{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T19:02:56Z","timestamp":1784660576689,"version":"3.55.0"},"reference-count":46,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health and Care Research School for Primary Care Research","award":["518"],"award-info":[{"award-number":["518"]}]},{"name":"National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration","award":["NIHR204295"],"award-info":[{"award-number":["NIHR204295"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2025,7,22]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prescribed opioids are potent analgesics associated with high safety risks due to their adverse effects, drug-drug and drug-disease interactions and potential for dependency. To support the implementation of prescribing indicators for further interventions, this study examined the prevalence of different types of potentially hazardous opioid prescribing (PHOP) in general practices across England and investigated underlying factors and variation between practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional study focusing on adults (aged \u226518 years) at risk of triggering 17 PHOP indicators on 1 April 2021, involving 1358 general practices contributing to the Clinical Practice Research Datalink Aurum. PHOP prevalence was calculated by dividing the number of patients triggering an indicator by the total number at risk. Variation was assessed with intraclass correlation coefficients (ICCs), and multilevel mixed-effects logistic regression models identified associated factors, presented as adjusted ORs (aORs) with 95% CIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3 121 852 patients observed, 361\u2009505 (11.58%, 95% CI 11.54, 11.62) triggered at least one PHOP indicator, yielding an ICC of 0.07 (95% CI 0.06, 0.07). The prevalence of the 17 PHOP indicators ranged from 1.97% to 32.02%. Significant variability was noted across the 17 indicators, especially for persistent opioid prescriptions in patients with alcohol use issues (ICC 0.08, 95% CI 0.07, 0.09), chronic obstructive pulmonary disease or asthma (ICC 0.08, 95% CI 0.07, 0.09) and hypothyroidism (ICC 0.07, 95% CI 0.06, 0.07). Patients from the most deprived regions (aOR 1.28, 95% CI 1.22, 1.34) and the Northwest of England (aOR 1.73, 95% CI 1.66, 1.81) had a higher risk of PHOP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and relevance<\/jats:title>\n                    <jats:p>The high prevalence of PHOP, particularly among the most socioeconomically disadvantaged populations, emphasises existing prescribing risks and the need for their appropriate consideration within primary care. The high variation between practices indicates potential for improvement through targeted practice-level intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjqs-2025-018794","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T17:20:34Z","timestamp":1754414434000},"page":"541-550","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Examining variations in the prevalence of hazardous opioid prescribing across general practices in England: a cross-sectional study"],"prefix":"10.1136","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9491-0421","authenticated-orcid":false,"given":"Teng-Chou","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan"},{"name":"Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex M","family":"Trafford","sequence":"additional","affiliation":[{"name":"Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Carr","sequence":"additional","affiliation":[{"name":"Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"},{"name":"National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9897-8757","authenticated-orcid":false,"given":"Neetu","family":"Bansal","sequence":"additional","affiliation":[{"name":"Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"},{"name":"National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6450-5815","authenticated-orcid":false,"given":"Evangelos","family":"Kontopantelis","sequence":"additional","affiliation":[{"name":"Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Avery","sequence":"additional","affiliation":[{"name":"National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK"},{"name":"School of Medicine, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Chia","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren M","family":"Ashcroft","sequence":"additional","affiliation":[{"name":"Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK"},{"name":"National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK"},{"name":"National Institute for Health and Care Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"2026071702100887000_35.8.541.1","unstructured":"Office for National Statistics . Deaths related to drug poisoning in England and Wales: 2023 registrations, 2024. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/bulletins\/deathsrelatedtodrugpoisoninginenglandandwales\/2023registrations"},{"key":"2026071702100887000_35.8.541.2","doi-asserted-by":"publisher","DOI":"10.1177\/20494637231160684"},{"key":"2026071702100887000_35.8.541.3","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000267542.72315.34"},{"key":"2026071702100887000_35.8.541.4","unstructured":"National Institute for Health and Care Excellence . Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain, 2021. Available: https:\/\/www.nice.org.uk\/guidance\/ng193"},{"key":"2026071702100887000_35.8.541.5","doi-asserted-by":"publisher","DOI":"10.1002\/j.1532-2149.2014.496.x"},{"key":"2026071702100887000_35.8.541.6","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000557"},{"key":"2026071702100887000_35.8.541.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003829","article-title":"Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study","volume":"18","author":"Jani","year":"2021","journal-title":"PLoS Med"},{"key":"2026071702100887000_35.8.541.8","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/S2215-0366(18)30471-1","article-title":"Opioid prescribing trends and geographical variation in England, 1998-2018: a retrospective database study","volume":"6","author":"Curtis","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"2026071702100887000_35.8.541.9","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/S2215-0366(19)30331-1","article-title":"Medicines associated with dependence or withdrawal: a mixed-methods public health review and national database study in England","volume":"6","author":"Marsden","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"2026071702100887000_35.8.541.10","unstructured":"Public Health England . Dependence and withdrawal associated with some prescribed medicines: an evidence review, 2019. Available: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/940255\/PHE_PMR_report_Dec2020.pdf"},{"key":"2026071702100887000_35.8.541.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7456.15"},{"key":"2026071702100887000_35.8.541.12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2006.02698.x"},{"key":"2026071702100887000_35.8.541.13","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1177\/01410768221077360","article-title":"Trends and characteristics of hospitalisations from the harmful use of opioids in England between 2008 and 2018: Population-based retrospective cohort study","volume":"115","author":"Friebel","year":"2022","journal-title":"J R Soc Med"},{"key":"2026071702100887000_35.8.541.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2021.06.049"},{"key":"2026071702100887000_35.8.541.15","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.15028"},{"key":"2026071702100887000_35.8.541.16","doi-asserted-by":"publisher","DOI":"10.1093\/bjaceaccp\/mkt046"},{"key":"2026071702100887000_35.8.541.17","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0b013e3182738655"},{"key":"2026071702100887000_35.8.541.18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7103a1","article-title":"CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022","volume":"71","author":"Dowell","year":"2022","journal-title":"MMWR Recomm Rep"},{"key":"2026071702100887000_35.8.541.19","first-page":"732","article-title":"Long-term opioid use in non-cancer pain","volume":"111","author":"H\u00e4user","year":"2014","journal-title":"Dtsch Arztebl Int"},{"key":"2026071702100887000_35.8.541.20","unstructured":"National Institute for Health and Care Excellence . Medicines Optimisation in Chronic Pain, 2017. Available: https:\/\/www.nice.org.uk\/advice\/ktt21"},{"key":"2026071702100887000_35.8.541.21","unstructured":"Public Health England . Public Health England; Opioids Aware: a resource for patients and healthcare professionals to support prescribing of opioid medicines for pain, 2016. Available: https:\/\/www.fpm.ac.uk\/faculty-of-pain-medicine\/opioids-aware"},{"key":"2026071702100887000_35.8.541.22","doi-asserted-by":"publisher","DOI":"10.1177\/20494637221083837"},{"key":"2026071702100887000_35.8.541.23","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/papr.13032","article-title":"What does it take to facilitate the integration of clinical practice guidelines for the management of low back pain into practice? Part 2: A strategic plan to activate dissemination","volume":"22","author":"Longtin","year":"2022","journal-title":"Pain Pract"},{"key":"2026071702100887000_35.8.541.24","unstructured":"Haaijer-Ruskamp FM , Andersen M , Vander Stichele RH . Prescribing quality indicators. In: Hartzema AG , Tilson HH , Chan KA , eds. Pharmacoepidemiology and Therapeutic Risk Assessment. Harwey Whitney Books, 2008."},{"key":"2026071702100887000_35.8.541.25","doi-asserted-by":"publisher","DOI":"10.1136\/qhc.11.4.358"},{"key":"2026071702100887000_35.8.541.26","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-023-03213-x","article-title":"Development of prescribing indicators related to opioid-related harm in patients with chronic pain in primary care-a modified e-Delphi study","volume":"22","author":"Bansal","year":"2024","journal-title":"BMC Med"},{"key":"2026071702100887000_35.8.541.27","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.d3514","article-title":"High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice","volume":"342","author":"Guthrie","year":"2011","journal-title":"BMJ"},{"key":"2026071702100887000_35.8.541.28","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyz034"},{"key":"2026071702100887000_35.8.541.29","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"Benchimol","year":"2015","journal-title":"PLoS Med"},{"key":"2026071702100887000_35.8.541.30","doi-asserted-by":"publisher","DOI":"10.1037\/1082-989X.1.1.30"},{"key":"2026071702100887000_35.8.541.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2017.01.013"},{"key":"2026071702100887000_35.8.541.32","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h5501","article-title":"Examining variations in prescribing safety in UK general practice: cross sectional study using the Clinical Practice Research Datalink","volume":"351","author":"Stocks","year":"2015","journal-title":"BMJ"},{"key":"2026071702100887000_35.8.541.33","unstructured":"National Health Service Digital . National Health Service Digital; Quality and Outcomes Framework (QOF), 2024. Available: https:\/\/digital.nhs.uk\/data-and-information\/data-tools-and-services\/data-services\/general-practice-data-hub\/quality-outcomes-framework-qof"},{"key":"2026071702100887000_35.8.541.34","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2013-003190","article-title":"Relationship between quality of care and choice of clinical computing system: retrospective analysis of family practice performance under the UK\u2019s quality and outcomes framework","volume":"3","author":"Kontopantelis","year":"2013","journal-title":"BMJ Open"},{"key":"2026071702100887000_35.8.541.35","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003270","article-title":"Time trends and prescribing patterns of opioid drugs in UK primary care patients with non-cancer pain: A retrospective cohort study","volume":"17","author":"Jani","year":"2020","journal-title":"PLoS Med"},{"key":"2026071702100887000_35.8.541.36","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000248"},{"key":"2026071702100887000_35.8.541.37","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1089\/jpm.2015.0051","article-title":"Identification of Challenges to the Availability and Accessibility of Opioids in Twelve European Countries: Conclusions from Two ATOME Six-Country Workshops","volume":"18","author":"Linge-Dahl","year":"2015","journal-title":"J Palliat Med"},{"key":"2026071702100887000_35.8.541.38","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1080\/17512433.2022.2102972","article-title":"Regional variation in longitudinal trajectories of primary care opioids prescribing across Health Boards in Scotland: a population-based study","volume":"15","author":"Chen","year":"2022","journal-title":"Expert Rev Clin Pharmacol"},{"key":"2026071702100887000_35.8.541.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2018.10.013"},{"key":"2026071702100887000_35.8.541.40","first-page":"i","article-title":"General Practitioners at the Deep End: The experience and views of general practitioners working in the most severely deprived areas of Scotland","volume":"2012","author":"Watt","year":"2012","journal-title":"Occas Pap R Coll Gen Pract"},{"key":"2026071702100887000_35.8.541.41","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1002\/pds.3931","article-title":"The extent and correlates of community-based pharmaceutical opioid utilisation in Australia","volume":"25","author":"Degenhardt","year":"2016","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2026071702100887000_35.8.541.42","unstructured":"Department of Health . Health survey for England - 2011: chapter 9, chronic pain London, 2012. Available: http:\/\/content.digital.nhs.uk\/catalogue\/PUB09300"},{"key":"2026071702100887000_35.8.541.43","unstructured":"Public Health Scotland . Public Health Scotland; Chronic pain waiting times Edinburgh, 2020. Available: https:\/\/beta.isdscotland.org\/find-publications-and-data\/healthcare-resources\/waiting-times\/chronic-pain-waiting-times"},{"key":"2026071702100887000_35.8.541.44","first-page":"183","article-title":"SMASH! The Salford medication safety dashboard","volume":"25","author":"Williams","year":"2018","journal-title":"J Innov Health Inform"},{"key":"2026071702100887000_35.8.541.45","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003286","article-title":"Evaluation of a pharmacist-led actionable audit and feedback intervention for improving medication safety in UK primary care: An interrupted time series analysis","volume":"17","author":"Peek","year":"2020","journal-title":"PLoS Med"},{"key":"2026071702100887000_35.8.541.46","unstructured":"NHS Business Services Authority . Opioid Prescribing Comparators Dashboard, 2023. Available: https:\/\/www.nhsbsa.nhs.uk\/access-our-data-products\/epact2\/dashboards-and-specifications\/opioid-prescribing-comparators-dashboard"}],"container-title":["BMJ Quality &amp; Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjqs-2025-018794","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T18:57:03Z","timestamp":1784660223000},"score":1,"resource":{"primary":{"URL":"https:\/\/qualitysafety.bmj.com\/lookup\/doi\/10.1136\/bmjqs-2025-018794"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,5]]},"references-count":46,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,7,17]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bmjqs-2025-018794"],"URL":"https:\/\/doi.org\/10.1136\/bmjqs-2025-018794","relation":{},"ISSN":["2044-5415","2044-5423"],"issn-type":[{"value":"2044-5415","type":"print"},{"value":"2044-5423","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,5]]}}}