Background
The risk of iatrogenic harm from prescription drug use, misuse and abuse of drugs
such as gabapentin, pregabalin and oxycodone is substantial. In recent years, deaths
associated with these drugs in England have increased.
Aims
To characterise general practice prescribing trends for gabapentin, pregabalin and
oxycodone – termed dependence forming medicines (DFM) – in England and describe
potential drivers of unwarranted variation.
Design and Setting
This study is a retrospective secondary analysis of open source, publicly available
government data from various sources pertaining to primary care demographics and
prescriptions.
Methods
This study used five consecutive years (April 2013 – March 2018) of aggregate data
to investigate longitudinal trends of prescribing and variation in prescribing trends at
practice and clinical commissioning group (CCG) level.
Results
Annual prescriptions of gabapentin, pregabalin and oxycodone have increased each
year over the period. Variation in prescribing trends were associated with GP practice
deprivation quintile, where the most deprived GP practices prescribe 313% (p<0.001)
and 238% (p<0.001) greater volumes of gabapentin and pregabalin per person than
practices in the least deprived quintile. The highest prescribing CCGs of each of these
drugs were predominantly in northern and eastern regions of England.
Conclusions
Substantial increases in gabapentin, pregabalin and oxycodone prescriptions are
concerning and will increase iatrogenic harm from drug-related morbidity and mortality.
More research is needed to understand the large variation in prescribing between general practices; and to develop and implement interventions to reduce unwarranted
variation and increase the appropriateness of prescribing of these drugs.