[Appropriateness of strong opioid prescribing chronic non-cancer pain in primary care: a cross-sectional study].

OBJECTIVE

To assess the appropriateness of strong opioid prescribing for chronic non-cancer pain (CNCP) in primary care and to analyse factors associated with inappropriate prescribing.

DESIGN

Cross-sectional observational study. SITE: Three primary care centres in a health area in northern Spain.

PARTICIPANTS

Active prescriptions of strong opioids in adult patients with CNCP. A total of 441 prescriptions corresponding to 387 patients were analysed.

INTERVENTIONS: No interventions were performed. A retrospective review of prescriptions and electronic health records was conducted.

MAIN MEASUREMENTS: Therapeutic appropriateness according to eight clinical recommendations on indication, previous analgesic escalation, concomitant treatment and safety. Descriptive analysis and multivariable logistic regression were performed.

RESULTS

Mean age was 67.1years (SD: 16.0), and 71.4% of prescriptions corresponded to women. Overall, 82.8% of prescriptions were considered inappropriate. The most frequent non-adherence criterion was concomitant benzodiazepine use (55.1%). In the multivariable model, age (OR: 1.02; 95%CI: 1.00-1.04; P=.038) and concomitant antidepressant treatment (OR: 4.76; 95%CI: 2.17-10.64; P<.001) were associated with inappropriate prescribing. A high-risk clinical profile was observed in 31.5% of prescriptions.

CONCLUSIONS

Strong opioid prescribing for CNCP showed a high proportion of inappropriate use. These findings support the implementation of prescribing review and medication safety interventions in primary care.