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.

The authors have declared no competing interest.

This study is funded by the Health Research Board in Ireland (HRB) through the Secondary Data Analysis Projects scheme (CDRx project, grant number SDAP-2019-023). The funder had no role in in study design; in the collection, analysis, and interpretation of data; in the writing of this paper; or in the decision to submit this paper for publication. EW is funded by an HRB Emerging Clinician Scientist Award (grant number: ECSA/2020/002). MEW is funded by an HRB Applying Research into Policy and Practice Award (ARPP/2020/004).

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the RCSI University of Medicine and Health Sciences Research Ethics Committee (ref: REC202201015) and Health Service Executive (HSE) Reference Research Ethics Committee B (ref: RRECB1022FM).

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The datasets analysed during the current study are not publicly available as this was not covered by the Data Exchange Agreement between RCSI and HSE-PCRS. Data can be requested from HSE-PCRS via an information request as detailed at https://www.hse.ie/eng/staff/pcrs/pcrs-publications/. Full results for initiations, discontinuations, chronic use, and high-risk dispensings by age group and sex are available from Zenodo (doi: 10.5281/zenodo.14870683)