Evidence map›Paper›PMID 40819028›Full record

ArticleBMC primary care2025

Co-prescribing of antidepressants and opioids for non-cancer pain in England, 2010-2019: a descriptive study using CPRD primary care electronic health records.

Jake Butler, Rebecca M Joseph, Carol Coupland, Roger David Knaggs, Anthony J Avery, Richard Morriss, Debbie Butler, Louisa Gerrard, Dave Waldram, Ruth H Jack

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Article in BMC primary care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Jake ButlerCentre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.
Rebecca M JosephCentre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.
Carol CouplandCentre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.
Roger David KnaggsSchool of Pharmacy, University of Nottingham, Nottingham, UK.
Anthony J AveryCentre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.
Richard MorrissNational Institute of Health and Care Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Debbie ButlerNational Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK.
Louisa GerrardNational Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK.
Dave WaldramNational Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK.
Ruth H JackCentre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK. ruth.jack@nottingham.ac.uk.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere is a complex relationship between pain and mood disorders, and interactions between opioids and antidepressants can affect the effectiveness and adverse effects of these medicines when taken together. However, little is known about the scale of co-prescription for these medicines.

methodsWe used routinely collected primary care data from the Clinical Practice Research Datalink to describe the extent of opioid and antidepressant co-prescribing in over 4.3 million adults in England. Linked data included deprivation information and hospital episode statistics admitted patient care data to improve completeness of ethnicity information. We identified all primary care prescriptions of opioids and antidepressants between 2010 and 2019 and counted if an opioid and antidepressant prescription overlapped, and if so, for how long. People were censored at the first date of a record of cancer, terminal illness, heart failure or opioid misuse.

resultsThere were 4,355,694 people included in the study population. Of these, 304,029 (7.0%) had an opioid and antidepressant co-prescribed at least once during the study period. The prevalence of co-prescribing increased from 35.8 per 1000 person-years in 2010 to 44.1 in 2015 and then decreased to 39.2 in 2019. Co-prescribing rates were higher in females, older age groups, people living in more deprived areas and the White ethnic group. The overall median length of the opioid and antidepressant co-prescriptions was 29 days (interquartile range: 17 to 51 days). The most commonly co-prescribed medicines were codeine and amitriptyline, co-prescribed 235,017 times to 87,274 people. The second most commonly co-prescribed combination was codeine and citalopram, co-prescribed 55,792 times to 158,812 people. Combinations of opioids and antidepressants both metabolised by CYP2D6 were also common.

conclusionsThere is a substantial group of people co-prescribed opioids and antidepressants in England, including combinations that may be less effective. This information will be useful to help GPs, dispensing professionals, policymakers and others understand how many people in the UK may be at risk of harm from using both types of medicines at the same time, and which groups are particularly affected. Future research should determine whether there are higher risks of adverse events in these co-prescribed groups.

Indexed as

Analgesics, OpioidAntidepressive AgentsPainPractice Patterns, Physicians'Primary Health CareAdolescentAdultAgedAged, 80 and overDrug Therapy, CombinationElectronic Health RecordsEnglandFemaleHumansMaleMiddle AgedAnalgesics, OpioidAntidepressive AgentsAntidepressantsCo-prescribingOpioidsPrimary care

Identifiers

PMID40819028
PMCPMC12357414

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.