The prescribing of pain medication, including highly addictive opioids, has risen significantly in the State in recent years, according to new research.
Usage rates of pain medications now outpace those in England, prompting concerns that overprescribing certain drugs could result in dependency issues among patients.
Researchers at the RCSI University of Medicine and Health Sciences say long waiting lists for orthopaedic surgery, such as hip and knee replacements, are partially to blame for the surge in prescriptions in the State.
Published in the British Journal of Clinical Pharmacology on Thursday, the RCSI study raises questions about healthcare access, prescribing practices and the availability of non-drug interventions to address pain.
RM Block
Researchers examined national prescribing data between 2014-2022, focusing on patients in the Republic covered by the General Medical Services (GMS) scheme – people with a medical card, representing about one-third of the population – and on data from all general practices in England.
The use of opioids in the State increased by about 25 per cent over the period, while prescriptions for paracetamol rose by 50 per cent. Specific medicines including codeine and stronger opioids such as tapentadol and oxycodone increased by even higher percentages. By contrast, England experienced declining use across most classes of pain medications during the same time frame.
The analysis revealed prescribing levels in the State were substantially higher than in England by 2022: twice as high for opioids, four times higher for anti-inflammatories, and nearly five times higher for paracetamol.
“Many of these medications carry risks such as dependency which can be worsened by overprescribing,” said Prof Frank Moriarty, senior author of the study and associate professor at the RCSI school of pharmacy and bimolecular sciences.
Mr Moriarty said part of the disparity in the prescription rates can be attributed to the differing populations studied. The National Health Service (NHS) data covers the entire population of England, while the Irish data reflects prescribing to GMS patients, a group in which older adults are over-represented.
However, even taking this into account, more patients in England have access to pain clinics and non-pharmacological interventions such as physical therapy through the NHS. In the Republic, such services are less widely available, particularly for medical card holders who cannot afford to pay for private healthcare.
Mr Moriarty said extensive waiting lists for surgery in the Republic likely result in “more decisions to prescribe [strong painkillers] for longer than otherwise”. A patient’s tolerance to and dependence on a certain medication will increase over time, he added.
Mr Moriarty said the researchers “can’t say for certain how many of these prescriptions might be over-prescriptions or inappropriate prescriptions”.
“Ultimately it comes down to an assessment between the prescriber and the patient, and what is in the patient’s best interests. Sometimes the person is dealing with very severe pain and the prescription may be the most appropriate course of action so the patient has a good quality of life.”
In a bid to reduce the upward trend of prescribing strong painkillers for long periods, the Irish health service must address long waiting times for surgery and ensure patients “have access to safe, evidence-based alternatives to medications”, he said.
The study was carried out in collaboration with the HSE’s Quality and Patient Safety Directorate, University of Oxford, University College Cork and University College Dublin.
