A report by NHS England in March 2023 revealed opioid prescriptions have reduced by 450,000 in under four years. The article credits GPs and pharmacists who have cracked down on prescribing prescription pain relief when there are alternatives.
Within the same report, NHS England introduced a new plan to further reduce incidents of unnecessary prescriptions of high-strength painkillers and other addiction-causing medications like benzodiazepines (prescribed for sedation, anxiety, and muscle spasms).
The NHS invested almost £50 million in the 2022/2023 financial year for the programme that they believe has reduced the number of opioid painkillers by 8%, saving nearly 350 lives, and prevented more than 2,100 incidents of patient harm.
In the grand scheme of the issue, 8% is low. Another report published by the National Library of Medicine revealed the number of people in treatment for abusing prescription painkillers and over-the-counter medicines was 54% in 2019–2020. Another study published by The Faculty of Pain Medicine revealed that 5.4% of adults aged between 16 and 59 years had abused prescription-only painkillers not even prescribed to them.
The statistics could continue, and at what cost to the public?
Below, we'll take a deep dive into the impact of the abuse of prescription painkillers.
The Impact of Abusing Prescription Painkillers
Abusing prescription painkillers is a spiral. What starts as seemingly innocent seeps into every aspect of being. And it happens almost without noticing.
Physically, the abuse of these substances can lead to numerous adverse effects. Even taking them as prescribed for a long time negatively impacts the body. It begins with symptoms like nausea, constipation, lack of appetite, fatigue, and cognitive impairment. Over time, more severe symptoms develop:
- Liver or kidney (or both) disease and failure
- Cardiovascular issues
- Respiratory depression (collapse of the respiratory system)
- Lowered immunity
- Gastrointestinal issues
What's the main issue? Tolerance. Increased tolerance leads to increased consumption - the main worry is overdosing. In 2023, The World Health Organisation (WHO) released statistics stating that, in 2019, over 600,000 deaths worldwide were caused by drug overdoses. The WHO blames multiple factors, two being using prescription opioids without medical supervision and high prescribed dosages of opioids.
And that's just physically and only scratching the surface of what happens to various body systems. More on that further along the article.
On a psychological level, the dependency on painkillers can and does severely impact mental health. Symptoms of depression, anxiety, and dependence-related anxiety quickly develop. The relentless pursuit of the drug can overshadow other priorities. That then spirals into relationship troubles, job loss if abuse is discovered through workplace drug testing and financial instability.
Socially, people tend to become reclusive and isolate themselves. Loneliness leads to depression, and depression leads to further reliance to numb the feelings.
Call it a trifecta of problems that sends people into a vicious cycle of reliance.
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Impact of Opioid Abuse
Opioid abuse is the focal point. You might be aware of the issues in the US (more than two million Americans abuse opioids and 95 people die each day from it), but did you know the UK is experiencing similar issues? According to research, 250,000 people required treatment for opioid abuse, and opioid-related hospitalisations increased by 49% from 2008 to 2018. Well, perhaps it's not on the same scale. It isn't remotely comparable with the situation in the UK, but the numbers are increasing, hence the NHS England initiative to reduce prescriptions.
Here are the most common opioids to abuse in the UK:
- Codeine (co-codamol, co-dydramol, etc)
- Morphine (not as easily accessible)
- Tramadol (synthetic opioid, most commonly prescribed of all medications)
- Methadone (synthetic, prescribed for misuse treatment)
- Oxycodone (synthetic)
- Fentanyl (rarely prescribed, typically for palliative patients)
Tramadol shot to the top of popularity as co proxamol was banished in 2005. Tramadol is more commonly prescribed than non-steroidal anti-inflammatory drugs (NSAIDs), and it's highly addictive. And there are more statistics from studies that could be fuelling the growing issue of the abuse of prescriptions. A study published in the British Medical Journal (BMJ) in 2017, focusing on opioid habits and including 703 participants, revealed:
- 59% were prescribed opioids
- 1/4 of the participants were prescribed them outside the National Institute for Health and Care Excellence (NICE) guidelines
We could carry on with the statistics - they're almost endless.
These drugs alleviate pain, but they also have a potent effect on the brain's reward system (artificial dopamine). The chemical components of opioids attach to proteins called mu-opioid receptors that sit on the surface of opiate-sensitive neurons, or brain cells if you don't understand science. That then triggers the same biochemical processes that give people pleasure. And so, the cycle of motivation to use the drug for pleasure begins.
And when people stop taking them, withdrawal kicks in. Increased depression, anxiety, aggression, fevers, vomiting, etc.
Short-term impacts of opioid abuse are drowsiness, constipation, and nausea to more severe effects like respiratory depression (overdoses). Long-term abuse exacerbates these risks, leading to liver damage, brain damage due to hypoxia (lack of oxygen), and mental health disorders. Opioid dependence can also lead individuals to illegal drug use, such as heroin.
There are also social implications:
- Family and child custody disputes
- Financial issues
- Job losses
- Increased hospitalisation
The time it takes to become dependent varies. Typically, it's only a few weeks.
Impact of Benzodiazepine Drug Abuse For Pain Relief
Gabapentin, pregabalin, and diazepam are the top three benzodiazepines prescribed (or mis-prescribed) to people in the UK. Prescriptions treat epilepsy, anxiety, muscle spasms, and other neurological conditions. Xanax, Valium, and Klonopin are less commonly prescribed in the UK.
They're known as central nervous system (CNS) depressants and bind to the inhibitory neurotransmitter GABA at various receptor points throughout the CNS system and reduce abnormal nerve activity. Once stimulated, people feel calm, drowsy, relaxed, etc.
According to research, there are over 12 million prescriptions for benzodiazepines, with 1.5 million people battling with addiction.
Like with opioids, benzodiazepines increase dopamine levels and trigger long-lasting synaptic adaptations to the reward system. People essentially become hooked on the relaxing feeling.
Similarly to opioids, the body adapts tolerance increases, doses increase, and so do the associated risks. Withdrawal symptoms can also be severe.
Short-term impacts of abuse include:
- Dizziness
- Fatigue
- Blurred vision
- Cognitive impairment
Long-term abuse can lead to serious neurological issues, organ damage, and persistent cognitive deficits. There's also a risk of developing a polysubstance dependence (using more than one substance).
The social issues are the same as opioids - withdrawal from life, financial issues, relationship issues, etc.
The Impact of Regular Painkiller Abuse
Interestingly, Good Morning Britain did a feature in one of their recent TV shows about the impact of regular painkiller (over-the-counter, OTC) abuse. It's drugs like paracetamol, ibuprofen, and aspirin. It's not as commonly spoken about, but it's an issue.
Paracetamol overdose, for example, is one of the most common reasons for emergency treatment in the UK and the primary cause of acute liver failure in the Western Hemisphere. It's the result of over 50,000 hospital admissions and 200 deaths.
Similarly to opioids and benzodiazepines, long-term abuse affects liver and kidney function and raises blood pressure. It also causes tiredness, breathlessness, and blue fingers and lips.
Why is it not commonly spoken about? Dependency works differently - people don't see it as a threat. Rather than physiologically and chemically altering the brain and causing dependence, it's more psychological. They're known as safe (although some supermarkets now ask for ID to purchase them), but these commonly used drugs can become tools for abuse when individuals rely on them excessively. To some, it's simply habitual. Some people have ongoing chronic pain and rely on the tablets without seeking proper medical help.
Short-term impacts of abuse can include gastrointestinal issues and liver and kidney damage (particularly with excessive paracetamol use). There's also an increased risk of bleeding with ibuprofen.
Long-term abuse can lead to severe health complications. Chronic overuse of ibuprofen, for example, can result in ulcers, gastrointestinal bleeding, and kidney damage.
With paracetamol, it can cause long-term liver damage and, in severe cases, liver failure - especially with overdoses.
But is the NHS making this worse? An article published the NHS Wales in 2023 told the public it's OK to take the prescribed dose of paracetamol (and other OTC drugs) as long as more than the recommended dose isn't consumed. Yet, studies totally contradict that.
Conclusion
Solving the abuse of painkillers is a critical public health priority - and clearly, the NHS is investing a lot of money to do so. But it doesn't tackle illegal abuse. Healthcare, policy, and community efforts must join to combat this challenge.
DNA Legal can test a wide range of pharmaceuticals and help identify if substances are being misused