Millions of people are addicted to, or at risk of becoming dependent on, prescription opioid painkillers, according to international research.
The study found that one in three people taking prescribed opioid analgesics, which include codeine, tramadol, oxycodone and morphine, show symptoms of being dependent on them, while one in 10 become fully dependent on the drugs.
The research, led by academics from the University of Bristol and published in the journal Addiction, also showed that one in eight people are at risk of prescription opioid misuse.
It examined data from 148 international studies involving more than 4.3 million patients aged 12 and over who had non-cancer pain for three months or longer and who were prescribed the medicines.
While they are useful for short-term acute pain and managing end-of-life care, “opioid painkillers are not effective in the management of long-term pain,” said Kyla Thomas, a professor of public health medicine at the University of Bristol and lead author of the study. “They are associated with many harms. Our findings show that opioid misuse is much more common among patients taking them for long-term pain than perhaps people imagine.”
Chronic pain affects up to a quarter of adults globally. About a third are estimated to be prescribed opioid analgesics. In the US and England alone, more than 50 million and 15.5 million people respectively have chronic pain, meaning more than 20 million could be taking opioid painkillers.
Extrapolating the findings, that suggests that 1.7 million patients with chronic non-cancer pain in the US and about half a million patients in England could be dependent on opioid painkillers, while across the two countries around 7 million people could show signs of dependence and around 3 million could be at risk of opioid misuse.
Thomas acknowledges that the NHS in England cut opioid prescriptions by 450,000 between 2019 and 2023, but says more could be done. “Clinicians and policymakers need a more accurate estimate of the prevalence of problematic opioid use in pain patients so that they can gauge the true extent of the problem, change prescribing guidance if necessary, and develop and implement effective interventions to manage the problem. Knowing the size of the problem is a necessary step to managing it.”
Prof Kamila Hawthorne, chair of the Royal College of GPs, said: “Chronic pain can cause untold misery for patients, and GPs want to help them manage this safely and effectively.
“Opioid painkillers can be an appropriate and effective intervention for some patients – particularly those suffering from acute pain – but GPs will be acutely aware of how addictive they can be, and that they can also cause other unpleasant side effects.
“As such, if opioids are to be prescribed, GPs will always aim to prescribe the smallest possible dose for the shortest possible time, in line with clinical guidelines – and data from last year showed that prescriptions for opioids in primary care fell by 8% in less than three years.”
While alternative treatment options are explored, “access to physical and psychological therapies that can help with pain, or specialist pain clinics, can be patchy across the country, and come with long waiting times for patients”, Hawthorne said.
Robin Pollard at the drug and alcohol charity WithYou said the figures were “incredibly concerning”.
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“We would like to see clearer national guidelines on the use of all prescription pain medication,” he said. “We would also like to see more research into the number of people who have problems with prescription medication and the factors that might have a role, such as an ageing population, cuts to treatment services and increasing poverty levels.”
A Department of Health and Social Care spokesperson said: “Clinicians should work with their patients to decide on the best course of treatment, ensuring it is appropriate and that they take account of national guidance on the treatment’s effectiveness.
“NHS England has an action plan to help local healthcare providers reduce inappropriate prescribing of high-strength painkillers and other addiction-causing medicines, while we are committed to ensuring people who misuse substances get the support they need.”
An NHS England spokesperson said: “When used appropriately, medicines can help deliver life-changing treatment for patients. It is important to be alert to the potential risks of dependence and withdrawal from certain medicines, including opioids, which is why our personalised care framework sets out guidance to deal with problem opioid use.”
