Man has used opium for pain relief since Neolithic times. Opioids don't remove pain; they make it bearable. Victorians self-medicated with tincture of opium (laudanum) purchased over the counter. Morphine – named after Morpheus, the Greek god of sleep – was first extracted from the opium poppy, Papaver somniferum, in the early 1800s.
Just 10 years ago, a million prescriptions for strong opioids were filled. Now it is more than four million. Increasingly, the bathroom cabinets of middle England are stocked with painkillers so powerful that one of them, OxyContin is known as "hillbilly heroin" in America.
And the figures are startling. According to NHS statistics*, the number of opioid prescriptions dispensed in England from 1999 to 2008 increased from 6.2 million to 14.8 million. And research has revealed that prescriptions for the strongest compounds – morphine, oxycodone (Oxycontin), fentanyl for example – rose from one million to 4.1 million.
What explains this increase?
For one thing, drugs such as OxyContin are relatively new. Drug companies like to devise innovative delivery systems for old drugs – lollipops, lozenges, transdermal patches etc, so we would expect to see an upward trend as patients take up new products. Another possibility is that doctors are switching to opioids from non-steroidal anti-inflammatory drugs, which can cause gastric bleeding and other long-term problems.
The most intriguing explanation, however, is that the increase in these kinds of drug prescriptions reflects a shift in the way doctors treat chronic pain. Only a fraction of the prescriptions are for terminal cancer. Most are given for chronic conditions such as back pain and osteoarthritis. This is not how it used to be. In the last century, chronic pain was undertreated and doctors were reluctant to use strong opioids except in the most desperate cases.
In the past 20 years, pain patients have lobbied for better treatment, and drug companies poured money into educating doctors about their new medicines.
Research has shown that when opioids are used to relieve real discomfort, such as in trauma or disease they rarely cause addiction. Addiction – where a person craves an ever higher dose and finds it impossible to give up – is what happens when a person takes a drug for its euphoric effect. And it can result in the patient never returning to work, and problems with self care and neglect yet alone the impact to families. Long term use of opioid drugs can result in addiction and there is research to show that only low doses of opioid drugs are effective in treating chronic pain in the long term.
So what is the NHS doing about it?
The UK is government is planning new guidance for doctors and there are NHS clinics that assist people detox for those specifically on prescription drugs. There is recognition of the need to prevent new cases of opioid addiction caused by medical use and expanding access to opioid addiction treatment.
And what does that mean for Claims Handlers?
For claims handlers managing chronic pain claimants there is a clear need to really look at the medication regime of claimants – a huge cocktail of various painkillers, including opioids, may be leading to addiction and a complete review by the case manager and medical team necessary to ensure the claimant is getting the right medication for the long term. In particular, if funding for medications falls within the claims’ damages we could be funding drugs that are unnecessary and in the long term causing harm.
*Opioids in Chronic Pain, Dr C Stannard
