According to the NHS, the number of prescriptions for opioids dispensed in England between 1999 and 2008, increased from 6.2 million to 14.8 million.
Prescriptions for the strongest drugs – morphine, Oxycodone, Fentanyl and Buprenorphine – rose from 1 million to 4.1 million.
So what explains this dramatic rise in prescriptions?
One reason is that there are now more strong painkilling drugs available, for example OxyContin. In addition, drug companies have devised new ways to deliver existing drugs – lollipops, lozenges, patches, etc – and doctors also seem to be switching from prescribing non-steroidal anti-inflammatory drugs to opioids, the former being a common cause of gastric bleeding and other long term side effects.
However, the most intriguing explanation is that the increase in prescriptions for this group of drugs, reflects a shift in the way that doctors treat chronic pain. Only a fraction of the prescriptions are given for terminal conditions. Most are given for chronic pain conditions. That is not how it used to be. Chronic pain used to be under treated and doctors were reluctant to use strong opioids, except in the most serious of cases. That philosophy seems to have changed.
Research has shown that when opioids are used to relieve real discomfort they rarely cause addiction. A patient who is suffering from trauma or disease will become physically dependent, but generally, not addicted. It is a key distinction.
Many pain specialists cite patients who have rebuilt their lives after learning how to manage their pain with powerful drugs. Patients tell of the drugs’ miraculous effect on debilitating pain.
Man has used opium for pain relief since Neolithic times. Opioids do not remove pain, they make it bearable. Victorians self medicated with tincture of opium (laudanum) purchased over the counter at the chemist shop. Morphine was first extracted from the opium poppy in the early nineteenth century. Sir William Osler, known as “the father of modern medicine”, considered it to be “God’s own medicine”.
Today, morphine remains the gold standard, although it is no longer the most potent remedy, and patients prefer drugs that are not called “morphine”. However, drugs like Oxycodone are morphine-like drugs, but they do not carry the social stigma that comes with “morphine”.