Problematic pharmaceutical opioid use ‘appears to be common’ in chronic pain patients treated with opioid analgesics, according to a new scientific review, with one in three ‘showing signs and symptoms’ of dependence and opioid use disorder.
Researchers looked at almost 150 studies, covering a total of 4.3m participants who had non-cancer pain for three months or more, with the review providing a ‘more accurate and more concerning rate of opioid misuse than has previously been calculated’. The studies were predominantly from North America or other high-income countries, and were mainly carried out since 2010.
The researchers divided the studies into four categories – ‘dependence and opioid use disorder’ (a formal diagnosis), ‘signs and symptoms of dependence and opioid use disorder’ (craving, tolerance, withdrawal), ‘aberrant behaviour’ (repeated dose escalations, seeking early refills, ‘lost’ prescriptions), and ‘at risk of dependence and opioid use disorder’ (characteristics that might increase the risk of dependence in the future).
While nearly one in three patients in the studies fell into category 2, almost one in ten were in category one, with one in five showing aberrant behaviour says the research, which was led by the University of Bristol and is published in the journal Addiction.
NHS England published a framework for prescription drugs last year, setting out that health professionals needed to regularly discuss prescriptions with their patients – including the potential risks – and that services for people experiencing withdrawal symptoms should be built into service specifications. A Public Health England review from 2019 found that some people were being prescribed opioids – along with other potentially addictive drugs such as benzodiazepines – for up to three years at a time.
‘Clinicians and policy makers 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,’ said lead author Kyla Thomas, professor of public health medicine at the University of Bristol. ‘Knowing the size of the problem is a necessary step to managing it.’
‘Despite good progress in reducing the prescribing of these drugs in primary care in England over the last few years, there are currently limited options for people with severe chronic pain and there is a clear need for improved access to both multidisciplinary pain clinics and evidence-based non-pharmacological treatment options such as physiotherapy,’ added Turning Point’s clinical director, Dr Martyn Hull. ‘Additionally, psychological therapies for those with chronic pain should be more widely available. There is also a very obvious gap in provision for those dependent on prescription opioids, many of whom have a complex mix of physical and mental health issues.’
While there were pockets of good practice in England, community drug and alcohol services were generally not commissioned to provide support, he said. ‘For those patients who have developed a dependency on prescription opioids, we need to take a more joined-up approach with specialists in the areas of pain, addictions and mental health working together to provide dedicated support for this group.’
Prevalence of problematic pharmaceutical opioid use in patients with chronic non-cancer pain: A systematic review and meta-analysis available here