The UK is dangerously close to having a full-blown opioid crisis

Drug-related deaths are rising, and in our most deprived communities, prescribing rates are increasing. Rather than over medicalising, we need to look at the bigger picture

Melissa* has lived with anxiety for as long as she can remember. As a child, it prevented her from making friends as she preferred to stay at home. As she grew older, it became worse, framing her as aloof and detached. Aged 20, she fell and fractured her knee badly. Four operations later, the pain hadn’t subsided so her doctor prescribed her tramadol, an opioid pain medication.

Opioids work by attaching to receptors across the body. They block pain messages sent from the source of the pain through the spinal cord to the brain whilst also creating feelings of well-being and euphoria. The tramadol didn’t just help ease Melissa’s knee pain in the short term, for the first time it lifted her out of the fog of anxiety. In her own words, “It made me feel beautiful.” As her tolerance increased, Melissa started seeking out more tramadol. She lied to her doctor that she’d lost her prescription, she bought more from online pharmacies as well as from a drug dealer. She went from taking eight tablets a day to 90. She stopped eating and lost four stone in weight, “I didn’t care about my life much, I just wanted to feel calm.” In my work for drug treatment charity Addaction, Melissa’s story is becoming more and more common.

Prescriptions for opioid-based painkillers have increased by more than 60 per cent in the past decade. Official statistics show tramadol was implicated in 220 drug-related deaths in England 2018 compared to just seven in 1998. And oxycodone, the drug at the centre of the epidemic in America, was implicated in 79 deaths in England in 2018 compared to zero 10 years earlier. With this in mind, people are inevitably comparing the situation here with the epidemic across the pond. Let’s be clear, opioid prescribing is monitored much more closely in the UK than in the US, meaning the situation here is nowhere near as severe. But that doesn’t mean we should become complacent in the face of what is clearly a growing issue.

Public Health England are currently reviewing practices around prescribing drugs. But the government’s main tangible response so far has been introducing prominent health warnings on boxes of opioid painkillers. This might help to inform patients that the drugs are potentially addictive, but it doesn’t help those who have already developed a problem with their medication. Addiction is a craving for a relief from suffering. It’s characterised by someone continuing their behaviour despite the negative consequences. This could be the gambler who applies for a payday loan to keep on betting or Melissa buying more and more tramadol at the expense of her health. Long-term opioid use is a way of papering over the cracks of a much deeper emotional problem. The search for that rush of pleasure is always likely to trump potential health complications.

That’s why prescribers need to thoroughly understand whether a patient has any underlying mental health problems before prescribing opioids. This is especially true for pain lasting longer than three months. So-called chronic pain often has no obvious ongoing cause and is frequently accompanied by anxiety and depression. The evidence tells us that opioid-based painkillers are largely ineffective in treating this complex condition. But, particularly in the UK’s most deprived communities, prescribing rates are increasing. Rather than over medicalising what are often social problems, we need to look at the bigger picture. Part of the response needs to be focused on making people’s lives better through better-funded treatment and mental health services as well as access to better housing and employment opportunities.

But drug treatment organisations also need to do more to help people access support. Ten years after her doctor first prescribed her tramadol, Melissa walked through the door of an Addaction service. During her assessment she started shaking and lost consciousness before she collapsed and stopped breathing. She was given the opioid overdose reversal drug naloxone and taken to hospital, before coming back to finish her assessment the next day. She could well have died if she’d waited any longer.

There’s a misapprehension among many people that they too need to hit this kind of “rock bottom” before reaching out for help. In actual fact, anyone who’s concerned about their drug use should access treatment. People who use prescription opioids often don’t see themselves in the same light as a heroin or crack cocaine user but they need the same level of support. As a sector we need to rise to the challenge and do more to reach out to this group.

Melissa is now taking care of herself again. She’s seeing a counsellor to address her anxiety rather than medicating it with tramadol. She still has ups and downs but says some days she’s “shocked at how well I’m doing.” Her advice to anyone worried about their use of painkillers is to “work out whether they’re actually taking them for pain or for other reasons.” If it’s the latter, it’s never too early to reach out for help.

*The person’s name has been changed to protect their identity.

Rachel Britton is lead clinical pharmacist at Addaction