Millions of people are addicted to, or at risk of becoming dependent on, prescription opioid painkillers, according to international research.
The study found that one in three people who use prescription opioid painkillers, which include codeine, tramadol, oxycodone and morphine, show symptoms of dependence, while one in 10 become fully dependent on the drugs.
The research, led by academics from the University of Bristol and published in the journal Addiction, also showed that one in eight people are at risk of abusing opioids.
It examined data from 148 international studies involving more than 4.3 million patients aged 12 and over who had non-cancer pain for three months or longer and were prescribed the medicine.
Although useful for short-term acute pain and managing end-of-life care, “opioid analgesics are not effective in managing long-term pain,” said Kyla Thomas, a professor of public health medicine at the University of Bristol. and lead author of the study. “They are associated with a lot of damage. Our findings show that opioid abuse is much more common among patients who take it for long-term pain than people might think.”
Chronic pain affects up to a quarter of adults worldwide. About a third is estimated on prescription opioid painkillers. In the US and England alone, more than 50 million and 15.5 million people have chronic pain, respectively, meaning more than 20 million may be taking opioid painkillers.
Extrapolating the findings suggests that 1.7 million patients with chronic non-cancer pain in the US and about half a million patients in England may be dependent on opioid painkillers, while about 7 million people in the two countries show signs of dependence can show and approximately 3 million may be at risk of opioid abuse.
Thomas admits that the NHS in England opioid prescriptions reduced 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 gauge the true extent of the problem, change prescribing guidance if necessary, and develop and implement effective interventions to manage the problem. Knowing the extent of the problem is an essential step in managing it.”
Prof Kamila Hawthorne, Chair of the Royal College of GPs, said: “Chronic pain can cause untold misery for patients, and GPs want to help them manage it safely and effectively.
“Opioid analgesics may be an appropriate and effective intervention for some patients – particularly those suffering from acute pain – but GPs will be well aware of how addictive they can be, and that they can also cause other unpleasant side effects.
“As such, if opioids are going to be prescribed, GPs will always aim to prescribe the smallest possible dose for the shortest possible time, in line with clinical guidelines – and data from last year showed that prescriptions for opioids in primary care fell by 8%. in less than three years.”
While alternative treatment options are explored, “access to physical and psychological therapies that can help with pain, or specialist pain clinics, can be unclear 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”.
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“We would like to see clearer national guidelines on the use of all prescription pain medication,” he said. “We would also like to see more research into the number of people who have problems with prescription drugs and the factors that may play a role, such as an aging population, cuts in treatment services and increasing levels of poverty.”
A department of Health and Social Care spokesperson said: “Clinicians should work with their patients to decide on the best course of treatment, to ensure that it is appropriate and that they take into account national guidelines on the effectiveness of the treatment.
“NHS England has an action plan to help local healthcare providers reduce inappropriate prescribing of high-strength painkillers and other addictive medicines, while we are committed to ensuring that people who misuse substances get the support they need. “
A spokesman for NHS England said: “When used appropriately, medicines can help deliver life-changing treatment 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 personal care framework includes guidance for dealing with problem opioid use.”
