Statement on Opioid prescribing

30 May 2018

Reason for concern

The number of people attending hospital with poisoning from opioids almost doubled to 11,000 between 2005-06 and 2015-16. Data from NHS Digital shows an increase in people attending hospital with poisoning from prescription opioids such as codeine, morphine, oxycodone and fentanyl, rising from 4,891 in 2005-06 to 11,660 last year in England (source: Hospital Episode Statistics (HES), NHS Digital. Note: 2016-17 data provisional).

The recent release of the death rate in the United States due to opioid use, prescribed or not – 42,249 in 2016 (a 28% increase on 2015) – means that opioid overdose has contributed to a 0.1 year drop in life expectancy in men.

Note that here in the UK although the annual death rate for Tramadol overdose slowed between 2014 and 2015, that of fentanyl is increasing.

A timely statement

In light of these statistics, a recently released statement from the International Association for the Study of Pain (IASP) on the use of opioids is therefore very timely.

IASP’s position statement makes clear that although opioids are indispensable for the treatment of severe short-lived pain, recent prescribing patterns in the United States and Canada mean “the role of opioids in the treatment of chronic pain has come into question.”

IASP’s statement covers a number of aspects of opioid prescribing, and “recommends caution when prescribing opioids for chronic pain”, especially in situations of continuous longer-term use, instead advocating “treatment strategies that focus on improving the quality of life, especially those integrating behavioural and physical treatments.”

IASP’s statement means that you can confidently share with patients that:

  • strong opioids are best in acute pain conditions e.g. post trauma etc, or in end of life care management
  • their role in chronic pain is unhelpful in changing pain intensity and experience itself for most people. It is causing many problems, both side effects and long term harm, hence the need to reduce and where possible stop strong opioids.

You can read the full IASP position statement on opioids here.