Huge rise in prescriptions for strongest painkillers

By Andrew M Brown Published: 7:00AM GMT twenty-two February 2010

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Painkiller robe Photo: TETRA/CORBIS

"When you"re in pain, you only wish something to stop it," says Robert, 53. He used to be a sales physical education instructor but has not worked given 2003, when he grown determined and puzzling intestinal pain. Eventually, a dilettante prescribed slow-release hypnotic tablets (MST). Robert assimilated the flourishing series of patients in Britain who embrace heavy-duty opioids for ongoing conditions.

His every day sip climbed to a gigantic 3,000mg sufficient to kill majority people. Robert, who speaks gently with a West Country accent, is smart and level-headed, even genial. But his celebrity run-down drastically with the morphine. "It creates you sluggish," he says. "It creates you some-more aggressive, some-more abrupt." He relied on Viagra to revitalise his flagging sex life, and if he forgot to take his midday sip of MST, horrible withdrawal symptoms set in. "You"ve seen the junkies on the radio shaking, sweating, agitated. Exactly the same."

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Just 10 years ago, a million prescriptions for clever opioids were filled. Now that figure is some-more than 4 million. Increasingly, the lavatory cabinets of center England are stocked with painkillers so absolute that one of them, OxyContin (timed-release oxycodone), is well well known as "hillbilly heroin" in America.

Opioids, from codeine to diamorphine (heroin), all action on the executive shaken system, banishing anxiety, inducing a blithe feeling of security and easing pain. That creates them a prime in Hollywood, where a small in the movie and radio industry similar to to "decompress" by swallowing a integrate of small teal-blue OxyContin tablets instead of a dry martini.

In Britain, a small doctors are worried. They acquire the actuality that ongoing pain, prolonged ignored, is at last being taken seriously. But they fright that some-more inexhaustible prescribing is releasing ever-greater quantities of addictive drug in to the population.

And the total are startling. According to NHS census data gathered by Dr Cathy Stannard, writer of Opioids in Chronic Pain, the series of prescriptions for opioids dispensed in England from 1999 to 2008 increasing from 6.2 million to 14.8 million. And investigate for this essay has suggested that prescriptions for the strongest compounds morphine, oxycodone, fentanyl and buprenorphine rose from one million to 4.1 million.

This month the British Pain Society is edition new recommendations on great have make use of of in opioid prescribing. Compared with prior guidelines, the document, edited by Dr Stannard, strikes a discreet note, balancing benefits with burdens.

What explains the fourfold climb in prescriptions? Well, for one thing, drug such as OxyContin are comparatively new. Drug companies similar to to digest novel smoothness systems for old drug lollipops, lozenges, transdermal rags etc, so you would design to see an ceiling direction as prescribers take up new products. Another probability is that doctors are switching to opioids from non-steroidal anti-inflammatory drugs, that can means gastric draining and alternative long-term problems.

The majority appealing explanation, however, is that the enlarge in prescriptions for this organisation of drug reflects a change in the approach doctors provide ongoing pain. Only a fragment of the prescriptions are for depot cancer. Most are given for ongoing conditions such as behind pang and osteoarthritis. This is not how it used to be. In the last century, ongoing pang was undertreated and doctors were demure to have make use of of clever opioids solely in the majority unfortunate cases.

In the past twenty years, pang patients have lobbied for improved treatment, and drug companies poured income in to educating doctors about their new formulations. Research has shown that when opioids are used to soothe genuine annoy they frequency means addiction. Addiction where a chairman craves an ever higher sip and finds it unfit to give up is what happens when a full of health chairman takes a drug for the overjoyed effect. The studious who is pang from mishap or disease will turn physically contingent but, generally, not addicted. It is a key distinction.

That is the theory, anyway. But what is pain? Is it simply what the case says it is? If so, how do we insist the noted movement in people"s experience of it?

"The display of determined pang is not a singular thing,"" says Dr Stannard. ""It"s complex." Cultural, social, biological and mental factors lend towards to be commingled. According to investigate by the World Health Organisation, the superiority of determined pang in women in Santiago, Chile, for example, is 40.8 per cent; for men in Verona, Italy, the figure is a small 3.9 per cent.

Certainly, the era is not as stoical as the grandparents were. Dr Stannard points to "the medicalisation of life" and says, "There are conditions that people used to live with, but they won"t now."

Dr Des Spence is a GP in Glasgow who feels so strongly about the have make use of of of opioids that he contributed a forceful perspective square on the theme to last month"s British Medical Journal. He believes the enlarge in prescribing cannot simulate a genuine enlarge in pain; instead, he says, doctors "are intent in the drawn out over-diagnosis of pain". He thinks that clever painkillers might not be what we, the patients, need even if they are what we want. Opioid diagnosis can deteriorate amicable functioning and emanate a "pain disability".

He additionally refers anxiously to the injustice of remedy medicines in the US. To be fair, the American experience is doubtful to be replicated in Britain. Our healing culture, with a centralised health service, is different. British doctors are not theme to the marketplace forces that describe the American consumer all-powerful. Since Harold Shipman, the NHS exhaustively monitors prescriptions. Doctor-shopping obtaining mixed prescriptions from opposite doctors is majority simpler in the United States. Even so, the Department of Health is now conducting a examination of all "addictive medicines."

Dr Spence believes the center classes are generally exposed to this category of remedy drugs. Dr Stannard agrees: "A lot of the people I see removing in to a mess-up are center category given they are the people who are outspoken about their health caring [and thus some-more perfectionist of in outcome treatment]." Patient energy could be piece of the trouble. "The component of the studious regularly being right and being seen as a patron has led us in to problems," Dr Spence adds.

Talk to majority pang specialists, on the alternative hand, and they cite patients who have made up their lives after guidance how to conduct their pang with absolute drugs. "We"re here to emanate a pain-free window," says Dr Christopher Jenner, a expert at Imperial College NHS Trust in London. "Then you can begin to rehabilitate them. I do not know of any pang clinics that only say: "Oh, here"s your tablets. Next." "

Patients discuss it of the drugs" supernatural outcome on debilitating pain. Miriam, 39, suffers from sciatica, herniated discs and incontinence. She has been off work given 2006. She requested OxyContin after a crony endorsed it. The pang sanatorium was demure but concluded a trial.

"It was smashing at first," Miriam says. "It was literally similar to somebody branch on a switch. Oh, I"ve eventually found something that full of blood works. I thought it was the majority appropriate thing ever." Now she is some-more ambivalent. She feels "snappy and irritable" and her GP is assisting her to revoke her dose. "I am blissful I went on the oxycodone. Obviously I"ve got concerns. I think I have turn a bit of an addict," she says.

Man has used drug for pang service given Neolithic times. Opioids don"t remove pain; they have it bearable. Victorians self-medicated with whiff of drug (laudanum) purchased over the counter. Morphine declared after Morpheus, the Greek God of nap was initial extracted from the drug poppy, Papaver somniferum, in the early 1800s. Sir William Osler, well well known as the father of complicated medicine, deliberate it to be "God"s own medicine".

And today, hypnotic stays the bullion customary nonetheless it"s no longer the majority manly pill and patients essentially cite drug that aren"t called "morphine". "[With morphine] you open up the Pandora"s box of fright about opioids," says Dr Jenner. "But even though you contend to people that oxycodone is a morphine-like drug, it doesn"t have that amicable tarnish given it doesn"t have that name."

As for Robert, he says he felt "locked in" to receiving his pills, even though he insists that: "I never got a hum or a high on any hypnotic whatsoever." In the finish he came off the remedy in hospital. "Now I take a milder painkiller," he says. "And I suffer. My preference is hypnotic or pain. The pang is a sobering thing."