Our group has shown that opioid prescribing for non-cancer pain in the UK has risen considerably, with the most common opioids being prescribed being codeine, tramadol and dihydrocodeine. These medications are associated with a range of severe adverse events that lead to hospitalisations and affect people’s quality of life. People who are ultra-rapid metabolisers of opioids such as codeine (CYP2D6 Genotype) are at increased risk of serious adverse events, including premature deaths. Those who are poor metabolisers however do not benefit from these medications being prescribed to them, as they cannot break down the drug into its active form, morphine. Reducing opioid prescribing for non-cancer pain is an NHS England drug optimisation priority for 2024/2025.
The proposed project harnesses the strengths of UK Biobank and would have considerable public health/ real world impact as well as addressing current national priorities. It would strengthen the case for pharmacogenetic testing to be implemented in routine primary care to personalise pain management in the future.
Research Questions
1. What is the frequency of ultra-rapid / poor metabolisers of codeine and tramadol across different ethnicities in UK Biobank
2. What is the prevalence of opioid use in people who are ultrarapid/poor metabolisers of opioids
3. The incidence of serious adverse events in people on codeine and tramadol who are ultra-rapid metabolisers