The Impact of the COVID-19 Pandemic Lockdown on the Prescribing Trends and Utilisation of Opioids for Treating Pain in England Primary Care Setting

Abstract

Background: The prescription of opioids for chronic pain (CP) is prevalent in the UK. In March 2020, the emergence of the COVID-19 pandemic affected the world and presented unprecedented challenges for healthcare systems, including patients with CP. The need for self-quarantining and social distancing has resulted in limiting most of the conventional medical services, including CP management. Subsequently, a change in opioid prescription may be expected. This study aimed to assess the impact of the COVID-19 pandemic on the opioid utilisation trend in England. Method: This cross-sectional study applied a segmented linear regression analysis to monthly opioid prescriptions using the Prescription Cost Analysis database, from March 2019 to March 2021. Opioid utilisation was measured using the number of items dispensed/1000 inhabitants and Defined Daily Dose (DDD)/1000 inhabitants/day during the 12 months pre and post the first COVID-19 national lockdown in England in March 2020, stratified by strong and weak opioids. Results: In terms of the number of items dispensed/1000 inhabitants pre the first COVID-19 lockdown, a reduction in the trend was noted in the number of total and strong opioids (β1=-0. 064, p=0.298 and β1=-0.055, p=0.184), respectively, and a small increase in weak opioids (β1=.009, p=0.667). There was an increase in the level immediately post-COVID-19 lockdown for total, strong, and weak opioids (β2=0.494, p=0.398), (β2=0.448, p=.252), (β2=0.045, p=0.822). There was a decline in the trend post- COVID-19 lockdown (β3=-0.024, p=.766), (β3=-0.010, p=0.857), and (β3=-0.014, p=0.607) for total, strong, and weak opioids, respectively. A reduction in the DDD/1000 inhabitant/day baseline trend was observed pre-COVID- 19 lockdown for total (β1=-0.028, p=0.363), strong (β1=-0.027, p=0.186), and weak opioids (β1=-.001, p=.940). There was an immediate increase in the level post- COVID-19 lockdown (β2=0.386, p=0.194), (β2=0.360, p=0.073), and (β2=0.026, p=0.799) for total, strong, and weak opioids respectively, then a decline in the trend post-COVID-19 lockdown for total (β3=-0.040, p=0.333), strong (β3=-0.029, p=0.280), and weak opioids (β3=-0.008, p=0.477). Conclusion: Opioid utilisation does not appear to have been significantly affected by the COVID- 19 pandemic during the study period. However, patient level data is needed to determine a more accurate estimate of the trend change in opioid prescription.