NICE guideline advises GPs to stop prescribing opioids for chronic pain

**Interview with former prescription drug addict and drug addiction expert available on request**

Published today, the first ever NICE guideline on the treatment of chronic pain has said that GPs should not prescribe opioids and other medicines like paracetamol to patients because they could be ‘harmful’ and cause addiction.

Eytan Alexander

Alternatives like exercise programmes, CBT, acupuncture or certain antidepressants should be advised instead.

The news is welcomed by drug addiction treatment experts who reveal admissions for prescription drug addiction have risen by 40% in the last 18 months, with the majority of those seeking treatment being female.

The draft guidance reveals that the treatment of chronic pain by commonly prescribed medicines including opioids and gabapentinoids in fact have limited evidence of effectiveness, but that there was evidence that they could be ‘harmful’ to patients and cause addiction.

It states clearly;

“Do not offer any of the following, by any route, to people aged 16 years and over to manage chronic primary pain;

• opioids
• non-steroidal anti-inflammatory drugs
• Benzodiazepines
• anti-epileptic drugs including gabapentinoids
• Paracetamol
• Ketamine
• Corticosteroids
• antipsychotics”

The guidance suggests that: “The lack of evidence for effectiveness of opioids, along with evidence of long-term harm, persuaded the committee to recommend against opioid use for people with chronic primary pain.

“Although there were limitations, evidence from non-randomized studies on the long-term use (more than six months) of opioids for chronic pain suggested an increased risk of dependence.

The committee also agreed that even short-term use of opioids could be harmful for a chronic condition.

As for those already on prescribed opioids, today’s NICE guidelines advises GPs to explain the ‘risks of continuing’ to those already taking any of the above medicines, and also warned of the withdrawal problems that could occur should a shared decision to stop taking the drugs be made.

Today’s report is welcomed by drug addiction treatment experts UKAT (www.ukat.co.uk);

Finally, it is written in black and white the dangers and addictive nature that prescribing opioids and other ‘pain relief’ drugs can have on patients. We’ve seen exponential rises in the number of clients we treat for prescription drug addiction every year for the last four years, and unfortunately, the general consensus for a long time has been that this isn’t a ‘real’ addiction, but trust us, it is. Prescription drug addiction is as real as a Heroin addiction, but in this case, the addict gets their drugs from their GP rather than a dealer, to ‘treat’ their pain. We’re pleased to hear that today, the advice is that this should no longer be an option. GP’s need to be supported and resourced well enough so that they can spend a longer amount of time with their patients in order to provide a more holistic, safer treatment plan for chronic pain. One that doesn’t lead to addiction.”

Eytan Alexander, Managing Director of the drug addiction firm UKAT.

Today’s update follows last year’s Public Health England’s review into prescription drug addiction, which revealed that 1 in 4 adults- over 11m in England - received a prescription for antidepressants, opioids, gabapentinoids, benzodiazepines or z-drugs in the previous year.

Data released by UKAT shows that admissions across its seven rehab facilities for prescription drug addiction has risen by almost 40% in the last 18 months, and that in the last four years, the vast majority (62%) of clients treated were female.