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Opioid prescribing is rising in many countries

BMJ 2019; 367 doi: (Published 17 October 2019) Cite this as: BMJ 2019;367:l5823

Related article

BMJ opinion: Prescription drugs are no cure for deprivation

  1. Blair H Smith, professor of population health science1,
  2. Emma H Fletcher, consultant in public health2,
  3. Lesley A Colvin, professor of pain medicine1
  1. 1Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
  2. 2NHS Tayside, Dundee, UK
  1. Correspondence to: B H Smith b.h.smith{at}

Chronic pain strategies must be embedded within broader efforts to tackle deprivation

Opioids are effective in managing acute and cancer pain.1 However, their effectiveness in chronic pain is uncertain, with limited evidence of consistent pain relief beyond 12 weeks. Tolerance and opioid induced hyperalgesia can develop, leading to prescription of higher doses with minimal benefit.2 In addition, adverse effects occur with prolonged use and higher doses, including dependency, overdose (intentional and unintentional), cardiovascular events, and impaired respiratory, endocrine, and immune functioning.34

The United States is currently in the middle of a so called opioid epidemic. Its causes are complex but include an ageing population with increased risk of chronic pain, changes in prescribing practice with new opioid formulations, changes in recommendations about opioid use for chronic pain, and aggressive marketing by drug companies (including direct marketing to patients) that overstated the benefits and misrepresented the potential dangers.5

Although marketing may have a less prominent effect outside the US, there are indications that opioid prescribing is increasing worldwide, with considerable variation among and within …

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