Britain on the brink of opioid addiction crisis as prescriptions for powerful painkillers rocket
BRITAIN could be on the brink of an opioid-addiction crisis, experts have warned.
It comes after new research found prescriptions for the powerful painkiller codeine have jumped fivefold in a decade.
Codeine is an opioid drug which can turn livers into morphine - the basis of heroin - and experts warn people can become addicted within a fortnight.
Yet, the painkiller is available to buy over-the-counter at high street chemists across the country.
It tends to be sold as a combination with other painkillers such as ibuprofen (for instance, in Nurofen Plus) or paracetamol (Solpadeine Plus).
Like morphine, codeine works by blocking pain-transmitting opioid receptors in the brain and mimics natural endorphins, only more intensely.
"This problem’s frequency hasn’t changed noticeably in the last decade, yet our results show that the use of opioids for treating pain have escalated considerably.”
The National Institute for Health and Care Excellence (Nice) issued draft guidelines in August telling doctors to stop prescribing codeine to chronic-pain patients.
Instead, the treatment watchdog advised offering alternatives such as exercise programmes, psychological therapy and acupuncture.
But GPs say that at the moment, access to these treatments are patchy, and the only practicable way to help chronic-pain sufferers is with medication.
Professor Martin Marshall, the chairman of the Royal College of GPs, told the Times: “Most patients in pain do not want to take medication long-term. GPs do not want this either. But sometimes medication has been the only thing that brings relief.”
Nice is expected to publish definitive guidance next year - but GPs could resist.
CALLS FOR ACTION
Researchers behind the new Manchester study say their findings support the call for action for safer and more consistent opioid prescription practices in the UK to avoid the addiction epidemic seen in other countries.
The authors point out that identifying general practices with abnormally high prescription rates through audit and feedback tools could help drive safer prescribing practices.
Dr Jani said: "Given the potential harms of these drugs, we think it is imperative to promote safe practices in prescribing opioids and reduce the variability we observed between regions, practices and prescriber.
"One way to do this would be to harmonise prescribing practices across regions through future well-researched policies.
"The other would be developing targeted interventions in high risk groups including areas of social deprivation and for those undergoing major surgery."
GROWING CRISIS
Researchers conducted a retrospective cohort study using UK primary care electronic health records from the Clinical Practice Research Datalink (CPRD).
They found that the most commonly used opioids were codeine, dihydrocodeine, and tramadol.
Over a 12-year period, 2006-2017, codeine use increased from 484 to 2,456 prescriptions per 10,000 population per year.
Dihydrocodeine, tramadol, and fentanyl prescriptions increased between 2006 and 2012, and plateaued thereafter until the end of 2017.
Within the strong opioids group, oxycodone prescribing rose approximately from five to 169 prescriptions per 10,000 population per year over 12 years.
While morphine prescriptions also rose, from 18 to 422 prescriptions per 10,000 population per year between 2006 and 2017.
The authors point out a number of limitations to their study, including that it was limited to patients prescribed opioids in primary care and did not include opioids available over the counter or prescribed in hospitals or drug treatment centres.
Because CPRD data captures electronic prescription data from primary care physicians, the findings likely underrepresent overall drug utilisation of weaker opioids.
Another limitation is that in 2014 tramadol was reclassified as a schedule 3 drug, and prescriptions longer than one month were prohibited at any one time.
Therefore, the rise in prescriptions may reflect shorter prescriptions for certain medications, the researchers say.
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They add: "Treatments for opioid addiction are mainly prescribed through specialist addiction centres in the UK, rather than through primary care, and are thus not available in the dataset.
"We were therefore not able to account for these in the analysis."