In a number of earlier articles we have highlighted the growing war on opiods in the UK. Now, with the debate over the prescription of opioids hotting up, new research published in the UK suggests that opioid prescribing by GPs has continued to increase, especially in more deprived areas of the country.
A North/South divide?
A study led by Dr Luke Mordecai, a pain research fellow at University College London Hospital (UCLH) revealed what amounts to a North/South divide, with nine out of the ten highest opioid prescribing areas located in the north of England. The study, which took place over a 43 month period between August 2010 and February 2014, has been published in the British Journal of General Practice. It concluded that “there was an association between social deprivation and higher opioid prescription.”
Controversially, the authors were keen to stress their opinion that the long term use of opioids was ineffective for people suffering chronic pain. They were also keen to highlight problems associated with their long term use such as addiction, hyperalgesia, gastrointestinal disturbance, immunological dysfunction and the risk of fracture in older people.
The most prescribed opioid drug over the period study was Tramadol. In reference to Tramadol, the authors said “it is not as weak as over-the-counter codeine but does not have the stigma of the powerful morphine.”
The authors’ opinion was that whilst many GPs did not believe that opioids worked for chronic pain, they prescribed them because they believed it was unethical to refuse painkillers to their patients.
Specialist Pain Services
One conclusion of the report which will no doubt receive universal agreement is that there is wholly insufficient capacity in hospital specialist pain services, with only one in five people requiring those specialist services having access to them.
However, even if there is access to specialist pain services, only 40% of them are able to offer multidisciplinary assessment and treatment, which is considered best practice.
In conclusion, and more controversially, the authors have recommended a national database of patients taking large amounts of opioids.
“A national database of high opioid users is essential to identify this incredibly high risk patient population and ensure that they are known to specialist pain services in an attempt to minimise avoidable harm and on-going potentially avoidable escalations in opioid doses,” said Dr Mordecai.