ORIGINAL ARTICLE Factors associated with primary care prescription of opioids for joint pain D.J. Green, J. Bedson, M. Blagojevic-Burwell, K.P. Jordan, D. van der Windt Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK Correspondence Daniel Green E-mail: d.j.green@cphc.keele.ac.uk Funding sources Daniel Green was funded by the National Institute for Health Research (NIHR). This report presents independent research com- missioned by the National Institute of Health Research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The study was supported by Medical Research Council, UK (grant code: G9900220). Conflicts of interest The authors declare no conflict of interest. Accepted for publication 17 May 2012 doi:10.1002/j.1532-2149.2012.00185.x Abstract Background: Opioids are commonly prescribed in primary care and can offer pain relief but may also have adverse effects. Little is known about the characteristics of people likely to receive an opioid prescription in primary care. The aim is to identify what factors are associated with primary care prescribing of high-strength analgesics in a community sample of older people with joint pain. Methods: A prospective two-stage postal survey completed at baseline and 3-year follow-up in a population aged 50 and over registered with eight general practitioner (GP) practices in North Staffordshire (North Staffordshire Osteoarthritis Project cohorts) linked with data from medical records. Participants were selected who reported joint pain in one or more joints at baseline. Outcome measures were the number of prescriptions for high-strength pain medication (opioids) in the following 3 years. Socio-demographic and health status factors associated with prescription were assessed using a zero-inflated Poisson model. Results: 873 (19%) people were prescribed opioids (out of 4652 providing complete data) ranging from 1 to 76 prescriptions over 3 years. Baseline factors significantly associated with increased rates of prescription were younger age group [65–74 group: incidence rate ratio (IRR) = 1.26 (1.18–1.35)], male gender [IRR = 1.17 (1.12–1.23)], severe joint pain [IRR = 1.19 (1.12–1.26)] poor physical function [IRR = 0.99 (0.99–0.99)] and lower frequency of alcohol consumption [once/twice a year: IRR = 1.13 (1.06–1.21), never: IRR = 1.14 (1.06–1.22)]. Restricting the analysis to those without prior prescriptions for strong opioids showed similar results. Conclusion: Poor physical function and participation restrictions were strongly associated with prescriptions of stronger opioids in addition to several socio-demographic and lifestyle factors. Given the uncertainties over the effectiveness and risks of opioid use, future research could investigate decision making of GPs, exploring reasons for prescribing them. 1. Introduction Osteoarthritis (OA) is the most frequent type of arthritis currently affecting over 9 million people in the United Kingdom (Arthritis Care, 2010) and is a leading cause of disability, making it one of the most regular causes of long-term absence from work (Arthritis Research UK, 2010). NICE (National Insti- tute for Health and Clinical Excellence) has sug- gested a core set of treatments for OA patients, which include advice, self-management approaches, exercise, interventions to reduce weight and the 1 Eur J Pain •• (2012) ••–•• © 2012 European Federation of International Association for the Study of Pain Chapters