A recent article on the academic and current affairs website, The Conversation, by Professor Blair Smith from the University of Dundee, regarding his team’s study on the global increase in opioid use, has sparked debate over the overprescription of opioids in the UK. Professor Smith has found that while short-term opioid use for pain management can be effective, ‘there is clear evidence that they cause widespread and potentially serious harms, when taken long term.’ Another important factor identified by Professor Smith and his team is the social aspect of opioid prescriptions, with ‘four times more prescriptions for strong opioids’ given out in the most deprived, compared to the most affluent, areas of the country.
Professor Smith concludes, ‘Clear guidelines for doctors and screening processes could help reduce the harm caused by opioids. But we must also address the causes of long-term pain, which drives their use. Most importantly, these include deprivation, and the ageing demography of our society. Without investment to address these, the opioid epidemic is set to spread globally.’
An opinion piece in The Guardian, titled ‘Opioids don’t work for most people with chronic pain. So why do we still prescribe them?’, by NHS psychiatrist Mariam Alexander, questions the use of opioids as a means of managing chronic pain. The article, which puts more emphasis on the patients for whom opioids are ineffective, rather than the one-in-ten patients who do benefit from their use, comments on the fact that most GP appointments last only ten minutes. This is cited as a factor in the prescription of opioids as a first response, an issue to which Paul Evans refers in his article about The Navigator Tool in the next issue of Pain Matters, due to be published in March 2019.
Regarding the overprescribing of opioids, The National Institute for Health Research (NIHR) has awarded £2.4 million to researchers at Keele University to investigate overprescribing of opioid painkillers in primary care so as to improve the treatment of people with persistent pain – without the use of long-term opioids. The research programme, funded by NIHR Programme Grants for Applied Research, will involve developing an intervention for clinical pharmacists to help people with persistent pain reduce or stop taking opioids (where appropriate), and support them to self-manage their pain. The research will test this intervention in approximately 1000 patients to establish whether it leads to less opioid use, without making patients’ pain worse, and whether this results in better use of NHS resources compared to usual GP care.