Prescribing of pain medications in Ireland has risen significantly over the past decade, with usage rates now outpacing those in England, according to new research from RCSI University of Medicine and Health Sciences.

Published in the British Journal of Clinical Pharmacology, the study highlights differences in how pain is treated in primary care in Ireland and raises questions about healthcare access, prescribing practices and the availability of non-drug interventions to address pain.

Researchers examined national prescribing data between 2014 and 2022, focusing on patients in Ireland covered by the General Medical Services (GMS) scheme – people with a medical card, representing about one third of the population – and on data from all general practices in England.

In Ireland, the use of opioids increased by approximately 25% over the study period, while prescriptions for paracetamol rose by 50%. Specific medicines like codeine and stronger opioids like tapentadol and oxycodone increased by even higher percentages. By contrast, England experienced declining use across most classes of pain medications during the same timeframe.

“These results suggest a growing reliance on prescribing pharmacological treatments for pain in Ireland for the GMS patients we analysed,” said Dr Molly Mattsson, first author of the study and Postdoctoral Fellow at the RCSI School of Pharmacy and Biomolecular Sciences. “The trends raise important questions about healthcare access and the availability of non-drug options to manage pain, particularly for medical card holders who avail of public services.”

The analysis also revealed that prescribing levels in Ireland were substantially higher than in England by 2022: two times higher for opioids, four times higher for anti-inflammatories, and nearly five times higher for paracetamol.

Some of this disparity can be attributed to the differing populations studied. NHS data covers the entire population of England, while the Irish data reflects prescribing to GMS patients – a group where older adults are overrepresented. However, the Irish and English health systems also take markedly different approaches to managing pain issues.

In England, broad access to healthcare services including pain clinics and non-pharmacological interventions such as physical therapy through the NHS may help reduce reliance on medication. In Ireland, such services are less widely available, particularly for medical card holders, which may be contributing to higher medication use.

“Many of these medications carry risks such as dependency which can be worsened by overprescribing,” said Professor Frank Moriarty, senior author of the study and Associate Professor at the RCSI School of Pharmacy and Biomolecular Sciences. “While medication can play an important role in treating pain, we must address issues like orthopaedic surgery waiting times and ensure Irish patients also have access to safe, evidence-based alternatives to medications. Access to data is equally vital to track how prescribing patterns evolve across this and other disease areas over time.”

The study was carried out in collaboration with the Health Service Executive (HSE) Quality and Patient Safety Directorate, University of Oxford, University College Cork, and University College Dublin and was funded by the Health Research Board (HRB). The full paper is available to read here.