Patterns of Analgesic Prescribing and High-Risk Prescribing in Primary Care in Ireland 2014–2022—A Repeated Cross-Sectional Study

Background

Pain is a significant burden on individuals, healthcare systems and society. Analgesic drugs carry many therapeutic benefits; however, all drugs are associated with adverse effects and risk of harm. Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids have been identified as particularly high-risk due to the risk of side effects and/or dependency. This study aims to examine how patterns of analgesic prescribing have changed in primary care in Ireland between 2014 and 2022.

Methods

Monthly data on medicines prescribed and dispensed in primary care on the means-tested General Medical Services (GMS) scheme in Ireland was used. Prevalence, initiations, discontinuations, chronic use and high-risk prescribing, as defined by Scottish Polypharmacy Guidance, were summarised per year.

Results

The prevalence of overall analgesic use decreased slightly over time, with 48.3% of GMS-eligible individuals dispensed an analgesic in 2014 and 46.3% in 2022. This was largely driven by decreasing NSAID use, from 29.4% in 2014 to 25.0% in 2022. Prevalence for all other analgesic drug classes increased; however, after age/sex adjustment, higher odds of use in 2022 versus 2014 only persisted for gabapentinoids and amitriptyline. Some forms of high-risk prescribing increased over time, including NSAIDs dispensed with oral anticoagulants, corticosteroids and SSRIs, with fewer decreasing.

Conclusion

There was an overall reduction of analgesic use in Ireland, driven by decreasing systemic NSAID use. Although most other analgesic drug classes are increasing, this may largely be explained by changing demographics, particularly the age profile of the population. Despite this, interventions addressing rising high-risk prescribing may be needed.

Statement of Significance

Analgesic drug classes are an important focus for improving medication safety. This study suggests analgesic use is falling in Ireland, particularly for systemic NSAIDs, especially in older adults where adverse effects may be most harmful. The increasing prevalence of other analgesics may largely be explained by an ageing population. Analgesic use, and high-risk prescribing, remains high, suggesting a need for enhanced access to non-pharmacological services and interventions and also improved education and deprescribing support for healthcare professionals to address high-risk prescribing.