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      Prevalence and Incidence Trends for Diagnosed Prescription Opioid Use Disorders in the United Kingdom

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          Abstract

          Introduction

          The prevalence of prescription opioid use disorders in the US has increased markedly in parallel with increases in opioid prescribing. Whilst an increase in opioid prescribing has also occurred in the UK, it remains unknown if there have been concurrent increases in opioid use disorders. The aim of this study was to examine national trends in the prevalence and incidence of physician-diagnosed opioid use disorders in the UK.

          Methods

          In a retrospective electronic health care database analysis using data from the UK Clinical Practice Research Datalink (CPRD), we identified persons receiving a first opioid prescription between January 1, 2008 and December 31, 2012. Persons with an opioid use disorder were identified by Read codes assigned by patients’ physicians within 6 months following an opioid prescription. We calculated prevalence and incidence rates by dividing the analysis population by the total number of patients exposed (prevalence) or the total patient-years of exposure (incidence) using the ‘exact’ Clopper–Pearson Binomial method.

          Results

          Our analysis included 714,699 person-years of prescription opioid exposure. The 5-year period prevalence of opioid use disorders was 4.61 (95% CI 4.28–4.96) per 10,000 individuals, or 0.05%. The incidence rate of opioid use disorders was of 6.51 (95% CI 5.93–7.13) patients per 10,000 patient-years exposed. When examined by study year, there was no clear suggestion of a changing trend over time. When stratified by opioid drug, trends in the incidence rate during the study were either stable (i.e., codeine and tramadol), increasing (i.e., morphine) or decreasing (i.e., dihydrocodeine).

          Conclusions

          Our study demonstrates that despite the marked increase in overall opioid prescribing in the UK in the past decade, there has not been an increase in the incidence of physician-diagnosed opioid use disorders.

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          Most cited references 15

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          Is Open Access

          Data Resource Profile: Clinical Practice Research Datalink (CPRD)

          The Clinical Practice Research Datalink (CPRD) is an ongoing primary care database of anonymised medical records from general practitioners, with coverage of over 11.3 million patients from 674 practices in the UK. With 4.4 million active (alive, currently registered) patients meeting quality criteria, approximately 6.9% of the UK population are included and patients are broadly representative of the UK general population in terms of age, sex and ethnicity. General practitioners are the gatekeepers of primary care and specialist referrals in the UK. The CPRD primary care database is therefore a rich source of health data for research, including data on demographics, symptoms, tests, diagnoses, therapies, health-related behaviours and referrals to secondary care. For over half of patients, linkage with datasets from secondary care, disease-specific cohorts and mortality records enhance the range of data available for research. The CPRD is very widely used internationally for epidemiological research and has been used to produce over 1000 research studies, published in peer-reviewed journals across a broad range of health outcomes. However, researchers must be aware of the complexity of routinely collected electronic health records, including ways to manage variable completeness, misclassification and development of disease definitions for research.
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            Validation and validity of diagnoses in the General Practice Research Database: a systematic review

            AIMS To investigate the range of methods used to validate diagnoses in the General Practice Research Database (GPRD), to summarize findings and to assess the quality of these validations. METHODS A systematic literature review was performed by searching PubMed and Embase for publications using GPRD data published between 1987 and April 2008. Additional publications were identified from conference proceedings, back issues of relevant journals, bibliographies of retrieved publications and relevant websites. Publications that reported attempts to validate disease diagnoses recorded in the GPRD were included. RESULTS We identified 212 publications, often validating more than one diagnosis. In total, 357 validations investigating 183 different diagnoses met our inclusion criteria. Of these, 303 (85%) utilized data from outside the GPRD to validate diagnoses. The remainder utilized only data recorded in the database. The median proportion of cases with a confirmed diagnosis was 89% (range 24–100%). Details of validation methods and results were often incomplete. CONCLUSIONS A number of methods have been used to assess validity. Overall, estimates of validity were high. However, the quality of reporting of the validations was often inadequate to permit a clear interpretation. Not all methods provided a quantitative estimate of validity and most methods considered only the positive predictive value of a set of diagnostic codes in a highly selected group of cases. We make recommendations for methodology and reporting to strengthen further the use of the GPRD in research.
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              Trends in opioid analgesic abuse and mortality in the United States.

              The use of prescription opioid medications has increased greatly in the United States during the past two decades; in 2010, there were 16,651 opioid-related deaths. In response, hundreds of federal, state, and local interventions have been implemented. We describe trends in the diversion and abuse of prescription opioid analgesics using data through 2013.
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                Author and article information

                Contributors
                andrew.cooper@mundipharma-rd.eu
                Journal
                Pain Ther
                Pain Ther
                Pain and Therapy
                Springer Healthcare (Cheshire )
                2193-8237
                2193-651X
                27 April 2017
                27 April 2017
                June 2017
                : 6
                : 1
                : 73-84
                Affiliations
                [1 ]GRID grid.459800.0, , Mundipharma Research Ltd., ; Cambridge Science Park, Milton Road, Cambridge, CB4 0GW UK
                [2 ]ISNI 0000 0004 0390 9594, GRID grid.476538.b, , Mundipharma Research GmbH & Co. KG, ; Höhenstraße 10, 65549 Limburg, Germany
                [3 ]ISNI 0000 0001 2218 4662, GRID grid.6363.0, Institute of Social Medicine, Epidemiology and Health Economics, , Charité-Universitätsmedizin Berlin, ; Berlin, Germany
                [4 ]Frank Andersohn Consulting and Research Services, Berlin, Germany
                [5 ]QuintilesIMS, London, UK
                [6 ]ISNI 0000 0004 0551 2937, GRID grid.412471.5, , Berufsgenossenschaftliches Universitätsklinikum, Bergmannsheil gGmbH, ; Bürkle-de-la-Camp-Platz, Bochum, Germany
                [7 ]ISNI 0000 0004 1936 8868, GRID grid.4563.4, School of Pharmacy, , University of Nottingham, ; Nottingham, UK
                [8 ]ISNI 0000 0001 0440 1889, GRID grid.240404.6, Pain Management Service, , Nottingham University Hospitals NHS Trust, ; Nottingham, UK
                Article
                70
                10.1007/s40122-017-0070-9
                5447547
                28451867
                © The Author(s) 2017
                Funding
                Funded by: Mundipharma
                Categories
                Original Research
                Custom metadata
                © Springer Healthcare 2017

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