English Opioid Inequality
By Steve Dechan
Chronic pain is a worldwide problem, and the burden it places on our society is constantly increasing. In 2018, the USA’s annual cost of chronic pain was estimated to exceed US$500 billion, while UK estimates suggest it costs the economy around £12 billion per year.
In response to this problem, treatment strategies have become heavily reliant on the use of opioids, a broad group of pain-relieving drugs that work by interacting with opioid receptors in your cells.
The prescription rate of opioids is increasing at a significant rate across the world, despite the reported lack of long-term effectiveness and the health-based consequences the drugs have become associated with, for example, sleep disturbances and reduced immune function.
Figures from the UK show that, in 2014, there were around 23 million prescriptions written for opioids, at a cost of around £322 million. The increased use, and subsequent misuse, of opioids is becoming a significant public health concern.
In England, there is significant geographical variation in opioid prescribing, with more people in the North of England prescribed opioids, at a greater cost, than in the rest of England. For example, the North of England (population of 15 million) accounts for approximately 33% of the total costs of opioids, compared with London (population of 8.2 million), that accounts for only around 8%.(1)
The North-South health divide is well documented, with mortality and morbidity rates being higher in the North of England than in the rest of England. However, the question I want answered is, why does this divide have to result in an increase of opioid prescriptions?
Social science suggests that the reasons for the health divide are both compositional and contextual. Compositional factors include demographic factors (e.g., age, sex, marital status), socioeconomic status (e.g., employment, income, education, occupation), and health behaviours (eg, smoking, alcohol, physical activity). Contextual factors include the physical (e.g., air pollution or contaminated land), social (e.g., place-based stigma or social networks or access to services such as general practitioners) and economic (e.g., area-level deprivation, local job availability) environments.
The split in prescription levels of strong opioids reflect this health gap, with studies confirming that patients in the North East of England are prescribed more opioids than other parts of England because of their higher health need.
However, I feel that the prescribing practices play a part in this health divide. I feel that, unless prescribing practices change, the North-South health divide will continue to deepen.
We need to find a new pain-relief strategy, one that doesn’t come with adverse physical, economic and health-based consequences, but that relieves people of pain, without charging a mental and physical interest rate.
This strategy needs to be both structural and physical, from increased funding into pain solutions, to improved treatment plans, patient aid and support structures. Everyone is affected by pain, and it’s time governments answered these calls and addressed the issue properly.