Can the UK avoid an opioid crisis?
One could be forgiven for thinking this headline refers to drug gangs and County Lines operations but, in fact, in the UK the issue of opioid addiction is largely driven by the over-prescribing of these powerful drugs by health professionals, with the level of such prescriptions having doubled in the twenty years between 1998 and 2018.
Opioids provide a great deal of relief when prescribed for acute pain and pain at the end of life. These ‘morphine-type’ medications include codeine, dihydrocodeine, tramadol, morphine, fentanyl, oxycodone, buprenorphine and diamorphine.
And yet many doctors are prescribing opioids on a long-term basis for patients with chronic pain, even though the risk of addiction and other extremely harmful side-effects are well documented. According to the NHS Business Services Authority, 12.8% of the adult population in England were prescribed opioids in 2017/18.
In the US, experts say the country in in the throes of an opioid crisis. According to the US Department of Health & Human Services (HHS), more than 130 people died every day from opioid-related drug overdoses in 2016 and 2017, with opioid prescriptions peeking in 2011. Opioid overdoses accounted to over two-thirds of overdose deaths in the US in 2017, resulting in the HHS declaring the opioid crisis a public health emergency.
Opioids are highly addictive
Opioids are highly addictive and, unless over-prescribing by doctors is brought under control, the UK will continue to replicate the situation in the US and hurtle to towards its own opioid crisis.
The NHS has fully acknowledged the issue and is taking steps to tackle the problem. These include, but are not limited to, clinical pharmacists based at GP surgeries who can monitor and manage those with complicated health issues and/or patients on long term medications. Pain management programmes, available in many areas across the UK, provide a structured approach to developing individual pain management plans that might include physiotherapy, CBT, relaxation and mindfulness, and non-medical pain management strategies. This approach is aligned with the development of social prescribing which acknowledges that many health conditions can be supported through external non-medical interventions instead of habitually and sometimes mindlessly offering a prescription to almost every patient visiting the doctor’s surgery.
The NHS is very much aware that it needs to educate both the general public and those who prescribe opioids. Patients who are suffering from chronic pain will invariably visit a doctor expecting to receive strong painkillers, to the extent they can be quite vociferous if their request is not met. This makes the situation extremely difficult for GPS. Patients need to better understand the addictive nature and potential side effects of opioids, and also have a better understanding of alternatives available which may not have the same immediate effect but will result in a better quality of life for the longer term.
For the general public, the NHS has produced a video:
Sean’s Story – There is another way.
Sean, from Cornwall, describes how he has found an alternative to opioid medication to help manage his chronic pain. He was eventually referred to a pain management programme which, he says, changed his life.
He says his life has totally changed since he has stopped taking the opioid medication he had been described.
There is also an educational video for prescribers: (If you are a prescriber, see also below information about a toolkit for GPs)
But perhaps the greatest inspiration, when considering alternative ways of controlling chronic pain instead of relying on prescribed opioids, can be gleaned from previous articles we have published on Healthy Life Essex such as:
Kelly Swain had a long history of mental health issues compounded by physical problems and daily chronic pain as a result of the traumatic birth of my second child and subsequent medical procedures.” In her story, she tells how close she came to killing herself with lethal concoctions of medication and alcohol. But Kelly had a light-bulb moment when she realised that, if she wanted to be a proper mother to her two beautiful children, she needed to rid herself of her dependence on medication and find more holistic ways of dealing with her chronic pain and mental health issues. Kelly says:
A friend gave me a book which opened my eyes to the power I had within me. I have now retrained my brain and used holistic therapies to help me recover, instead of dependence on prescribed opioid drugs which caused numerous side effects including exacerbating my depression!
Of course, we do understand it isn’t easy if you are suffering from chronic pain and one can certainly understand the tendency to want a ‘quick fix.’ But it is important to remember that opioids are often just that: a drug that can offer immediate relief but with baggage that, longer-term, can have drastically negative impacts on every area of your life.
Before you accept that opioid prescription, ask your GP if any alternative pain management programmes are available.
Toolkit for prescribers
The University of East Anglia’s opioid-reduction expert Dr Debi Bhattacharya has launched a toolkit to help GPs reduce the amount of opioids they prescribe.
Dr Bhattacharya said:
Opioids, like morphine, tramadol and fentanyl, can be effective for the short-term management of severe pain. However, they are highly addictive which makes stopping difficult yet long-term use can impair quality of life and overuse can be deadly.
GPs and other health professionals need to urgently, proactively work with patients prescribed long-term opioids for non-cancer pain to gradually reduce or ‘taper’ their doses.
Reports of this new service are incredibly encouraging. The service includes access to CBT which was a key effective element identified by the research conducted at the University of East Anglia as often omitted from opioid tapering programmes.