Reducing Addictive Prescribing in Neurodivergent Patients with Hypermobility: Reducing health inequality by reducing medication burden

Bredbury Medical Centre

Project summary

Neurodivergent patients — autistic, ADHD, or AuDHD — with co-occurring hypermobility spectrum disorders (HSD) or hypermobile Ehlers-Danlos Syndrome (hEDS) are among the most under-served patients in primary care. They present late, are frequently misdiagnosed, and accumulate high prescribing loads for pain and anxiety that is neurological and proprioceptive in origin rather than straightforwardly nociceptive. Without a clinician who understands the intersection, the default response is escalating pharmacology.

This project, led at Bredbury Medical Centre in Stockport, addressed this directly. Over three years (2022–2025) we systematically identified patients with a neurodivergent diagnosis and confirmed or suspected hypermobility who were carrying a burden of opioid, gabapentinoid, and NSAID prescribing. We conducted structured medication reviews, reframed their symptom experience through an educational lens, and supported a shift away from standing medication toward a flare-based, as-needed approach.

Non-pharmacological education covered: pacing and energy management, physiotherapy and proprioception-focused movement, nervous system and pain psychology, sensory regulation strategies specific to neurodivergent patients, and sleep hygiene. All changes were made through shared decision-making — no patient had medication reduced without understanding and agreement.

The results, measured through publicly available OpenPrescribing data (practice P88044), are significant:

• High-dose opioids per 1,000 patients fell by 63% (2022 average: 3.78; 2025 average: 1.40)

• Pregabalin prescribing volume fell by 43% per 1,000 patients

• Gabapentin and pregabalin combined DDD fell by 26%

• Non-preferred NSAID ratio fell by 24%

• The practice moved from the 93rd–97th national percentile for these measures in 2022 to the 75th–81st percentile by 2025

These reductions occurred while the practice list grew by approximately 35%, making the per-patient change larger than the raw figures suggest. The programme ran within existing medication review capacity with no additional staffing or commissioning required. It is replicable by any GP practice willing to view this patient group through a neurodivergent and connective tissue lens.