Millions of people in Britain take strong prescription drugs for chronic pain – but are opioids actually effective in treating long-term pain? What are the risks of painkilling medications over time? And how do opioids impact quality of life? UKAT’s Nicki Hari, seven years into her recovery from opioid addiction, contributed to two investigative broadcasts this month – ITV Tonight’s Britain on Painkillers: The Silent Epidemic and The Guardian’s Science Weekly podcast. These reports also feature insights from leading pain experts in the UK.
In ITV’s Britain on Painkillers, Julie Etchingham reported there were 29 million prescriptions for morphine-based painkillers in 2017. These include drugs like codeine, tramadol and fentanyl. They calculated that British people consumed over 3.2 billion individual opioid pills and medicines last year.
The Guardian’s Science Weekly podcast highlighted the US epidemic, where drug overdoses are now the leading cause of death. “In 1991, there were 76 million opioid prescriptions; by 2011, there were 219 million.” The Guardian reported that the same trend is happening now in the UK – opioid prescriptions have almost doubled in Britain in the last ten years.
In Britain, opioids are the go-to drugs for pain management. They are routinely prescribed for acute and chronic pain.
The ITV Tonight investigation reported that opioids are “normally prescribed to treat short-term pain following an accident, injury or surgery. They do have proven benefits. They can also be successful in cancer-related treatment or palliative care.”
Chronic pain affects almost half of the population. The Britain on Painkillers report estimated that 43% of people suffer from ongoing pain. UKAT’s Nicki Hari, for example, first began taking opioids after knee surgery. Speaking to the Guardian, Nicki said: “It started when I was in my early teens and I was struggling with knee problems. It didn’t go away and eventually, my parents took me to see a consultant and I ended up having surgery. I was put on low painkillers. I didn’t realise at the time how addictive it was. […] As I ended up having more knee surgeries and more complications, the dosage got higher and that’s when I became addicted.”
Speaking about her pain medicine research, Professor Lesley Colvin told the Guardian: “[In] 2012, 1 in 5 of the Scottish population were prescribed some form of an opioid.”
Professor Colvin highlighted lower back pain as the number one cause of disability. She also said that chronic pain is increasing, due to the fact we live in an ageing society. There are also many people who suffer from debilitating nerve pain. In one study, 16% of people with neuropathic pain rated their quality of life as worse than death – so many are prescribed pain-relieving medications.
In the Science Weekly podcast, Professor Colvin said there was a cultural shift in the late 1990s in terms of opioid prescribing. “Prior to that, strong opioids didn’t tend to be prescribed for chronic pain,” she said. Then new opioid preparations came on to the market and pharmaceutical companies were pushing for them to be used. At the same time, people suffering from chronic pain wanted access to the same painkillers that were prescribed to cancer patients.
In Nicki Hari’s experience, it was a straightforward process to access opioids over the long term, which was a significant factor in her 20-year addiction. “I was put on a repeat prescription,” Nicki said. “Each time I came out of the hospital, they give you a month’s worth until you get to your own GP. You see your GP after a month and they just put you on an ongoing repeat prescription. So it was just as simple as phoning up the surgery, getting in your request and there it was at your chemist, ready to pick up.”
The medical experts who contributed to the ITV and Guardian investigations agreed. In the short term, opioids can be very effective at managing pain. In the long term, they do not work for the majority of people who take them. Long-term opioid use typically decreases quality of life, leads to debilitating side effects and can result in addiction.
In the Britain on Painkillers report, Pain Rehabilitation Specialist, Dr Frances Cole, said: “In long-term or persistent pain, opioids are pretty useless. People and pain become a complete muddle of hopelessness, unhappiness, despair, loss of jobs, loss of income – are opioids really going to address that? No.”
Dr Cathy Stannard, Complex Pain Consultant at NHS Gloucestershire, told ITV that opioids are not effective for long-term pain. “Statistically, the medicines will work in probably about one in ten patients, at best. […] And I’ve never seen anyone who is on high dose opioids who is not in pain.”
Dr Sally Marlow, a researcher at King’s College London, said to Science Weekly: “Opioids work in the short term and are an extremely effective painkiller – and if you’re hurting, you might want them. […] I do think though that what we all need to be aware of – GPs and the general public – is that for long-term back pain, for example, there are studies that show that these drugs are no better than placebo.”
Put simply, opioids make people feel better – but only in the short term. Over the long term, higher dosages are needed to maintain the same effect due to adaptations in brain chemistry. As opioid doses continue and increase, the side effects outweigh or cancel out any pain-relieving benefits.
ITV’s report said: “They work by targeting opioid receptors in our brain and blocking pain signals sent from the rest of the body. A chemical, dopamine, is released instead, triggering feelings of pleasure, of happiness – and we feel less pain. Whilst effective at first, that feeling of elation is addictive and it makes opioids hard to come off.”
Nicki Hari told The Guardian: “You don’t get a buzz from [prescription opioids] but what you do get addicted to is that feeling of being on a pink, fluffy cloud – so that feeling of tranquillity, of your stress, going away, the pain disappearing…that’s what becomes addictive.”
Dr Sally Marlow, a researcher at King’s College London, explained to Science Weekly how an opioid drug works. “It’s a drug that does two things. It’s what we call an analgesic – it kills pain. But it’s also euphoric – if you take one of these pills, you are going to feel better. […] What’s interesting though, as, with lots of drugs of addiction, it’s when you take a drug away that people really notice it.”
Genetics also play a role in addiction, as do structural factors like poverty, deprivation and discrimination.
Experts and recovering addicts alike are calling for much clearer warnings about addiction on opioid medication packaging, as well as better guidance from medical professionals on risks and side effects.
In Britain on Painkillers, the ITV Tonight team reported that European studies estimate more than 250,000 people are addicted to opioids in Britain.
Georgia Jeffs was initially prescribed strong opioids for nerve damage. She told ITV that her addiction became all-consuming and her withdrawal was horrible. “I couldn’t sleep. I had no appetite. I couldn’t stop crying. Basically, if I could have, I would have unzipped my skin and walked out.”
Nicki Hari told the Guardian: “It had a massive impact on my life towards the end. It got to a point where I couldn’t function. I couldn’t focus. I was isolating from everybody. I was withdrawing. And I didn’t understand what these pains were – the leg shaking, the cramping, the flu-like symptoms. And it just got to a point where my friends and family were saying, ‘you’re always ill, what’s the matter with you?’ And I would just go to bed at night crying because I actually didn’t know what was wrong with me.”
In Nicki’s case, her friends arranged an addiction intervention. They drove her to see a psychiatrist, who carried out an assessment and diagnosed opioid addiction. The following week, Nicki went into a 28-day residential detox and rehabilitation programme. “There was a lot of humility in rehab because I finally understood what all these problems were and where they were all coming from,” she said.
Prescription painkiller addiction can be as devastating as an addiction to alcohol or illegal drugs such as heroin, cocaine, amphetamines or ketamine. Opioid withdrawal is often extremely painful, physically and mentally. Medical supervision is always advisable when coming off opioids. For people with an addiction, residential detox and rehab is often the safest and most effective treatment pathway.
UKAT specialise in abstinence-based programmes for alcohol, drug and behavioural addictions, which include medically-supervised detox where necessary. Free and confidential advice about addiction treatment options is available by phone, email and web chat.
ITV Tonight’s Britain on Painkillers: The Silent Epidemic is available to view until 20th October 2018.
Listen to The Guardian’s Science Weekly podcast on opioid addiction in the UK.
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