The UK’s Opioid Crisis: What You Need To Know

Firstly, what exactly are opioids?

Opioids provide pain relief by acting on the brain, attaching to tiny nerve cells known as opioid receptors to block the transmission of pain signals. Some opioid drugs – like heroin, codeine, oxycodone and morphine sulphate – are derived from the opium poppy, while others – synthetic opioids like tramadol and fentanyl – are manufactured to emulate its effects.

Although heroin is an illegal class-A drug, opioid painkillers are controlled drugs, meaning they can be prescribed by a doctor. They take the form of tablets, capsules, liquids, patches or injections.

What did the new investigation reveal?

The Evening Standard’s ‘Opioid Timebomb’ investigation revealed 3.1m Brits were prescribed opioids in 2017 – an 80% rise on the 2007 figure. This means the UK is now the biggest consumer of painkillers in Europe.

These opioids cost the taxpayer £263 million last year, but that’s not the only issue. Around 200,000 Brits are said to be chronic prescription painkiller users; admissions to private detox centres are up 30% in two years; and overdoses have almost doubled in a decade, amounting to more than 60 hospital admissions per day.

While opioids still have an important place in medicine – effectively treating acute pain (such as a broken rib) and pain at the end of life – experts now believe they’re unsuitable for treating chronic conditions. Recent studies show that in 90% of cases opioids don’t work for chronic pain, yet the overwhelming majority of prescriptions (90% in the UK) are being given to chronic pain sufferers.

Why are opioids such a problem?

You’ve most likely heard horror stories from the States – America’s opioid crisis claimed almost 17,000 lives in 2016, has been declared a “public health emergency” by President Trump and is the subject of countless documentaries. Celebrity deaths (Prince, Tom Petty) and addiction to opioids (Ant McPartlin, Lorraine Kelly) have hit the headlines in recent years and months too.

The problem with prescription opioids is they’re addictive and deadly, yet often viewed as ‘safe’. Harry Sharpiro, founder of online drug information service DrugWise, told the Evening Standard people taking prescription pills often don’t “see themselves as addicts”. And the path from taking painkillers prescribed by a doctor to having a full-blown heroin habit is well documented – the American Society of Addiction Medicine says opioids are the gateway drug for 80% of people who try heroin in the US.

Doctors will often up the dose of opiates as a patient’s tolerance builds, before eventually cutting them off completely. This can send people into terrifying, painful states of withdrawal, leading them to turn to illegal online pharmacies or even street dealers for an opiate fix. 

What do they feel like?

Part of the reason opioid drugs are so addictive is that they create endorphins. Known as the ‘feel-good’ chemical, endorphins are the body’s own naturally-produced opioids. Low doses of opioid painkillers can produce feelings of well-being, warmth, relaxation and sleepiness, while high doses can also give a ‘rush’ and euphoria.

And the reason why strong opiates are known to cause psychological addiction, even after just one use? Opioids can create 100 times more endorphins than the body can, along with flooding the brain with an unnaturally large surge of dopamine – a key neuromodulator in reward learning and reward-seeking behaviour. Many scientists believe humans are pre-programmed to seek out dopamine, meaning taking high doses of opiates is likely to leave people craving more.

Common side effects of opiate painkillers including headaches, nausea, vomiting, constipation, confusion, itching and dizziness. Due to their sedative effects on the part of the brain which regulates breathing, opioids in high doses can cause respiratory failure and death. Over time, opiates can also trick the brain into stopping natural endorphin production.

How has all this happened?

Many experts are blaming 'Big Pharma', and a case of history repeating itself. The first opiate painkiller – morphine – was developed in the US around 1810, but quickly led to a ‘morphine epidemic’, with growing numbers of addicts and doctors perplexed about how to treat them. Enter, heroin: trademarked by a German pharmaceutical company, heroin was marketed as a “safe, non-addictive” substitute for morphine – and we all know how that worked out.

Fast forward to the 1990s, and it’s a scarily similar story. OxyContin, the patented version of oxycodone, was marketed by Purdue Pharma as a painkiller with a low addiction rate. This turned out to be false. Now known as ‘hillbilly heroin’, OxyContin is stronger than morphine and is often blamed for fuelling America's latest opioid crisis, which has killed 200,000 people from 1999 to 2016.

In 2007, Purdue Pharma pleaded guilty to criminal charges for the over-aggressive marketing of OxyContin in the nineties, paying a record $600m fine. Yet it’s still being prescribed. In fact, oxycodone prescriptions in the UK have grown at one of the fastest rates, with prescriptions tripling to 1.65m last year.

What’s being done to stop it?

The UK government has announced a review into prescription drug addiction and will report back early next year. Public Health Minister Steven Brine said: “We cannot be complacent. This is a huge problem in the US and we must be absolutely sure it doesn’t become one here.” However many experts worry it already is.

The Evening Standard’s investigation, published on 15th March, has already brought about change. The publication highlighted the fact that none of the five strongest opioids — fentanyl, morphine sulfate, buprenorphine, oxycodone or tramadol — had explicit addiction warnings on the packaging. Now, Britain’s Medicines and Healthcare Products Regulatory Agency says it is looking at putting “prominent” warnings on the outside of oral opioid painkiller packets, with clearer wording on the leaflet.

Still unaddressed, however, is the way in which doctors view and treat chronic pain. According to the BMJ, one of the UK’s leading medical journals, chronic pain affects 28m adults in the UK, of whom eight million suffer pain enough to be disabling. It’s clear a crucial alternative to opiates are needed.