Opioid prescribing varies considerably across England and is especially marked in areas of high socio-economic deprivation, according to an analysis of English primary care prescribing data for 2018/2019.

In England GPs prescribed 624.4 million defined daily doses (DDD) of opioids. Prescribing at the lower layer super output areas (LSOAs) – a geographical unit representing about 1,500 people – varied between 1.7 and 121.04 DDD per 1,000 of the population a day.

Prescribing in the most deprived areas was, on average, 9.70 DDD per 1,000 people a day higher than the least deprived areas. Nationally, prescribing in the most deprived areas was, on average, 1.7 times higher than in the least deprived parts. Higher prescribing LSOAs were in the Midlands, the North, Cornwall and coastal areas.

The study suggests, however, “that the relationship between deprivation and opioid prescribing is complex and varies across the country”. Prescribing in the most deprived areas in the North of England was 1.2 times higher than the national average for areas of similar deprivation, but 3.3 times higher than the most deprived areas in London.

Prescribing in the least deprived areas in the North of England was 1.4 times higher than the national average for the least deprived areas and 2.8 times higher than in the equivalent areas in London. Prescribing in the most deprived areas was about 48 per cent higher than in the least deprived areas of the Midlands and the East of England. In contrast, the difference in London was about 27 per cent.

The study provides evidence that “levels of opioid prescribing differ significantly across small geographical areas in England, even after adjusting for population structure”, say the authors. The study could not assess whether opioids are prescribed at a higher dose or for longer in some parts of the England.

“Further analysis of the relationship between socio-economic deprivation and opioid prescribing, including the social, cultural and medical mediators, which may explain how deprivation leads to increased opioid prescribing, may provide valuable evidence for policymakers and clinicians to improve opioid-related health outcomes,” the authors conclude.