change in trend of opioid prescribing rates (-2.82 items per 1,000 population per quarter [PTPPQ]; P<0.01). By Q2 2020, the relative reduction in opioid prescribing rate was -20.67% (95% CI: -23.67, -17.77). This persisted after controlling for gabapentinoid prescribing and was mainly driven by reduction in weak opioids, whereas strong opioid prescribing rates continued to rise. Gabapentinoid prescribing showed a significant rise in level (8.00 items per 1,000 population; P=0.01) and trend (0.27 items PTPPQ; P=0.01) following SIGN 136 publication.
ConclusionsPublication of SIGN 136 was associated with a reduction in opioid prescribing rates. This suggests that changes in clinical policy through evidence-based national clinical guidelines may affect community opioid prescribing, though this may be partially replaced by gabapentinoids, and other factors may also contribute.
