Patterns of analgesic prescribing and high-risk prescribing in primary care in Ireland 2014-2022 – a repeated cross-sectional study

Background Pain is a significant burden on individuals, healthcare systems, and society. Analgesic drugs carry many therapeutic benefits; however, all drugs are associated with adverse effects and risk of harm. Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids have been identified as particularly high-risk due to the risk of side effects and/or dependency. This study aims to examine how patterns of analgesic prescribing have changed in primary care in Ireland between 2014 and 2022. Methods Monthly data on medicines prescribed and dispensed in primary care on the means-tested General Medical Services (GMS) scheme in Ireland was used. Prevalence, initiations, discontinuations, chronic use, and high-risk prescribing, as defined by Scottish Polypharmacy Guidance, were summarised per year. Results The prevalence of overall analgesic use decreased slightly over time, with 48.3% of GMS-eligible individuals dispensed an analgesic in 2014 and 46.3% in 2022. This was largely driven by decreasing NSAID use, from 29.4% in 2014 to 25.0% in 2022. Prevalence for all other analgesic drug classes increased, however after age/sex adjustment, higher odds of use in 2022 vs 2014 only persisted for gabapentinoids and amitriptyline. Some forms of high-risk prescribing increased over time, including NSAIDs dispensed with oral anticoagulants, corticosteroids, and SSRIs, with fewer decreasing. Discussion There was an overall reduction of analgesic use in Ireland, driven by decreasing systemic NSAID use. While most other analgesic drug classes are increasing, this may largely be explained by changing demographics, particularly the age profile of the population. Despite this, interventions addressing rising high-risk prescribing may be needed. Statement of Significance Analgesic drug classes are an important focus for improving medication safety. The findings of this study suggest an overall reduction of analgesic use in Ireland, driven by a decrease in systemic NSAID use. Increasing use of other analgesic drug classes may largely be explained by a change in demographics, particularly the age profile of the population. Analgesic use, and high-risk prescribing remains high and suggest a need for enhanced availability of and access to non-pharmacological services and interventions, as well as improved education and deprescribing support for healthcare professionals.