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    Pain: strong opioid use (osteoarthritis and chronic low back pain)

    GID-IND10347: The percentage of patients with osteoarthritis or chronic low back pain prescribed strong opioids in the preceding 12 months.

    Indicator type

    General practice indicator suitable for use in the QOF

    Rationale

    This indicator aims to prevent harm from the overuse of strong opioid medicines for conditions in which they are not recommended. The intention of the indicator is to reduce prescribing of strong opioids therefore a lower value would equal better achievement.

    Opioids have the potential for harm, including gastrointestinal and central nervous system adverse events as well as physical dependence, opioid-induced hyperalgesia and tolerance. Other non-pharmacological and pharmacological treatments are more effective in people with osteoarthritis or with chronic low back pain.

    Specification

    Numerator: The number of patients in the denominator prescribed strong opioids in the preceding 12 months.

    Denominator: The number of patients with a diagnosis of osteoarthritis or chronic low back pain in the preceding 12 months.

    Definitions:

    • Strong opioids are defined as those described in the BNF treatment summary for analgesics plus hydromorphone hydrochloride. Combination formulations should be included. All formulations and all routes of administration should be included. The date of a prescription for a strong opioid must come after the date of the relevant diagnosis code.

    • Patients with chronic low back pain will be identified using diagnosis codes in electronic patient records which include the terms chronic and low back pain.

    Exclusions:

    • Patients with palliative indications (based on the palliative care register).

    • Patients with opioid dependence who are prescribed methadone or buprenorphine for this indication will be excluded. All medicines for opioid dependence listed under BNF section 4.10.3 will not be included in the numerator.

    Question for consultation:

    5. Should the population for this indicator be limited to adults (age 18 years and over)?

    6. Should prescribing strong opioids for cancer pain be excluded as they can be an appropriate treatment option?

    7. Is it likely that people with osteoarthritis or chronic low back pain will be prescribed opioids for other reasons?

    8. Is it likely that this indicator will inappropriately include patients whose chronic low back pain has resolved?