In February this year an expert working group of the UK’s Commission on Human Medicines began a review of the benefits and risks (including dependence and addiction) of opioid medicines prescribed for pain management. This was instigated following a dramatic rise in the use of opioid painkillers in the UK, raising concerns that the UK is heading towards an addiction crisis, caused by opioids being overprescribed by overworked GPs.
In the US, where pharmaceutical companies in the 1990s reassured the medical community that patients would not become addicted to prescription opioid painkillers, widespread prescription of opioid painkillers has led to an epidemic of opioid misuse and addiction, with 4% to 6% of those who misused prescription opioids transitioning to heroin and many tragically losing their lives to opioid overdoses.
Dozens of civil actions have been brought in US courts against the manufacturers of opioid medicines by both patients, for compensation, and by state and local governments for reimbursement of public money spent on the crisis. The claims allege deceptive marketing by manufacturers misled the public about their products’ addictive properties.
In the UK overprescription of opioids is becoming an increasing problem. Prescriptions for these types of medicines have risen from 14 million in 2008 to 23 milion in 2018 and with that there has been a corresponding rise in mortality. Tramadol was found to be responsible for 240 deaths in 2014 compared to 132 deaths in 2010.
A recent study found that in the UK family doctors were signing repeat prescriptions of potentially addictive drugs such as Tramadol and Codeine rather than ordering pain counselling and encouraging behaviour change. Patients living in poorer areas were likely to be prescribed more opioids by their GPs.
Researchers undertaking a study at Universities of Manchester and Nottingham quantifying the association between opioid use and socio-economic status in England commented that there’s been a dramatic rise in the west of opioid overdosing of drugs including Fentanyl Morphine, Oxycodone, Tramadol and Codeine over the past two decades. However, there was no guarantee that long-term use of opioids analgesics could resolve chronic pain and the risk of opioid side-effects such as dependency, respiratory depression, and immunosuppression sometimes outweighed the potential benefits.
This month the Health Secretary, Matt Hancock, announced that all opioid medicines in the UK will carry prominent warnings on their labels saying that they can cause addiction.
While we welcome the measures introduced, they are too little too late. Many lives have already been ruined as a result of opioid drugs that they were prescribed to relieve pain. Manufacturers should be held accountable for their failure to properly warn patients and the medical community, from the outset, of the highly addictive nature of their product and should have advised that each prescription of an opioid should have been carefully monitored and managed.