Opioid Use in The Uk
Opioid use in the UK is a growing concern. While opioids are effective at treating pain, they can be dangerous when used improperly. Here we will examine opioid use in the UK, including the dangers of opioids and why they are prescribed in primary care.
What are Opioids?
Opioids are a class of drugs that include prescription painkillers such as oxycodone and morphine, as well as illegal drugs such as heroin.
They work by binding to opioid receptors in the brain, which reduces pain signals. Opioids can be addictive and can lead to overdose when taken in high doses.
Despite the risks, opioids are often prescribed to treat chronic pain. In the UK, opioid prescriptions have increased by 65% over the past decade. There are several reasons for this increase, including an ageing population and a rise in chronic conditions such as arthritis and diabetes.
There is also a perception among doctors that opioids are safe and effective at treating chronic pain. However, there is limited evidence to support this claim. A study suggests that opioids were no more effective  than other medications at reducing pain or improving quality of life.
Furthermore, opioids can have serious side effects, including addiction, overdose and death.
So why are opioids prescribed despite the risks? One reason is that there is no good alternative to opioids for treating chronic pain. Other medications such as non-steroidal anti-inflammatory drugs (NSAIDs) can also be addictive and cause serious side effects.
Another reason is that doctors may not be aware of the risks of opioids. A survey found that only half of doctors felt confident in their ability to prescribe opioids safely . This highlights the need for better education on opioid prescribing for doctors.
Ultimately, opioid use in the UK needs to be better regulated. Prescriptions should only be given when there is a clear need for them and patients should be made aware of the risks associated with these drugs.
When are Opioids Prescribed?
The guidance, which was issued by the National Institute for Health and Care Excellence (NICE) in November 2017, recommends that opioids should only be prescribed as a last resort for people with chronic pain.
Opioid medications are also commonly used for pain relief in end-of-life care at hospitals.
They should not be prescribed for mild or intermittent pain, or for people who are taking them recreationally.
The guidance also recommends that opioids should only be prescribed for short-term use (up to three months), and that the dosage should be reduced gradually when they are no longer needed. The aim is to reduce the risk of people becoming dependent on opioids and developing addiction problems.
There are concerns that the increasing use of opioids is contributing to an epidemic of addiction and overdose deaths. According to the National Office of Statistics we are seeing a yearly rise in people overdosing  on opiate drugs and medications.
The NICE guidance is intended to help address this problem. It provides clear advice on when and how opioids should be used, which should help to ensure that they are used safely and effectively.
Guidance from the royal college of anaesthetists also states.
- Opioids are good for relieving acute pain and severe, but little evidence exists they are helpful for long-term persistent pain.
- A small proportion of people may benefit from long-term use on a low dose and if use is intermittent or just taken occasionally for pain relief.
- The risk of harm increases substantially if taking 120 mg per day for no additional benefit
- If a patient is in severe pain even taking opioids, treatment should be stopped.
- Chronic pain among patients is complex, and the introduction of opioids can add another layer. A detailed assessment of their pain experience and emotional state is essential.
So why are so many people getting addicted to prescription drugs? Are the GP’s not following the guidelines?
Opioid Crisis USA
Frustratingly we should have seen this problem coming. In the USA, more people die from opioid addiction than in car crashes .
In the 1990’s general practitioners started prescribing opioid drug more routinely for pain management.
This has led to an opioid crisis in the US with over 100 people dying each day from opioid overdoses.
Still, this figure continues to rise and is now at its highest level on record. We now have more opioid deaths than have ever been recorded, even with all the publicity surrounding their dangers.
Opioid drugs may provide effective treatment in the short term, but there is an increased risk of adverse effects over the long term.
Prescribing opioid medication should as recommended be a last resort and viewed as short-term pain relief, not a long-term solution.
The scale of inadvertent overdose is huge and over 68’000 people passed due to opioid misuse between 2019 and 2020 in the USA alone. These drugs are responsible for more deaths than Heroin alone in the USA, a clear warning of the dangers of opioid use.
Is There a North-South Divide?
Opioid use in the UK is a growing concern, with reports of a north south divide in opioid use. The latest figures from the National Drug Treatment Monitoring System  (NDTMS) show that there are wide variations in the numbers of people receiving treatment for opioid addiction across England.
In the North East, there are 5,595 people receiving treatment for opioid addiction, while in London there are only 1,895 people being treated. This means that there are 3 times more people receiving treatment for opioid addiction in the North East than in London.
This divide is not just limited to England – there is a similar trend across the UK. In Scotland, there are 9,030 people receiving treatment for opioid addiction, while in Wales there are only 2,415 people being treated. This means that there are almost 4 times more people receiving treatment for opioid addiction in Scotland than in Wales.
So what is causing this north south divide? There are a number of possible explanations.
One possibility is that there is a higher prevalence of opioid addiction in the north of the UK. This could be due to a number of factors, such as social deprivation or unemployment.
But a study undertaken by the University of Manchester  study by found that in areas with similar deprivation levels in London compared to the north of England, opioid prescriptions issued were still far lower and less frequently prescribed. In fact, you are 3.3 times more likely to be prescribed opioids in the North of England.
Another possibility is that access to treatment services is better in the south of the UK than in the north. This could be due to a lack of funding or staff shortages in the north.
Differences In Prescription Rates
The clinical guidelines are clear, healthcare professionals should only prescribe opioids as a last resort for severe pain, and in the short term.
If we look at areas where opioids are prescribed we can see a clear distinction in the North with increased opioid use.
If we contrast this with waiting times for operations of more than 18 weeks we can see some correlation in the North of England and East Anglia and Devonshire regions.
If a patient is in chronic pain a GP may feel obliged to describe the best pain relief until a patient can have an operation to resolve a long-term illness or issue.
If you are in severe pain opioids provide strong relief. UCL highlighted that some practioners found it unethical not to prescribe patients strong opioids if they are really suffering.
Finally, it could be that people in the south are more likely to seek help for their addiction than people in the north. This could be due to a greater awareness of the dangers of opioids or because there is less stigma attached to addiction in southern counties.
Whichever explanation is correct, it is clear that more needs to be done to address the growing problem of opioid addiction in the UK. The north-south divide must also be addressed if we want to tackle this problem head-on.
Differences in UK primary care should be analysed and we need to learn lessons on why we are prescribing opioids in the North compared to the South.
Getting Help for Opioid Addiction
If you feel you may have an opioid use disorder or can not stop taking prescribed opioids, you may need to seek treatment.
Your Doctor may have stopped prescribing you opioids and you have resorted to the black market. Or you may still be getting prescribed opioids from your General practitioner against the recommended guidelines.
The chances of you moving onto other drugs are also heightened if you have a regular opioid prescription and find you are taking them in a high dose and using them up before your repeat prescription date.
If you are suffering from recreational opioid misuse or feel you can not stop using opioids, we can help find you access to a range of treatment programmes to help with both the physical and mental aspects of opioid drug dependence.