Drugs Can’t Fix ALL Our Pain!

Online opioids are feeding the addictions epidemic… according to many mainstream media emotive headlines.

Despite the UK Pharmacy regulator setting ‘new safety rules’ for the purchase of drugs online (see here), it appears the ‘guidance’ is probably falling on deaf ears. With the increasing availability and subsequent purchase of opioids online, is the UK heading towards a USA type of addiction disaster?

Why opioids are such an American problem: For every one million Americans, almost 50,000 doses of opioids are taken every day. That’s four times the rate in the UK. (2017 BBC News)

Crisis What Crisis?

The NHS have previously been accused of ‘fuelling a rise in opioid addiction’ (see here). When considering the answer(s) to this chicken or egg causality dilemma, as with many others, it’s often a good idea to follow the money (and the politics).

Back in 2018, Chris McGreal, a former Guardian correspondent in Washington, suggested that the making of an opioid epidemic had been intentional (see here).

When high doses of painkillers led to widespread addiction, it was called one of the biggest mistakes in modern medicine. But this was no accident. (Chris McGreal)

Earlier this year it was suggested that – “Britain is a long way from an opioid crisis on the US scale” (see here). This article cited our “superiority of single-payer healthcare” and qualified that by saying; “the NHS is stretched and imperfect, but its mere existence has prevented the abuses which produced the US crisis.” But could this past ‘safety blanket’ be wearing a little thin?

The assumption is probably mostly correct, our health care system is distinctly different to that which is present on the opposite side of the Atlantic, at least for now. My worry is, how long can we rely on that difference remaining robust?

Things are not as bad here as in America, but we must act now to protect people from the darker side to painkillers. (Rt.Hon Matt Hancock MP)

There is some hypocrisy at play here. When our Health Secretary says the UK is different to the USA, he is correct at least in part however; our government which he is part of, appears to be consistently and relentlessly dragging us kicking and screaming ever closer towards the American model of health care.

A system that is predominantly based around the assumption – there is actually a pill that can cure every ill known to humanity. The provision of ‘quick-fix’ chemicals that are too often readily dispensed for commercial as opposed to clinical reasoning. Often at great expense to society, as we are now witnessing, but clearly to the financial advantage of Big-Pharma and the commercialism of the American medical profession… a little too cynical? I don’t believe it is.

The UK is not the USA

Things might not be at USA ‘crisis’ levels (as yet) but with a UK “60% rise in prescriptions for opioid drugs over the past 10 years” and increased dispensing from in excess of 14 million in 2008 to 23 million in 2018 (read more), we can’t be complacent any longer.

That’s probably why the government has decided that opioid painkillers should ‘carry prominent warnings’ (see BBC report). OK, so that’s a start but really, is this the best we can do to address the issues? What are we doing to kerb the ‘aggressive marketing’ methods employed by some UK online pharmacies? Some of their sales tactics border on disgustingly immoral (see here).

At least two major online pharmacies – registered with the UK regulator – are sending customers emails urging them to order drugs by claiming stocks are running out or telling them their “limit” has been removed and they can now buy more codeine pills. (The Guardian)

Opiate Availability

Has the internet made even prescription medication too readily available? Is supply merely matching demand? Is the whole issue simply a matter of commercial economics? If so, and it probably is, how happy are we that commercialism now predominantly drives our clinical process? Was it not always thus, just to a lesser degree prior to the electronic age?

The control of purchasing opiates online certainly appears to be extremely lax, with some people reporting purchases way in excess of normal/safe levels (see here).

I for one can’t see that ‘prominent addiction warning labels’ (see here) will really cut the mustard when it comes to mitigating against the problems. That said, despite regulation and control providing improved management of the issues overall, governments need to resist the short-term fix of additional prohibition and punitive options.

We’ve all seen what the failed War On Drugs has delivered and it’s not pretty. There has to be education and ‘balanced’ legislation to mitigate against people purchasing their opiates from the dark-web, or using illicit street drugs. Both of these options can be extremely dangerous unknown quantities.

Pain Management

People use opiates to manage pain. It can be acute and/or chronic physical pain, or as is often the case with illicit opioids, for the self-medication and/or escape from past or present psychological pain and/or trauma. Often, it’s usually much easier to fix the physical pain.

The psychological variety has a tendency to be far more deeply ingrained and difficult to get at. That’s especially true when factors contributing to that pain are societal or emotional… but they also need to be addressed, rather than ignored or conveniently side-stepped as a problem too difficult (aka expensive) to fix. Too deep a subject for here and now.

Physical Pain

Persistent Pain: Over 14 million people over the world live with persistent pain and of those, almost one in four said that pain had kept them from their usual activities (including work) on at least 14 days in the last three months. (The NHS)

You might have persistent pain, you might be stuck in the pain cycle however; pills aren’t necessarily the best answer. Or even the most appropriate solution for combating the problem. It’s just that usually we simply want a quick and easy fix and pills can provide that.

The need to learn pain self management skills and using them in everyday activities, is very important. It is certainly not all up to your doctor or healthcare team to manage your pain. (Dr Pete Moore, The Pain Toolkit)

It’s clinically known that the mind mostly controls how and when we experience one or more of the three basic types of pain. But it should also be remembered, that’s not the full story.

It is worth remembering, when considering pills (or more of them), there could be a different and more productive way to manage how you’re feeling.

Often, our mind can provide better tools than simply resorting to even more pills to help us overcome our long-term pain. Using our mind and adjusting how we think can be an effective self-management tool. One that provides a far more rounded and holistic approach, without any of the addictive hooks. It’s also got to be a far better solution than becoming the latest victim of the Opiate Crisis.

CBT & Mindfulness

• Mindfulness-based stress reduction (MBSR) and cognitive-behavioural therapy (CBT) can improve physical functioning and reduce pain intensity and distress in patients with chronic pain (CP), when evaluated against control conditions.
• MBSR offers a potentially helpful intervention for CP management. Additional research using consistent measures is however required to guide decisions about the benefits of providing CBT or MBSR as a preferred option.

Source: Khoo E, Small R, Cheng W, et al Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: A systematic review and network meta-analysis Evidence-Based Mental Health 2019;22:26-35.

I don’t believe the UK is suffering from the same sort of issues that America currently finds itself impacted by. At least not yet. That said, we would be foolish to take our eyes off the ball. Just as our government has been immensely stupid in cutting back on so many of those public services which help to mitigate against such problems.

Yes, it’s a source of anger and frustration that public policy and societal factors have lead many towards the problems they now face however; it’s also worth remembering… Drugs Can’t (and won’t) Fix ALL Our Pain!

NB: Please seek the advice of a medical practitioner, or other suitably qualified clinical professional, prior to making any changes to how you use (or don’t use) any medication that has been prescribed to you.