IN 2017 President Donald Trump declared America’s addiction to opioid painkillers a “national shame” and a public health emergency. Unfortunately, it may actually be a global problem, at least in developed countries, where the prescription of opioids, which includes codeine, tramadol, morphine tablets and liquid, as well as patches, is steadily on the rise.

With the NHS accused of creating drug addicts and the number of prescriptions for opioids in the UK having almost doubled in the last ten years, are we too in the midst of a similar crisis?

Opioids first became fashionable about 30 to 40 years ago, when it was felt that chronic pain was not being addressed aggressively enough. They are absorbed quickly into the bloodstream, attaching to receptors in the brain, blocking pain signals and increasing feelings of calm and relaxation.

There are two main routes of addiction to opioids, either through the street drug heroin, or after prescription of a legal opioid.

Individuals may be given a short course for acute pain, perhaps after a serious injury or an operation.

However, if the message is not clear that these are a short term remedy, or they are repeatedly provided, addiction may result. This is despite robust evidence that their effectiveness in chronic pain is modest at best, and that opioids are only really useful for pain after surgery or in end of life care.

Chronic pain itself is a very complex entity, with both psychological as well as physical aspect to it.

It is also much higher in areas of social deprivation and this may explain why opioid prescriptions in the North-East and Cumbria are sadly four times higher than in London.

The pleasant effects of opioids are short lived. Addiction brings tolerance with larger amounts required to achieve the same feelings.

Even at low doses they can cause drowsiness and sleepiness, resulting in accidents due to misjudging a situation.

At higher doses they can actually stop breathing altogether. These effects are increased by even small amounts of alcohol, or the use of other sedative medications. Of the 3,700 UK drug-related deaths in 2016, more than half were due to opioids.

With this in mind, the future can still be seen as positive. Despite accusations from certain corners, your GP is not trying to turn you into a drug addict.

Any prescription for an opioid medication will be a considered decision, made after carefully weighing up the situation and exploring all alternatives.

Recent research has suggested that many people could come off opioids altogether, with help from specialist pain teams.

This is not meant to belittle chronic pain, nor to ignore the substantial positive contribution opioid medications have made to modern medicine. As Professor Helen Stokes-Lampard, chairwoman of the Royal College of General Practitioners, advised on the matter: “GPs will continue to work closely with patients in chronic pain… prescribing opioids when they are deemed to be the best treatment option, at the lowest possible dose for the shortest possible time.”

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