It was announced this year that GPs and pharmacists have helped cut opioid prescriptions in England by 450,000 in under four years. This comes after the National Institute for Health and Care Excellence (NICE) released a new action plan to crack down on the overuse of potentially-addictive medicines.
Opioids, such as codeine, morphine, oxycodone and tramadol are used to treat chronic pain. However, medical research is now showing that they are only effective in the short term and when used over longer periods, they can lead to dependence and cause physical and mental health problems.
As an alternative, chronic pain patients will now be encouraged to either take antidepressants, do exercise or undergo acupuncture as “there is little or no evidence that they make any difference to people’s quality of life, pain or psychological distress.”
This has caused concern within the chronic pain community. For people like Jo Taylor, a 57-year-old former nurse from West Yorkshire, these alternative therapies do not offer any hope.
To treat her pain caused by arthritis and fibromyalgia, Jo previously took medications including amitriptyline, pregabalin and gabapentin, all of which did not seem to even scrape the surface of her pain.
But now, with a ‘godsend’ prescription of slow release morphine, a much more powerful painkiller, Jo can cope with her daily life. Even the thought of coming off it sends her mind into overdrive. But thankfully, she is in agreement with her GP and is on a proper plan to ensure her dose is monitored.
"I take the morphine both in the morning and at night, there’s no sort of highs that come with it, it’s a slow delivery symptom and even though I had to come off it a few times, after a couple of tweaks with it it’s made the pain tolerable." She said.
"The pain is not gone but it’s been a godsend and my GP doesn’t want me to come off it at all.”
Despite Jo being able to stay on her opioid medication, when she heard the new guidelines about chronic pain patients being encouraged to stay physically active for longer-term general health benefits, she felt worried for those who were not in the same position.
Even with the morphine, Jo still has to use a walking stick and even a trip to the supermarket pushes her to her limit.
“Exercise makes fibromyalgia worst, my exercise is walking around the supermarket and I get swollen feet, ankles, knees and my hip and back will be in agony.” Jo said.
“I think that they just look at America, and we do have people here who have become addicted to opiates and morphine but with chronic pain patients, it’s keeping them functional.
"I think it’s completely irrational and unfair to take everyone off opioid medications if it’s helping them to stay sane and improve their levels of pain.” She continued.
The havoc and misery caused by over-prescribing opioid drugs in the US has seen more than a million people die of overdoses since 2000. Whilst opioid death rates in England have not reached the same levels of the US, the usage rates have continued to increase.
But just like Jo and her GP, healthcare professionals are sharing that they are working to build personal relationships with patients. This is to ensure that they have the steering wheel when it comes to reducing or stopping their opioid medications.
This is the case for Mohammed Patel, an NHS Specialist Pharmacist and Independent Prescriber. He works with patients individually to help optimise the use of their medication and to understand and reduce opioids in a gradual manner.
“It takes time, and a lot of hand holding but I always write to the GPs so we can support it and facilitate it, but ultimately it would be guided by the patients, they are in the driver's seat.
"So if we say reduce the drug by 10 percent every two weeks, if it gets to the end of that two weeks and you're not ready to make the next step down, then they can let us know if we have to change that or extend that." He said.
Mohammed said that the guidelines have to be taken with a pinch of salt, as if we did not put in these stringent controls, there is a risk of ending up in a similar situation as America.
Mohammed explained: "Somebody telling you that you have to reduce this can induce anxiety but I make sure that I never force patients to make reductions because in my opinion it doesn’t really work or it may work temporarily, but it just backfired further down the line so we take it one step at a time.
“Chronic pain particularly varies and so you have to look at everything and one of those pieces of the pie is medication. So sometimes you may be able to swap the opioids to an alternative. That might include antidepressants or other other medications and and then non pharmacological therapies might include things like CBT.”
A report found that more than 57 million opioid prescriptions were written for pain conditions in 2022, equating to more than 108 every minute. Despite there being evidence on the effectiveness of non-medical therapies for chronic pain, 52% of doctors surveyed said they aren’t always accessible.
Back at his Community Pain Management Service in Merseyside, Mohammed and a team of Doctors, Physiotherapists and Psychologists are changing this. They are working hard to support their patients, not only by reducing and managing their pain but by helping them to live well and build good habits.
This is taught through the Community Pain Management Programme. For nine weeks patients can take educational sessions, exercise groups, mindfulness and schedule one-to-one appointments with clinicians.
But Mohammed believes that more similar services should be vastly available on the NHS.
“I guess we're always fighting for appreciation and understanding of what we do as a service and even though other services do exist, I don't think they're fully understood as to what impact they have and I guess that's partially up to us to translate that.
"But within the trust, little things where you need a room to run a pain management programme, they don't see it as a massive priority because they just don't see the impact that that's having. So the more pain services that exist the more you can really shine on these things.” He said.
"I never knew how addictive they were" : Life after opioids
One woman who has experienced withdrawing from opioids is Kirsty Smith. After her first pregnancy in 2009, Kirsty suffered from two ectopic pregnancies and had a tumour removed from her throat. She then became dependent on co-codamol and antidepressants which were prescribed to balance out her hormones.
By 2016, she had undergone 13 operations, was unfairly dismissed from her job and attempted to end her own life.
The 37-year-old mum from Merseyside has been taking the addictive opiate co-codamol since the age of 14 to relieve endometriosis pain, a chronic condition in which tissue similar to uterine lining grows in other areas, such as the ovaries and fallopian tubes.
“I was completely suicidal, I was taking way too much opioid medications, technically it’s my job to manage the dose but there was nothing else that could be done." She said. "I hit rock bottom. I actually said at the time I wish I had cancer because at least I’d die.”
Kirsty shared that she had been taking up to 32 coco-damol tablets a day which turned her into a completely different version of herself. Sleeping through the days and nights, she lost precious time with her son, husband and friends.
But when she went to study science at university, her whole perspective on opioids changed as she began to learn about the detrimental effects and how they only masked her pain.
“I didn’t know until going to university myself that codeine is actually morphine, it’s ⅙ morphine and that’s really bad. my dad died of a heroin overdose so if I knew that I probably would have never taken it." She said.
"I never knew how addictive they were, I know they now put it on the packet but that’s only recently, going back 15 years I had no idea. Feeling very much like a drug addict is not nice either because you are associated with someone injecting themselves in an alley.”
With the knowledge Kirsty had obtained, she met with her GP and made a joint decision to come off her prescription but it was a slow and painful process.
Kirsty said there was no real exit plan for her, she admitted often finding herself buying similar medicines over the counter due to the side effects, and at times, she did feel like a drug addict.
“As hard as it is to say, you can’t come off this medication without having physical side effects. Being on them for so long and detoxing from them completely was absolutely horrendous, the brain zaps were the worse, I couldn’t think straight, I had nerve problems, excessive pain, bad breath and it all went on for a long time.” She said.
A year later and opiate free, Kirsty said it was the best decision she’s ever made and although the pain is still there, she now manages it through her own topical invention ZX10 and has shared the product around the globe.
“It’s made me really want to help people because people are dying unnecessarily, I know that’s a dramatic statement but it’s coming from my own personal experience.” she said.
Made up of the well-researched ingredients CBD, saffron, nigella, sativa, turmeric and vitamin E, Kirsty created the balm to provide effective pain relief without the risk of addiction or negative psychological impacts.
She has already received interest from nurses and has conducted patient surveys which concluded that 54% of people after three days no longer needed oral pain relief.
When reflecting on her experience, Kirsty said coming off her opioids was the best decision she made and after recovering, her one goal is to make sure other chronic pain patients don’t feel alone.
“I'm a normal person who's a parent and I’m trying my very best, I don’t want other people taking their own lives, you can get off of opioids. I’m not telling people to come off their meds, I just want to say you're not stuck, there is an option and you have got a future."
Samaritans - 116 123 (24 hours a day) or email jo@samaritans.org
National Suicide Prevention Helpline UK - 0800 689 5652 (6pm to midnight every day).
Shout Crisis Text Line – Text “SHOUT” to 85258 (24 hours a day)
Comments