The prescribing of opioids for chronic non-cancer pain in the menopausal and postmenopausal population: a drug utilisation study in the UK.

Abstract

Background: Opioid use for chronic non-cancer pain (CNCP) is consistently higher in menopausal and postmenopausal women than in younger women or men, elevating their risk of opioid-related adverse health outcomes. Since pain severity increases with hormonal changes accompanying menopause, these women should be a focus of opioid stewardship efforts.

Aim: To examine opioid prescribing trends for CNCP in menopausal and postmenopausal women diagnosed with a musculoskeletal condition.

Design & setting: Population-based drug utilisation study, which was undertaken with data from IQVIA Medical Research Data UK.

Method: Annual opioid prescribing incidence, prevalence, and average duration of use were calculated for a cohort of women aged 50-79 years with musculoskeletal conditions newly diagnosed between 2010 and 2021. Specific results were stratified by age, pain indication, and Townsend score.

Results: From 2010-2021, incident prescribing rates of opioids increased in women aged 50-54 years (161.4 [95% confidence interval {CI} = 149.7 to 174.0] per 1000 person-years at risk [PYAR] in 2010 to 239.6 [95% CI = 211.7 to 271.2] per 1000 PYAR in 2021); these women discontinued opioid use faster (<1 year) than older age groups (~2 years). Overall, opioid prescribing prevalence decreased from 23% in 2010 to 14% in 2021, and average opioid use duration decreased from 3 years to 1 year (2010-post-2017) in women aged 50-79 years.

Conclusion: The overall observed decrease in prevalence and average duration of opioid use is encouraging. Incident prescriptions are rising in women aged 50-54 years and those with fibromyalgia while remaining steady in women aged 55-79 years. Understanding the impact of menopause and post-menopause on opioid use trends is important for effective opioid stewardship.