Trends and factors associated with prescription opioid utilisation, dependence and deaths in patients with musculoskeletal conditions


Rising opioid use has been associated with an alarming rise in opioid-related harms, dependence and mortality in North America. However, fewer data are available in Europe. RMDs are one of the most common indications for prescribing opioids. These patients may already be at high-risk of opioid-related morbidity/mortality due to multimorbidity, immunosuppression and polypharmacy.

Facts and figures

Project lead
M Jani
University of Manchester
FOREUM research grant: € 200.000

Meet the team

Project Lead

M Jani
University of Manchester
B Birlie Yimer
University of Manchester
W Dixon
University of Manchester
D Jenkins
University of Manchester
M Lunt
University of Manchester
N Peek
University of Manchester
E Archer
University of Manchester
C Lowe
University of Manchester


In new opioid users with the following RMDs: rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, osteoarthritis and fibromyalgia to:

  • Characterise national UK opioid prescribing trends between 2006-2019
  • Evaluate trends in hospital admissions associated with opioid-related prescriptions, dependence and mortality
  • Identify individual, prescribing, demographic and contextual risk factors that predispose to opioid-dependence and mortality
  • Predict opioid-related mortality risk to enable a stratified approach to prescribing in clinical care


Month 6: Obtain linked data, prepare datasetsfor analysis, characterise study population including subpopulations for each condition using established algorithms
Month 12: Describe national opioid prescribing trends between 2006-19 for each condition
Month 18: Prepare and analyse data on hospital admissions related to opioids, opioid-related dependence and opioid-related mortality
Month 24: Complete analysis using multi-statemodel to assess individual, prescribing and contextual risk factors that predispose to opioid-dependence and mortality
Month 30: completed by month 36: Complete analysis using ML to identify individual and subgroup risk of death
Months 7-36: Submit publications and final dissemination of results

Patient voice

This project has been informed and revised as per recommendations from our Research User Group, a group of lay individuals with a musculoskeletal condition. Two patient partners will be involved in all phases of the research to improve the relevance, quality and validity. One has been prescribed a number of opioids for osteoarthritis and experienced a range of opioid-related harms. The other has fibromyalgia and is also affiliated with Versus Arthritis and Fibromyalgia Action UK. Having experienced both the benefits and harms of opioids personally, they are well-informed and passionate about the outlined work. They will attend relevant meetings, help with the interpretation of results and disseminate findings by tailoring key messages to patients and stakeholders including patient pain organisations.

Project Map