Opioid painkillers put millions at risk of addiction or dependence – study

According to international research, millions of people are addicted to prescription opioid painkillers or are at risk of becoming dependent on these painkillers.

The study found that one in three people who take prescription opioid painkillers, including codeine, tramadol, oxycodone and morphine, show symptoms of dependence on the drugs, while one in ten become fully dependent on the drugs.

The research, led by academics from the University of Bristol and published in the journal Addiction, also found that one in eight people are at risk of misusing prescription opioids.

Data from 148 international studies were examined involving more than 4.3 million patients aged 12 years and older who had non-cancer pain for three months or more and were prescribed medications.

While useful for short-term acute pain and managing terminal care, “opioid painkillers are not effective in managing long-term pain,” said Kyla Thomas, professor of public health medicine at the University of Bristol and lead author of the study. “They are associated with a lot of harm. Our findings show that opioid misuse is much more common in patients who use them for long-term pain than people might imagine.”

Chronic pain affects up to a quarter of adults worldwide. About a third are estimated to be prescribed opioid analgesics. In the US and England alone, more than 50 million And 15.5 million people respectively have chronic pain, which means that more than 20 million people use opioid painkillers.

Extrapolating the findings, it appears that 1.7 million patients with chronic non-cancer pain in the US and about half a million patients in England could be dependent on opioid painkillers, while in both countries about 7 million people could show signs of dependence and about 3 million people are at risk of opioid abuse.

Thomas acknowledges that the NHS in England reduce the number of opioid prescriptions by 450,000 between 2019 and 2023, but says more can be done. “Clinicians and policymakers need a more accurate estimate of the prevalence of problematic opioid use in pain patients so they can understand the true magnitude of the problem, change prescribing guidelines if necessary, and develop and implement effective interventions to manage the problem. Knowing the magnitude of the problem is a necessary step toward managing it.”

Prof Kamila Hawthorne, President of the Royal College of GPs, said: “Chronic pain can cause untold misery for patients, and GPs want to help them deal with it safely and effectively.

“Opioid painkillers may be an appropriate and effective intervention for some patients – particularly those suffering from acute pain – but GPs are well aware of how addictive they can be and that they can also cause other unpleasant side effects.

“When opioids are prescribed, GPs will always aim to prescribe the lowest possible dose for the shortest possible time, in line with clinical guidelines. Data from last year showed that the number of opioid prescriptions in primary care has fallen by 8% in less than three years.”

While alternative treatment options are being explored, “access to physical and psychological therapies that can help with pain, or specialized pain clinics, can be variable across the country and associated with long wait times for patients,” Hawthorne said.

Robin Pollard, from drug and alcohol charity WithYou, said the figures were “incredibly worrying”.

“We want clearer national guidelines on the use of all prescribed painkillers,” he said. “We also want to see more research into the number of people who have problems with prescribed medication and the factors that may play a role in this, such as an ageing population, cuts to treatment services and increasing poverty.”

A Department of Health and Social Care spokesperson said: ‘Medical practitioners should work with their patients to decide on the best treatment, ensure it is appropriate and that it takes into account national guidance on the effectiveness of treatment.

“NHS England has an action plan to help local healthcare providers reduce the inappropriate prescribing of powerful painkillers and other addictive medicines, while we work to ensure people who misuse substances get the support they need.”

An NHS England spokesperson said: “When used appropriately, medicines can provide life-changing treatments for patients. It is important to be aware of the potential risks of dependence and withdrawal from certain medicines, including opioids, which is why our personalised care framework includes guidance on managing problematic opioid use.”