Independent Review Underway Into Opioid Misuse

Peter Russell

February 18, 2019

An independent scientific review has been launched into the use of opioid medicines in the UK to help curb their over-prescription and misuse.

An expert working group of the UK's Commission on Human Medicines met for the first time last week at the Medicines and Healthcare products Regulatory Agency (MHRA) to begin the review of the benefits and risks of opioid medicines, including dependence and addiction.

Public Health England, which was commissioned last year to carry out its own review into dependence and addiction to prescription drugs, is due to report on its findings in the spring.

Advice for Health Professionals and the Public

The MHRA said the working group would consult with experts in the health sector as well as charities and addiction support groups to raise awareness among healthcare professionals and the public on the risks of addiction and how those risks could be managed.

Dr June Raine, director of the MHRA's Vigilance and Risk Management of Medicines division, said: "In response to the growing concern internationally and in the UK about overuse and increased prescribing of opioid analgesics, we are seeking expert advice on the benefits and risks of opioid medicines, including best practice for risk minimisation.

"We will be listening to patients, stakeholders, and relevant experts, and working across the health sector to make sure the warnings on opioid medicines are consistent, clear, relevant, and represent the known risks of tolerance and addiction."

The group said it would draw on best international practice, and would:

  • Consider the current data on the utilisation of opioid-containing medicines in the UK, both prescribed and over the counter

  • Examine whether the risk minimisation measures implemented for over-the-counter and prescription opioids have been effective or whether further measures are required

  • Consider the benefits and risks of opioid-containing medicines in particular for non-cancer indications, taking into account alternatives

  • Make recommendations for regulatory action to better support appropriate use of prescription opioids, such as relevant changes to the summary of product characteristics, labelling, packaging, and patient information leaflets

The group is made up of a wide range of experts in relevant scientific disciplines, including pain management, general practice, pharmacy, rheumatology, and psychiatry and substance abuse.

Increasing Addiction

Prof Jamie Coleman, chair of the opioid expert working group, said: "In taking forward this important work we will focus on providing clear information to healthcare professionals, patients and carers – no one should be unaware of the potential risks of opioid medicines.

"We have set out a clear programme of work to look at regulatory options. We have already planned some initial steps to work with stakeholders to produce consistent and clear label wording that opioid medicines may lead to addiction. We are also going to examine access to opioid medicines."

Prof Coleman, an expert in clinical pharmacology at the University of Birmingham, added: "In the United States there is a so-called 'opioid crisis' due to the increasing misuse of, and addiction to, opioids including prescription pain killers.

"There is no evidence that there is a similar opioid addiction crisis in the UK. However, the use of opioid based medicines has gradually increased in Britain over the last decade or so."

Public Health England Review

Last January, Steve Brine, the public health minister, commissioned PHE to undertake a review on dependence and addiction to prescription drugs and offer recommendations on how to address the problem.

It said the review would consider why prescriptions for addictive medicines had increased by 3% over 5 years.

One patient in 11 (8.9%) was prescribed a potentially addictive drug in 2017, the Government said.

There were further concerns raised from a survey which found that 7.6% of adults had taken a prescription-only painkiller that had not been prescribed to them, and that prescriptions for antidepressants had doubled in the past 10 years.

The review covers benzodiazepines and z-drugs, pregabalin and gabapentin, opioid pain medicines, and antidepressants.

'Alternatives Needed' for Long-term Pain Management

The British Medical Association (BMA) said it was important that alternatives to opioid medication were provided for managing patients with long-term pain.

Dr Andrew Green, BMA GP committee clinical and prescribing lead, said: "There is no doubt that we have an epidemic of opioid use at the moment, and we need to take great care to ensure that we don’t find ourselves in a similar position to the United States, where prescribing is even higher.

"In order to reduce prescribing, it is vital that alternatives to medication are provided for the management of patients with long-term pain, a condition for which we know opioids have little place.

"These patients must have timely access to specialist chronic pain services, provided by a range of healthcare professionals, from secondary care doctors specialising in this area to physiotherapists and pharmacists. All of these professionals can play a part in reducing the need to prescribe opioids, and commissioners have a duty to ensure ready access to them.

"However, as the BMA has highlighted in the past, there is variation in the provision of these services across the country, with pain clinics often not providing a full multidisciplinary team or not having the expertise to deal with the widest range of conditions. Wait times for patients to access these also varies significantly. Mental health support in these clinics can often be lacking too, despite evidence around the advantages of behavioural therapy in helping patients manage chronic pain."

Editor's Note: This article was updated to included a revised quote from the BMA.

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