Prescription drug addiction and dependence is a major problem area that has been bubbling under for a while. Finally, it has reached the surface.
President Trump recently declared the abuse of opioids in the US a ‘health emergency’ and Pulse revealed similar concerns here in the UK last year after evidence prescribing of strong opioids has increased markedly.
It is not just opioids. There has been concern over the potential for abuse with medications such as the gabapentinoids among many GPs for a while now. Credit must go to Glasgow GP Dr Des Spence, who has been leading opinion on this with some blistering columns on Pulse.
In an investigation last year, we looked at prescribing data and found a massive 88% increase in gabapentinoid use since NICE recommended them as first-line treatment in 2013, despite evidence showing over half of patients on them will not have worthwhile pain relief. The Home Office has since launched a (much-delayed) consultation on making them controlled drugs, although there are mixed signals from the BMA about the move.
The causes of this problem go back to the World Health Organization’s ‘analgesic ladder’, introduced in the 1980s, which made it much more acceptable for GPs to prescribe potent drugs, such as opioids, at stronger doses. It coincided – as Dr Shaba Nabi writes – with a change in society, influenced by pharmaceutical company marketing departments, that promotes drugs as the solution, rather than lifestyle change.
This review has to look at the alternatives, without leaving patients and GPs stranded without support
Not before time, the Government has launched a major review into prescription drug addiction. This has to be welcomed, but the review also has to look at the provision of alternatives to prescription drugs and the culture change needed to make this happen.
GPs’ options for analgesia in their patients have declined rapidly – with the rise and fall of co-proxomol, selective COX-2 inhibitors and traditional NSAIDs. And – as I have written before, there is a distinct lack of support for GPs to take any other route (other than pharmacological), when a multidisciplinary approach would likely to yield much better results.
If practices had better access to pain clinics, physiotherapy and psychosocial/self-care interventions then they could make a real difference to the lives of patients with chronic pain, but as it stands, this review risks placing further restrictions on analgesia, leaving patients and GPs stranded without support to manage chronic pain.
Let’s hope this Government review is broad in its scope and thoughtful about how to tackle this problem. It must mark a milestone; a line in the sand where the NHS decides to stop chucking pills at a problem and starts taking the treatment of chronic pain seriously. It is long past time.
Nigel Praities is editor of Pulse. You can follow him on Twitter @nigelpraities