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

Posted November 2, 2016

Paul Flynn MP, Chair of the APPG for Prescribed Drug Dependence, opened the meeting focused on the critical issue of opioid painkiller (OP) dependence.

Harry Shapiro, a member of the APPG Secretariat, introduced the topic, describing it as a “public health disaster” that claims hundreds of lives annually and severely impacts millions more. According to the BMJ, 28 million people in the UK are diagnosed with chronic pain, nearly half of whom are prescribed painkillers. Notably, from 1991 to 2014, prescriptions for Tramadol increased by 666%.

The meeting featured four speakers who shared insights from their respective professional and personal perspectives:

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

Most opioid analgesics are effective for only a limited time for chronic non-cancer pain patients.
The UK is responsible for nearly a third of all opioid prescriptions across the EU.
The focus should shift from drug misuse to drug mismanagement, with prescribers taking more responsibility.
A full range of non-drug interventions, such as acupuncture and mindfulness, should be considered for pain management.
Supporting patients’ self-efficacy and utilizing their own resources for recovery or symptom management is crucial.

Dr. Jane Quinlan, Consultant in Pain Management at Oxford University Hospitals Trust, highlighted:

The dramatic rise in opioid prescriptions in the US, now the leading cause of accidental death.
A 400% increase in opioid prescribing in the UK over the last decade.
The distinction between acute or cancer pain, which involves tissue damage, and neuropathic chronic pain, which results from a dysfunction in pain signaling, making opioids less effective.
A spectrum of use from low-dose, non-problematic pain management to more severe cases managed by drug treatment services.
The lack of support for the large group of patients in the middle who want to reduce or stop their usage—referred to as the “lost tribe.”

Dr. Farrukh Alam, Consultant in Addiction Psychiatry at Central and North West London NHS Foundation Trust, discussed:

His service’s experience with two distinct groups: those dependent on prescription opioids and those using heroin.
The physical, psychological, and social issues arising from long-term opioid use.
The need for an integrated approach to address these issues, ideally coordinated by primary care.

Cathryn Kemp, Director of the Painkiller Addiction Information Network (PAIN) and expert by lived experience, shared:

Her personal struggle with opioid addiction due to acute pancreatitis, particularly with fentanyl lozenges, and how addiction led to isolation.
The forthcoming republishing of her book, Coming Clean, in February 2017.

Summary Remarks:

There is a hidden crisis involving over-the-counter drugs that may be even more dangerous.
The lack of evidence on prevalence, science, and treatment poses significant challenges.
Sustainable Transformation Plans (STPs) aim to shift treatment from secondary to primary care, including opioid dependence.
Insufficient data on prescription numbers and dosages.
The need for psychological support for individuals without tissue damage.
Emphasis on the need for more evidence and data.
Shared responsibility between prescribers and patients regarding opioid prescriptions and usage.

Harry Shapiro concluded the meeting by stressing the need for increased political pressure. The government has consistently neglected the issue of over-medicalization and the need for specialized services to address its consequences. He noted that the APPG’s call for a national helpline is supported by the BMA, Royal Colleges, and others, with an announcement expected in a forthcoming BMA report. He urged practitioners and patient groups to support the campaign if approached by the media.

Paul Flynn thanked the speakers and closed the meeting.

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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