Letters Overprescribing and opioid crisis

Opioids are not just an American problem

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5514 (Published 06 December 2017) Cite this as: BMJ 2017;359:j5514
  1. Meghna Jani, NIHR academic clinical lecturer in rheumatology,
  2. William G Dixon, director and professor of digital epidemiology
  1. Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester M13 9PT, UK
  1. meghna.jani{at}manchester.ac.uk

The rise in opioid prescriptions and mortality in the US1 has shone a light on similar concerns in the UK. Opioid prescriptions for non-cancer pain rose by about 60% in the UK from 2000 to 2010.2

With more use comes a larger burden of side effects, dependency, and divergence. The number of deaths related to opioid misuse in England and Wales rose between 2012 and 2015.3 The factors contributing to the rise in prescribing are likely to be different from those in the US and perhaps secondary to the lack of effective alternatives for non-cancer chronic pain.

Concerns around drug safety have been raised with other analgesics—such as COX-2 inhibitors, non-steroidal anti-inflammatory drugs, and paracetamol—over the past 15 years.4 New evidence indicates that some traditional analgesics are ineffective in musculoskeletal pain, which is one of the most common indications for opioids. We need high quality evidence about the comparative benefits and harms of analgesics.

Opioids are associated with several harms, as publicised by the FDA in 2016.5 Opioids are commonly prescribed with other drugs such as gabapentin and benzodiazepines. This combination is associated with accidental overdoses and mortality,6 possibly due to effects on respiratory depression, which was announced recently by the Medicines and Healthcare Products Regulatory Agency.7

Rather than assigning opioids an “American problem,”8 we advise ongoing vigilance in the UK. A better understanding of the comparative safety of different opioids would be helpful to inform clinicians and patients about the safest choice when no suitable alternative exists. Large scale population health studies using electronic health records and, in time, incorporating patient reported benefits and harms will allow quantification of individual benefits and risks of opioids. This would enable future prescription of the safest drugs to those most likely to benefit—an urgent need given the escalating use of opioids.



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