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ADDICTION


Prescription addiction


northErn IrELanD IS In thE grIP of a DEaDLY aDDIctIon to PrEScrIPtIon mEDIcatIon, WIth thE nUmBEr of fataLItIES aS a rESULt of PrEScrIPtIon DrUgS rEachIng an aLL- tImE hIgh.¹ WE ExamInE WhEthEr oPIoIDS arE BEIng PrEScrIBED aS a QUIcK-fIx SoLUtIon anD thE VItaL roLE that toPIcaL anaLgESIcS PLaY In trEatIng chronIc PaIn.


c


hronic pain conditions are amongst the most significant causes of suffering and


disability worldwide. an estimated 49 per cent of patients in the UK, who have chronic pain, also suffer from depression, and it is associated with poorer mental wellbeing, anxiety, job loss, impaired function and limited daily physical and social activities.²


Are oral analgesics being over-prescribed? With chronic pain so prevalent in our society, it is hardly surprising that prescriptions for opioid painkillers have increased. they have, in fact, doubled from twelve million to 24 million in the past decade, with recent estimates suggesting that over 192,000 people could be dependent.³


In northern Ireland, tramadol is being handed out at a rate of 529 a day, costing £2 million and Pregabalin appears to be prescribed much more readily here than in the rest of the UK with the combined number of items of gabapentin and Pregabalin


10 - PharmacY In focUS


totalling 352,000 for 2013, a 29 per cent rise in two years.4


With such shocking statistics, it begs the question as to whether powerful and potentially addictive opiate painkillers are being prescribed too readily by gPs? addiction to any substance can have a potentially life- changing effect on a person’s health and wellbeing, which is why gPs should carefully consider the risks of a drug before prescribing it to a patient. a recent study by opioids aware concluded that opioids may reduce pain for some patients in the short and medium term (less than twelve weeks). however, there is a lack of consistent good quality evidence to support a strong clinical recommendation for the long term use of opioids for patients with chronic pain.5


the relief of pain should be seen as a clinical priority, yet the prescribing of opioids is often not the most appropriate or effective treatment option for many patients with chronic


pain, and can risk exposing patients to unnecessary harm. Despite this increasingly overwhelming body of evidence that oral analgesics do not work in the long term, it doesn’t appear to be putting patients off reaching for otc boxes of painkillers, or from making regular trips to their gP to request prescriptions for painkillers.


Deaths from addictive painkillers have almost doubled in a decade as trends in Britain follow ‘alarming’ US patterns. the figures, comparing trends in the decade ending 2011, show almost 900 such deaths, compared with almost 500 in 2001. In northern Ireland, the number of deaths in which tramadol was mentioned on the death certificate rose from zero to 20 between 2003 and 2013.


opioids act on different parts of the brain and nervous system, including the spinal cord. the latter receives sensations from the body before sending them to the brain. opioids


work on this area to decrease feelings of pain, even after injury.


all opioids are chemically related and interact with opioid receptors on nerve cells in the body and brain. opioid pain relievers are generally safe when taken for a short time and as prescribed by a gP but, because they produce euphoria in addition to pain relief, they can be misused (ie, taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). the 2016 Bma analysis report on prescribed drugs associated with dependence and withdrawal highlighted the potential that opioids, prescribed to treat chronic pain, will lead to tolerance and physical dependence, especially with prolonged treatment and at higher doses.6


What is the vital role that topical analgesics play in chronic pain relief? tablets are often the go-to pain relief treatment, but topicals are really >


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