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Opioid prescriptions up to 30 times higher in UK than decade ago, study suggests

Alexandra Thompson
·5-min read
Opioid epidemic, painkillers and drug abuse concept with close up on a bottle of prescription drugs and hydrocodone pills falling out of it on white
The National Institute for Health and Care Excellence has said commonly-prescribed painkillers like paracetamol, aspirin and opioids 'have little or no evidence they work' for chronic discomfort. (Getty Images)

Opioid prescriptions have risen dramatically in the UK in the past decade, research suggests.

A study of nearly 2 million users by the University of Manchester found five times as many codeine prescriptions were given out in 2017 than 2006.

Oxycodone use appears to have risen by 30 times, with the opioid making up 169 in every 10,000 prescriptions in 2017 compared with five in every 10,000 11 years earlier.

The scientists also found one in seven (14%) new opioid users go on to take the drug long term.

Read more: Mother overcame 25 year addiction to prescription painkillers

The research comes just two months after the National Institute for Health and Care Excellence (Nice) – a health watchdog – stressed commonly-prescribed painkillers like paracetamol, aspirin and opioids “have little or no evidence they work” for chronic discomfort.

The analgesics could even do “more harm than good” if a patient develops an addiction, it warned.

While the UK’s opioid situation is considerably less severe than the addiction epidemic in the US, overdose deaths are on the rise.

Neck pain, woman with backache isolated on white background, studio shot
Chronic pain affected up to half of Britons in 2019. (Getty Images)

“Chronic pain is estimated to affect more than 40% of the UK population,” said study author Professor Will Dixon.

“The frequency of this common problem hasn’t changed noticeably in the last decade, yet these new results show that the use of opioids for treating pain have escalated considerably.

“It is always vital to balance the benefits and potential harms of treatments.

“The variations in opioid prescribing shown here, even allowing for differences in types of disease and other factors, means there is room for improvement.”

Read more: Common painkillers for chronic discomfort ‘do more harm than good’

Chronic pain, whether a recurrent headache or back discomfort, affected between 13% and 50% of Britons in 2019.

While pain is a spectrum, 10.4% to 14.3% suffered moderately or severely.

The NHS recommends a combination of exercise, physical therapy and painkillers to ease the debilitating symptoms.

Opioids include the relatively mild drug codeine and the stronger medication morphine.

Watch: Spike in opioid deaths in US blamed on coronavirus

The US’ opioid epidemic is commonly reported, however, the Manchester scientists felt the situation in the UK was less well understood.

To learn more, the team analysed anonymous data from patients enduring non-cancer pain who had newly been prescribed opioids by their GP.

Results – published in the journal PLOS Medicine – suggest codeine use has increased five fold. The drug made up 484 out of every 10,000 prescriptions in 2006, rising to 2,456 prescriptions per 10,000 in 2017.

Prescriptions of the opioid tramadol increased seven fold over the same period, from 101 to 690 per 10,000.

Read more: Are branded painkillers more effective than a store’s own?

Looking at opioids overall, one in 10 (10.3%) of the participants who started on a “high dose” were on the same regimen or higher two years later.

Just under one in five (18.7%) of those on a “very high dose” continued to take the same medication two years on, the results show.

Long-term use was particularly high in the North-West, Yorkshire and the South-West.

Long-term users tended to be older or living in social deprivation. Many also had a history of self-harm, suicide attempts or substance abuse, as well as enduring fibromyalgia (widespread musculoskeletal pain) or rheumatological diseases, like arthritis or gout.

“All opioids have a potential for dependence and addiction, a fact that has been highlighted by the Medicines and Healthcare products Regulatory Agency recently through stronger warnings to patients starting these drugs,” said lead author Dr Meghna Jani.

“Importantly after adjusting for individual patient differences, prescribing practices resulting in long-term opioid use differ considerably across the country.

“Social deprivation, certain conditions such as fibromyalgia, rheumatological conditions, after major surgery and high initial opioid dose were amongst factors associated with long-term opioid use.

“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 in regions, practices and prescribers.”

Dr Jani added: “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.”

Why can opioids be dangerous?

Opioids are often associated with addiction, with many abusers experiencing euphoria, followed by withdrawal symptoms.

Misuse can lead to life-threatening respiratory depression, when the lungs fail to exchange carbon dioxide and oxygen efficiently.

An increasing number of fatalities in the UK mention an opioid pain medicine on the death certificate. Tramadol specifically is behind around 240 deaths a year.

In the US, more than 67,000 people died from a drug overdose in 2018, of which almost 70% involved a prescription or illicit opioid.

Unlike in the US, the UK’s publicly-funded healthcare system means patients cannot go from doctor to doctor requesting treatment, experts said at a Science Media Centre briefing in January.

Britons also have access to opioid substitution therapy, they added.

In its August report, Nice recommended acupuncture for some pain patients, “provided it is delivered within certain, clearly defined parameters”.