Summary and slides from recent meeting of APPG on opiate painkiller dependence

Paul Flynn MP, chair of the APPG for Prescribed Drug Dependence, opened the meeting whose focus was on the problem of opiate painkiller (OP) dependence.

APPG Secretariat member Harry Shapiro, introduced the topic, characterising the situation as a ‘public health disaster’ which is killing hundreds of people a year and ruining the lives of millions more. According to BMJ, there are 28m people in the UK with have a diagnosis of chronic pain, nearly half of whom are in receipt of prescription painkillers. One telling statistic: between 1991-2014 there was a 666% increase in prescriptions for Tramadol.

The four speakers all tackled the issue from their own professional or personal perspective.

Dr George Ryan, former GP, clinical advisor to PHE England discussed opioid analgesic prescribing for chronic non-cancer pain in UK primary care. His key points included:

  • Most opioid analgesics don’t work for these patients beyond a limited time.
  • Nearly a third of all prescriptions for OP across the EU are written in the UK.
  • We often talk about drug misuse, but maybe the bigger issue is drug mismanagement – prescribers need to take some  ownership of the problem.
  • There was a need to apply the full range of non-drug interventions for pain management – from acupuncture to zen.
  • There is a need to focus on supporting patients’ self-efficacy – all the resources they may bring to support their own recovery or symptom management.

Dr Jane Quinlan, consultant in pain management Oxford University Hospitals Trust

  • Dramatic rise in prescriptions in US – now the biggest single cause of accidental death.
  • In the UK over the last 10 years there has been a 400% increase in OP prescribing.
  • Drew the distinction between acute and cancer pain caused by tissue damage, and neuropathic chronic pain which is a dysfunction of the system signalling pain when there is no damage – in such cases OP do not work in the same way.
  • Described a spectrum of use from low dose pain management at one end which was largely non-problematic to those patients seen by drug treatment services.
  • But there was little help for the large numbers in the middle who might wish to reduce or stop their usage – the “lost tribe”.

Dr Farrukh Alam, consultant in addiction psychiatry Central and North West London NHS Foundation Trust

  • His service sees two different groups – those via prescription and those through heroin use.
  • His service sees range of issues associated with the physical consequences of long term opioid prescribing; psychological affective disorders and social issues affecting family and work.
  • All needs to be addressed ideally through an integrated approach co-ordinated by primary care.

Cathryn Kemp, director Painkiller Addiction Information Network (PAIN) and expert by lived experience

  • She described her own experience with addiction to OP as a consequence of acute pancreatitis – specifically fentanyl lozenges – stressing how addiction meant isolation for her.
  • Her book, Coming Clean, is being republished in Feb 2017.

Following a Q/A session, the speakers collectively made these summary remarks:

  • There is a hidden iceberg of those obtaining drugs OTC which are potentially more dangerous.
  • A lack of evidence of prevalence, science and treatment and that’s the main challenge.
  • Sustainable transformation plans (STPs) – OP dependence falls into these plans which aim to shift treatment from secondary care back to primary.
  • We have too little data regarding numbers of patients being prescribed and at what dosages.
  • Need to look at psychological support for those not suffering from tissue damage.
  • Emphasised need for evidence & data.
  • Responsibility needs to be taken by both prescribers and patients concerning what is prescribed and taken.

Harry Shapiro made the closing remarks that there was a need to ramp up political pressure; government had consistently refused to acknowledge the problem of over-medicalisation and the resulting need for specialist services to deal with the fallout.

Nor, until recently, has the medical establishment been that supportive. He was pleased to report that the APPG call for a national helpline is backed by the BMA, the Royal Colleges and others – which will be announced in what promises to be a well-publicised BMA report due out in the next few days. He urged any practitioners or patient groups who might be contacted by the media to support the campaign.

Paul Flynn thanked the speakers and closed the meeting.

The slides from the presentations can be downloaded from the links below:

Dr Jane Quinlan

Dr George Ryan

Dr Farrukh Alam

Cathryn Kemp

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