Opioid Analgesic Dependence: Where Do We Go From Here?

The British Medical Association has recently produced recommendations for the support of people with prescribed drug dependence.1 Their focus is appropriately broad, addressing benzodiazepines, antidepressants and opioids, with three main themes for development: However, a key stumbling block in the planning of such services is the lack of reliable data on the number of patients affected by dependence to these drugs.A review by Fayaz et al in the BMJ Open estimated that 35–50% of people in the UK suffer from chronic pain.2 A significant proportion of these patients with chronic pain will have been prescribed opioids: drugs that, when used long term, we now know to be generally ineffective, harmful, addictive, and difficult to stop. There were 16 million prescriptions for opioids in the UK in 2015, at a cost of £200 million. While some of this prescribing will be appropriate for acute or end-of-life pain, a significant contribution represents prolonged use of opioids in chronic non-cancer pain. Zin et al investigated UK primary care prescribing of strong opioids (morphine, oxycodone, fentanyl, and buprenorphine) and found a 466% increase from 2000 to 2010.3 Notably, only 12% of those prescriptions were issued to patients with a cancer diagnosis, the vast majority were for chronic non-cancer pain. The …