Comment; The opioid epidemic is expanding “across the pond” into the UK. There’s a lot of money in illicit drugs and very little conscience among criminals–only a matter of time…

Hugh Pym
Health editor@BBCHughPymon Twitter

  • 16 May 2019

It is said to be a public health crisis in the US and Canada and officials there have branded it an “opioid epidemic”.

But an authoritative report emphasises there are increasing problems with opioid painkiller addiction and abuse in other leading economies – including the UK.

The message is that policymakers are often unaware of the risks and need to sit up and take notice before there is further damage to their population’s health.

International comparisons on health are often difficult but the Organisation for Economic Co-Operation and Development (OECD), representing the world’s richer economies, is well placed to deliver them.

It has pulled together data on opioid painkiller supply and deaths related to their use for 25 member countries.

The OECD’s conclusions are stark.

It refers to a “surge in overdose deaths” and argues over-prescription of painkillers by doctors and the illicit drugs trade have fuelled a “mounting health and social crisis”.

Opioid abuse, it adds, has put a growing burden on health services.

Doctors used as ‘guinea pigs’ in opioid painkiller promotion

Opioids: Why ‘dangerous’ drugs are still being used to treat pain

Opioid painkillers ‘must carry prominent warnings’

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What are opioids?

  • A large group of drugs used mainly to treat pain
  • They include naturally occurring chemicals such as morphine and codeine, as well as synthetic drugs
  • Codeine, morphine and methadone are among opioids judged by the World Health Organization as essential for treatment of pain and end-of-life care
  • Some opioid medications – methadone and buprenorphine – are used to help people break their addictions to stronger opioids such as heroin
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How serious is the problem in the UK?

First, the OECD looks at the legal availability of opioids, which covers prescriptions, over-the-counter sales and drugs used for scientific research.

The UK is just above the OECD average and well below the US and Germany, measured by daily doses per million of population.

But worryingly there has been a faster rate of growth than in any other country surveyed, apart from Israel and Slovakia.

Over the three years to 2016, there was a 68% rise in the availability of opioid painkillers in the UK, a trend associated, as in other countries, with increasing medical prescriptions.

This rapid rate of growth in the UK should be ringing alarm bells, according to the OECD.

Lead author Cristian Herrera told me: “This is a warning sign and the key message is that what happened in the US and Canada starts with over-prescription and can then spread to the illegal market.”

The other important benchmark covered in the OECD report is opioid-related deaths per million inhabitants.

These deaths cover both legal and illicit use of the drugs. Most are said to follow from overdoses, often not deliberate, which can cause serious breathing problems.

Over the five years to 2016, there was a 20% increase on average, with countries above that average including England and Wales ( there is no UK wide data available) as well as the US, Canada, Ireland and Sweden.

What is to be done?

The OECD argues that doctors should be better at prescribing, with new clinical guidelines and better training.

It says drug companies have played a significant role in “escalating opioid prescription”, especially in the US, and spread messages that the products were low risk.

The authors call for better regulation of marketing and financial relationships with manufacturers.

The OECD also advocates better care and therapy for people with addiction challenges, so they don’t move from the prescription system to the illegal market.

More coordination of policy across health, social care and criminal justice is also called for.

The Department of Health and Social Care recently announced measures after the Secretary of State, Matt Hancock, expressed concern that prescriptions for opioid painkillers had increased more than 60% over a decade in England and Wales.

He said the Medicines and Healthcare products Regulatory Agency would have the power to enforce warnings about the addiction risks on opioids packaging.

The clear message is that this is an international problem.

But that will be little comfort for the government at Westminster and the devolved administrations.

They have to face up to the consequences of opioid addiction for their health and care systems.

Dr. Raymond Oenbrink