By Steve Dechan
What are opioids? If you search for the word, google will tell you that ‘Opioids are a broad group of pain-relieving drugs’. They work by attaching to receptors found on cells in different parts of the body. This stops the receptors transmitting messages signalling pain through the central nervous system to the brain.
Opioids have hit the headlines mainly because of their abuse in the United States. And whilst I will not pretend that the burden of opioid misuse in Britain is anywhere near as high as in America, the fact remains that there is an underlying pattern of increasing deaths in which an opioid pain medicine is mentioned as present on the death certificate.
The prescription of opioid drugs by GPs in England is steadily rising. There are undoubtedly a myriad of reasons as to why, but it seems as though despite being a public health issue, the trend is sliding under the radar.
When Should Opioids be Used?
According to existing guidance, opioids can be rightly given to people coping with cancer pain and to deal with short-lived acute pain following surgery for example. However, opioids are commonly being prescribed for people who have lived with pain for more than three months, otherwise known as chronic pain. A study by the British Journal of General Practice has found that opioids do not work as a long term solution for chronic pain, but that many GPs prescribe them because of a belief that it is unethical to refuse patients painkillers. It should also be noted that long term opioid use is not recommended by the National Institute for Health and Care Excellence (NICE) as appropriate treatment for chronic pain.
Prescribed Drug Dependence
Opioid use causes complications and adverse effects particularly with long-term use and larger regular doses. People living with chronic pain who may be taking opioids for a long time can develop a drug tolerance. This means that your body gets used to the painkiller and so a stronger dose or a different painkiller is needed to have the same effect on your pain.
I should be clear that developing a drug tolerance is not the same as developing prescribed drug dependence. Drug dependence or addiction occurs when you need one or more drugs to function and live your normal life.
Prescribed drug dependence has been recognised as a key public health concern by the British Medical Association, who in 2016 called for a national helpline to support patients affected by prescribed drug dependence.
Three recommendations were made, which I believe are still relevant and require careful consideration in 2021:
- The UK government, supported by the devolved nations, should introduce a national, 24 hour helpline for prescribed drug dependence.
- Each of the UK governments, relevant health departments and local authorities should establish adequately resourced specialist support services for prescribed drug dependence.
- Clear guidance on tapering and withdrawal management should be developed collaboratively with input from professional groups and patients.
It should be noted that NICE is working on guidance for the safe prescribing and withdrawal management of prescribed drugs in line with the third recommendation. Keep your eyes pealed for its publication.
Opioids and Pain Management
What can be done to prevent opioids being used for the long term treatment of chronic pain? The simple answer is time and investment. England really needs a national pain management service to assist the thousands of people currently living with chronic pain. Patients should be able to access a range of services on the NHS including physiotherapy, spinal cord stimulation and perhaps one day Biowave to help ease their symptoms. Opioids are not a long term solution and should be viewed as such.