Britain risks an opioid epidemic of its own

Just as US authorities are beginning to take action to deal with an opioid crisis is so severe that it has caused life expectancy to decline in ways not seen since the First World War Britain risks an opioid epidemic of its own. Nigel Parsely, the Senior Coroner for Suffolk, has written to Health Secretary Matt Hancock this week asking that urgent action be taken to resolve the issue of the easy availability of large quantities of addictive and potentially dangerous prescription medications on online pharmacies. This follows the case of Debbie (full name not released) who died after the large amounts of codeine medication she had been taking damaged her pancreas which in turn caused lung damage that killed her.

Debbie was prescribed painkillers by her GP for backpain in 2008. She subsequently became addicted and was able to supplement her GP’s prescription with prescription medication bought from online pharmacies. She spent over £100,000 buying medications in this way. Legislative gaps allowing online pharmacies to sell large quantities of controlled medications relatively freely are only part of the problem and the story, however.

According to a report released September by Public Health England that in 2017/18 12.8% of adults in the UK had prescriptions for opioid pain medications. Of these over 1.2 million had been taking prescription opioids for over a year and 540,000 had been taking them for over three years. This is despite the fact any prescription lasting longer than 90 days is “associated with opioid overdose and dependence” according to the report.

The numbers in the report might even understate the scale of the problem. Many people who become addicted go on to find obtain even opioids from other sources to either supplement their prescription supply or continue consuming once their prescription ends. Online pharmacies are an easy source of opioids.

This worrying trend is part of the wider surge in prescribing addictive medications across the UK. Between 2008 and 2018 prescription of opioids grew by 22%, prescription of antidepressants nearly doubled, and prescription of sleeping tablets grew by some 10%. Prescriptions of pregabalin, originally used for epilepsy but also now used to treat anxiety, exploded by an astonishing 661%.

In the US the boom was in large part fuelled by doctors seeking to treat pain and aggressive campaigns by pharmaceutical companies to encourage doctors to prescribe more medications including painkillers. In the UK other factors seem to be key. One is that overstretched GPs have an increasingly limited amount of time to spend on their patients and therefore they rely on prescriptions as a quick fix. Even if they do have enough time to discuss other palliative options with their patients, access is limited.

Public mental health services in the UK are notoriously patchy with long waits. Similarly, for physiotherapy patients are waiting on average 45 days for routine checks and 18 days for urgent appointments, in the worst performing NHS Trusts this rises to 77 and 44 days respectively. Lack of access to these services could conceivably even allow patients with mild issues to deteriorate to a point where they require medication.

Indeed, austerity and deprivation seem to have contributed to the problem as well. Prescriptions for opioids, though not antidepressants, correlates strongly with deprivation. The three areas with the highest rates of people long-term opioid prescriptions in England are Doncaster, Barnsley, and Bassetlaw in Nottinghamshire.

In terms of those affected, data from 2017/18 showed that women were at least 1.5 times more likely to be prescribed addictive medications. The difference was most pronounced for antidepressants, where 21.3% of adult women in the UK received a prescription compared to 11.6% of adult men. By contrast the smallest difference was for opioid painkillers, where figures stood at 15.3% of women and 10.1% of men respectively. Older patients are also more likely to be prescribed addictive medicines. As a result two thirds of those addicted to prescription medications are middle aged women.

If users of prescription medications do become addicted there are only two free services offering treatment for prescription medication addiction in the UK, The Prescribed Medication Support Service in Mold and the Bridge Project in Bradford. Both have only a single counsellor working for them.

Reports on this issue by the The Sunday Times and the Organisation for Economic Co-operation and Development earlier this year highlighted these concerns. In response Matt Hancock, the health secretary, has pledged to introduce cigarette-style warnings of addictions on the packaging. In September Hancock declared “we are in the grip of an opioid crisis”. Few noticed when Hancock said it. But he appears to be right. This crisis deserves a lot more attention.