The opioid crisis in the US is well known and the subject of much debate and media coverage; overdoses involving opioids contributed to over two thirds (67.8%) of overdose deaths in the US in 2017 alone, with 47,600 deaths in total.
Currently, 175 Americans die daily from drug overdoses and the majority of these involve opioids. In the UK, we have generally not seen the same levels of use which would cause concern in past years, though it would be complacent to assume that we do not have an issue.
According to the NHS Business Services Authority, 12.8% of the adult population in England were prescribed opioids in 2017/18. A review by Public Health England concluded that this is a decrease in prescriptions from 2016, though arguably this does not mean there is no problem to address. This figure only accounts for prescribed opioids and does not consider use of opioids obtained without a prescription or illicit opioids such as heroin. It also only presents findings from England, while Wales, Scotland and Northern Ireland should also be considered.
Prescription opioids are necessary and appropriate when used according to prescribing guidelines. But associated risks, especially where not used according to guidelines, are well documented and should not be ignored.
The potential adverse consequences of opioid use include dependence, overdose and withdrawal, which are serious and could place a substantial burden on the NHS.
It is encouraging that the Medicines and Healthcare Regulatory Agency (MHRA) is taking action to assess the benefits and risks of opioid medications, with the launch of an Opioid Expert Working Group.
This group has already recommended that the labelling for opioid medicines must carry a warning that informs patients about the risk of addiction, which was accepted by the MHRA in April 2019.
Sarah Branch, MHRA director of Vigilance and Risk Management of Medicines, said: “The MHRA continually monitors the benefits and risks of opioid medicines authorised for use in the UK and will take regulatory action as necessary to optimise the safe use of these products.
“Our clear priority at MHRA is to make sure that patients, carers and prescribers have clear and consistent warnings on the risks of dependence and addiction to a medicine containing an opioid. It is important to recognise that we will take action from all aspects of the UK’s healthcare system in order to minimise the risks of dependence and addiction in the UK and prevent a US-style opioid epidemic from taking hold.
“MHRA is also working with our partners in GPhC, CQC, GMC and counterparts in Scotland, Wales and Northern Ireland to review the UK legislative framework, while identify gaps and working to resolve them.”
With this action, it is likely we will see an increase in research into the risks of opioids in the UK. Whether or not the UK is facing its own opioid crisis is unclear at the moment but such research will certainly help provide clarity.