Project Description

Opioids are potent painkillers often prescribed for moderate to severe pain when other treatments fail. While they may offer short-term relief for non-cancer pain, long-term use is typically ineffective and associated with numerous adverse effects, such as constipation, sleep-disordered breathing, endocrine dysfunction, and osteoporosis. Tolerance and dependence are common, increasing the risk of opioid use disorder. Moreover, high doses can triple the risk of mortality.

Given these risks, international guidelines now recommend tapering long-term opioid use when the benefits no longer outweigh the harms. However, recent studies from the U.S. suggest that tapering may be associated with acute risks, including misuse, overdose, and mental health crises. It remains unclear whether similar risks are observed in the UK, given differences in healthcare systems and service provision.

This project has two objectives. First, it aims to synthesise the global risk of adverse mental health outcomes—including mood disorders, sleep disturbances, overdose, self-harm, and suicide—through a systematic review and meta-analysis of randomised controlled trials and cohort studies evaluating opioid tapering strategies. Second, it will use anonymised UK primary care records, linked to secondary care and other national data sources, to determine the rates of these adverse mental health outcomes and identify relevant risk factors. These findings will be compared with a cohort of individuals who continue prescribed opioids at a stable dose, forming a retrospective case-control study.

This interdisciplinary project addresses a critical mental health challenge linked to global opioid de-prescribing and offers ample opportunities to advance data analytics in mental health care.