Intended for healthcare professionals


Opioids in the UK: what’s the problem?

BMJ 2013; 347 doi: (Published 15 August 2013) Cite this as: BMJ 2013;347:f5108
  1. Cathy Stannard, consultant in pain medicine
  1. 1Pain Clinic, Macmillan Centre, Frenchay Hospital, Bristol BS16 1LE, UK
  1. cfstannard{at}

In many cases, doses are too high and treatment is too long

The extensive misuse of prescription drugs in the United States has brought into sharp focus the role of opioids for persistent pain. The US has seen a marked and progressive rise in the prescription of opioid analgesics over the past two decades. This has been paralleled by an increase in deaths from these drugs—now a leading cause of accidental death in the US.1 Prescription data from the United Kingdom show comparable trends in the use of opioids for non-cancer pain.2 3 However, prescribing statistics don’t tell the whole story, and we need to look at UK statistics on addiction and opioid related mortality to understand exactly what the problems are.

The UK has fewer sources of data on opioid misuse than the US, but there are places to look for indications of a problem. Drug related deaths are reported by the Office of National Statistics (ONS), and its most recent data (2011) show an overall downward trend in deaths from analgesics. A notable exception is a steady rise in deaths from tramadol (154 in 2010-11). There has also been a rise …

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