Researchers are calling for a national database of high opioid users after finding that the number prescriptions and related deaths in England is on the rise, especially in poorer communities.
A new study led by UCL and UCLH revealed an upward trend in opioid prescriptions in England between 2010 and 2014, and highlighted a stark North-South divide with nine out of ten of the highest prescribing areas found in the north of the country.
According to lead author Dr Luke Mordecai, from UCLH and UCL Institute of Epidemiology & Health Care, “the most important finding is the extremely strong association between the amount of opioid prescribed and lower socio-economic status.
“The variation across the country is undeniable and, given the morbidity and mortality associated with this class of drugs, unacceptable”.
Opioids are given to people to cope with cancer pain and short-lived acute pain, but it their growing use to treat long-term pain that is cause for concern, given that this is “not adequately supported by evidence”, the researchers stress.
Their long-term use can lead to problems such as addiction and abuse, hyperalgesia, gastrointestinal disturbance, immunological dysfunction, risk of fracture in older people and increased mortality.
In fact, in England, Scotland and Wales deaths attributed to opioids has increased with nearly 500 in 2001 compared with 900 in 2011, according to the study.
However, despite their risks and lack of supporting evidence in the long-term setting, the study found that many GPs are prescribing opioids as they believe it unethical to refuse their patients painkillers.
The authors are now calling on policymakers to identify the reasons for the variation in prescriptions, and warn that currently there is not enough capacity in the specialist pain service.
Just one in five people with problematic pain were found to have access to specialist pain services, and only 40 percent of those services offer best practice in the form of multidisciplinary team assessment and treatment, the findings show.
“This study highlights the lack of access to specialist pain services which practise pain self-management techniques and opioid reduction programmes, which demonstrate far better outcomes than opioid prescriptions,” said Dr Mordecai.
“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,” he stressed.
Earlier this year, the government launched what it described as a “landmark” independent review into prescription drug addiction in the UK, after figures showed that one patient in eleven was prescribed a potentially addictive drug in 2017.
The study was published in the British Journal of General Practice.