Assessing the comparative safety of opioid medications for non-cancer pain

Manchester icon Greater Manchester
Researchers Involved Dr Meghna Jani, Professor Will Dixon, Dr Kamilla Kopec-Harding, Dr Mark Lunt
Main disease areas impacted Urgent & Emergency Care
Partners Involved The University of Manchester

Project Overview

Electronic patient records (EPR) have great potential to improve our understanding of medication safety in a ‘real world’ setting. One of the projects in the Greater Manchester Connected Health Cities programme assesses the comparative safety of opioid medications for non-cancer pain. This subject has received much international attention recently, with an ‘opioid epidemic’ of rapidly escalating use and associated opioid-related deaths. The most serious opioid-related adverse event is respiratory depression: however, there are few data on its incidence outside of the post-operative setting and no information on comparative safety between drugs within this class.

What data are you using? Are the data anonymised?

This analysis is being done using de-identified data from the EPR system at Salford Royal Foundation Trust, one of the most digitally advanced trusts in the country. The unique strengths of using hospital EPR data include access to administered, as well as prescribed, medication to allow a more accurate assessment of medication exposure than possible previously. The routine capture of physiological measures recorded through electronic National Early Warning Scores for all inpatients has led to a robust definition of the outcome of respiratory depression. In addition, measures recorded within EPR (e.g. Waterlow scores) may allow for better control for confounding by indication to allow for a clearer picture of causal associations.

What methods are you using to conduct this work? (How are you using the data?)

This study is observational: we analyse the data as collected by the clinical teams during routine care and as recorded in the electronic care records used when patients are admitted to hospital. We will analyse the data estimating, for example, the number of patients who develop the safety event per 1000 person years on each opioid. We will also take into account additional factors that can affect the safety outcome such as patients’ comorbidities, the dose/potency of opioids as well as other medications commonly prescribed with opioids.

Who will/could benefit? (What will we know that we don’t already?)

The direct benefit will be to patients, who can hopefully in the future be prescribed the least harmful opioid when required for pain. The clinical care teams will also benefit as prescribing decisions can be based on scientific evidence, to help them choose the safest opioid in a given context.  Our aim is that a better understanding of comparative safety within the class of opioids could help facilitate informed decision making and reduce serious side effects such as respiratory depression, which can lead to mortality.

What will be the intended outcome of your research project?

Access to this rich, novel data source for pharmacoepidemiological research will deliver an improved understanding of how factors such dose, treatment duration and interactions with other medications can effect patient safety. Such work on medication safety will help clinicians and patients understand better the risk profile of different treatments and make more informed decisions.

Are there any early findings or indications you can report?

Early findings suggest that there is a clear difference between certain opioid drugs when assessing the first outcome of respiratory depression. These results have been presented at International Conference for Pharmacoepidemiology 2018 & the Royal Society of Medicine 

– The study window of the project has now been extended and the final published results will reflect these updated findings
– This project has also informed best practice guidelines on how best to utilise secondary care data for epidemiological research