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Back in the Spotlight: BBC Panorama’s “Hooked on Painkillers”

“When it comes to opi­oids the dan­gers of phys­i­cal depen­dance are well known. So why are doc­tors now hand­ing out more than 22 mil­lons prescip­tion a year?”

Declan Lawn in Panora­ma’s “Hooked on Painkillers”

Did you hap­pen to watch BBC Panorama​ last night? In their lat­est episode BBC reporter Declan Lawn met with chron­ic pain patients and also GPs and spe­cial­ists in a well-bal­anced dis­cus­sion over the rise of pre­scrip­tion painkiller usage by patients deal­ing with long term pain.

Amongst oth­ers, Dr Cathy Stan­nard (Con­sul­tant in Pain Med­i­cine at Fren­chay Hos­pi­tal in Bris­tol) and Dr Mar­tin John­son (Roy­al Col­lege of GPs) spoke can­did­ly about the research into the grow­ing­ly con­tro­ver­sial area. Bring­ing Opi­oids and chron­ic pain back in to the media spot­light, this pro­gramme fol­lows only 6 weeks after the launch of the Opi­oid Painkiller Addic­tion Aware­ness Day (OPAAD) on the 22nd Sep­tem­ber, and high­lights the need for fur­ther research into the area itself; so that every­one is made aware of the dif­fer­ence between effec­tive and non-effec­tive Opi­oid referral.

“One of the things is we have to be aware of is when to say no and when to try and bring in oth­er resources. We are not say­ing no enough at the moment because GPs like to help their patients.”

Dr Mar­tin Johnson

Both Cathy and Mar­tin have been involved in mul­ti­ple Air­ing Pain pro­grammes since 2010; includ­ing the dis­cus­sion over the dif­fer­ence between Opi­oid addic­tion and dependency.

Know the Dif­fer­ence (Dr Stan­nard, AP21 — 2011)

  • Depen­dence: you have been on the drug for a long time; you can’t stop it sud­den­ly because you will feel quite unwell with with­draw­al effects. And what that means is that we would take some­body off opi­oid drugs very slow­ly, to avoid with­draw­al effects and depen­dence is a nor­mal expect­ed effect for any­body tak­ing this class of drugs.
  • Addic­tion: much more of a behav­iour­al thing, which is to do with the way that patients take drugs and the fea­tures of addic­tion are crav­ing, con­tin­ued use despite harm, behav­iours focused towards drug seek­ing and inabil­i­ty to con­trol drug use.

You can lis­ten to all of the pod­casts that both Mar­tin and Cathy have been involved in by sim­ply typ­ing in their names in our search bar. Alter­na­tive­ly, click the links below for our pro­gram­me’s focussing on Opioids.

In Air­ing Pain Pro­gramme 21: Opi­oids and man­ag­ing pain in remote areas

Paul Evans talks to Jack­ie Mil­burn, Dr John Macleod and also Dr Cathy Stan­nard, out­lin­ing the use and mis­use of opi­oids in chron­ic pain man­age­ment. Dr Stan­nard points out that whilst opi­oids are a use­ful anal­gesic for some peo­ple, they can have a detri­men­tal effect on oth­ers due to their strong side effects. She empha­sis­es the need for health­care pro­fes­sion­als to be aware of how to use opi­oids effec­tive­ly as a pain man­age­ment resource.

In Air­ing Pain Pro­gramme 54: Opi­oids, mem­o­ries and prison healthcare

Paul speaks to Dr Cathy Stan­nard, Dr Rajesh Munglani and Dr Ian Brew about health­care with­in pris­ons. Stan­nard reveals some prob­lems in this area, say­ing that some med­i­cines are a trad­able com­mod­i­ty in pris­ons and that often pris­on­ers’ account of pain are treat­ed with mis­trust. She reports that the sit­u­a­tion is improv­ing, as the health­care needs assess­ment that pris­on­ers receive when they arrive in prison now includes a sec­tion on pain, along­side the orig­i­nal sec­tions on sub­stance mis­use and psy­chi­atric disorders.

My view is that opi­oids prob­a­bly are cur­rent­ly over-pre­scribed. I think there is a poor recog­ni­tion with opi­oid drugs that they may not always be effec­tive for per­sis­tent pain and there is a strange way that these drugs are pre­scribed com­pared to oth­er drugs. Many patients will have the expe­ri­ence that they will go to their doc­tor and they will be giv­en an opi­oid drug and if it doesn’t work, they will be giv­en a big­ger dose and a big­ger dose and actu­al­ly one of the things we are try­ing to encour­age in terms of guid­ing pre­scribers is to think of opi­oids like any oth­er painkiller and if it’s going to work, it will work in a sen­si­ble dose and once a pre­scriber has to start esca­lat­ing a dose, to get an effect, one should start won­der­ing whether that real­ly is the most effec­tive tool for treat­ing that par­tic­u­lar pain.”

Dr Cathy Stannard

Pain Con­cern’s helpline is also list­ed on the Panora­ma “Infor­ma­tion and Sup­port” page for the episode and we’re here to help you man­age your pain. Please also con­sid­er read­ing our leaflets on man­ag­ing med­ica­tions and watch­ing our self-man­age­ment videos.


Doreen Wiltshire

I watched the Panora­ma pro­gramme with inter­est. I am cur­rent­ly using 5mcg bu-trans patch­es with one 50mg Tra­madol (rarely) PRN for break­through pain. I have tried sev­er­al times to stop using the patch­es as, since I had spinal fusion surgery 2 years ago, my pain is much less and I feel I could cope now with Parac­eta­mol PRN and maybe the odd tra­madol if the pain is more severe (eg. after a long walk or stren­u­ous cleaning/gardening) As soon as the patch is more than 3 days past its usu­al 7 day use I start to feel like I have flu. My mus­cles ache all over and I become very shaky and dis­tressed to the point of tears. I have approached my GP who says to con­tin­ue with the patch­es as my chron­ic back pain will return??? Prob­lem is I am SO lethar­gic that I feel I am sleep­ing my life away and I am quite sure the patch­es are to blame. Who do I turn to?

Many thanks for your com­ment. You might find it help­ful to call our helpline: 0300 123 0789 (usu­al­ly avail­able 10am-4pm, weekdays).
Best wish­es from Pain Concern

My hus­band suf­fered a head injury in 2010 and was knocked uncon­scious for two hours with a large gash on the back of his head which need­ed sta­pling up in hos­pi­tal and admit­tance for 4 days for obser­va­tion and drips as he lost a great deal of blood.
There is no test in this coun­try for blood brain bar­ri­er dam­age, although there is in the States and Ger­many! After this event, my hus­band’s GP con­tin­ued his repeat pre­scrip­tions for Co-codamol for the next 15 months and after about 7 or 8 months, I noticed a prob­lem occur­ring with my hus­band’s skills dete­ri­o­rat­ing, which lead to stress and a sud­den stroke which ruined his life.
He was also giv­en a med­i­cine with Aspar­tame in it as a sweet­en­er which fur­ther brain dam­aged him and he is now in a care home, con­fined in a wheel chair and unable to look after him­self or put a sen­tence together.
He was sen­si­tive to the opi­ate drug and addict­ed — look­ing back and I have writ­ten a 3 page report called ‘What a Way to Learn’ as I have dis­cov­ered that humans have neur­al tis­sue in the head, the heart and the gut and they all work togeth­er, so if one area is affect­ed by dam­ag­ing chem­i­cals, then it can affect the oth­er neur­al areas. Also 90% of Ser­a­tonin is made in the small intes­tine — none of this is taught to doc­tors and my hus­band was sui­ci­dal before he was admit­ted to his care home.( I researched Dig­ni­tas and he want­ed to go Switzer­land.) His mood has improved now he is being well looked after by trained pro­fes­sion­al car­ers, but he is unable to com­plete a sen­tence and his life has been changed for ever.
I am cer­tain that if he had not been pre­scribed a strong opi­ate pain killer imme­di­ate­ly after his head injury, (which the drug com­pa­ny web site lists as a warn­ing — not to do so.…) then he would have con­tin­ued with his life and superb skills as a bob­bin lace mak­er, bril­liant dri­ver and Nation­al Trust Volunteer.
In 2013, we found out that he also had jaw­bone infec­tions from tox­ic den­tistry which was car­ried out 20 years ago (root filled tooth and bad­ly extract­ed wis­dom teeth) and the cav­i­ta­tions in his jaw were nev­er picked up by his den­tist and allo­path­ic doc­tors are not taught about the den­tal con­nec­tion to health. This is very impor­tant infor­ma­tion which is why your vet will treat your com­pan­ion ani­mal bet­ter than you if you vis­it your GP, as they are trained to link den­tal health with ill­ness and dis­ease etc. Check out Drs. Munro-Hall who are holis­tic, mer­cury free den­tists in Bed­ford who own a spe­cialised ultra-sound scan­ner which is able to reveal jaw­bone cav­i­ta­tions, but take out den­tal insur­ance first.…

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