Health

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.

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Britain may be on the brink of an opioid crisis like the US, experts warn[/caption]

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.

However, the brain can quickly build up a tolerance to the drug which results in feeling the need to take more and so an addiction can begin.

PRESCRIPTIONS RISE

Last week, researchers at the University of Manchester warned that opioid prescriptions had risen steadily in the UK between 2006 and 2017.

Their findings, published in the PLOS Medicine journal, showed 14.6 per cent of patients with new opioid prescriptions became long-term users starting in their first year.

Dr Meghna Jani, who led the study, said those most at risk were older, experiencing social deprivation, had a history of self-harm, suicide attempts or or substance or alcohol abuse, or suffering from fibromyalgia or rheumatological diseases.

Experts fear that the UK could be walking into an epidemic of people addicted to painkiller drugs – as has been seen in the US.

Last year, there were more than 70,000 opioid-related deaths in the US – a record high toll, which is thought to have jumped another 40 per cent, according to analysis of US federal drug-fatality data by the Washington Post.

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The US is in the midst of an opioid epidemic, pictured here is a 32-year-old man who was found unresponsive after an opioid overdose in Boston, MA[/caption]

In Britain, experts warn that prescriptions for codeine may have soared but the number of patients suffering from chronic pain has not.

Professor Will Dixon, one of author’s of the new report, told the Times: “Chronic pain is estimated to affect more than 40 per cent of the UK population.

“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.

What are opioids?

Opioids are a group of pain-relieving drugs that work with the opioid receptors in your body.

They can be derived from the poppy plant, like morphine, or made synthetically in a laboratory, like Fentanyl.

When used properly and with medical supervision, opioid medications can be used to help control acute pain.

Opioids, when used incorrectly, can be highly addictive.

When taken in high doses, opioids can seriously slow your heart rate and breathing – misuse of the drugs often result in fatal overdose.

Feelings of pleasure derived from taking the drugs at high doses can result in addiction.

Because of the danger they pose, opioids are often a poor long-term medical solution.

According to the National Instiute on Drug Abuse, more than 130 people in the United States die after overdosing on opioids a day.

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.

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.”

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