Public Health England Inquiry Finds 540,000 Britons Apparently Dependent on Opioids

On September 10, Public Health England (PHE), an agency of the United Kingdom Department of Health and Social Care, issued a report on the results of its review “to identify the scale, distribution and causes of prescription drug dependence, and what might be done to address it.”  The review covered adults 18 years and older and five categories of prescription drugs: antidepressants; opioids for chronic non-cancer pain; benzodiazepines (mostly prescribed for anxiety); z-drugs (sleeping tablets with effects similar to benzodiazepines); and gabapentinoids (used to treat epilepsy, neuropathic pain, and (for pregabalin only) anxiety).

With regard to opioids, the PHE report included the following findings:

• Prevalence: During 2017 and 2018, 5.6 million adults in England (13 percent of the population) received, and had dispensed, one or more prescriptions for opioids.
• Trends: “After a long increasing trend, the annual number of prescriptions for opioid pain medicines has slightly decreased since 2016.”
• Association with Deprivation: “Prescribing rates for opioid pain medicines and gabapentinoids had a strong association with deprivation, being higher in areas of greater deprivation.”
• Patients’ Experiences: “Higher initial opioid doses and prior mental health problems were associated with long-term use of opioids and opioid dependence, respectively. Prescribing opioid pain medicines for longer than 90 days was associated with opioid overdose and dependence.”
• Long-Term Receipt of Prescriptions: 540,000 adults in England “received a prescription continuously between April 2015 (and perhaps earlier) and March 2018.”

The report stated that there was insufficient evidence to reach conclusions about the effectiveness and cost-effectiveness of service models (e.g., involvement of general practitioners and other primary-care services, helpline and telephone support, and counselling and support groups).  It concluded, with regard to opioid dependence, that “prescriptions for opioid pain medicines are decreasing, after rising for many years,” but that “[l]ong-term prescribing of opioids for chronic, non-cancer pain is not effective for most patients.”

With regard to all five categories of prescription drugs under review, the report set out five categories of recommendations:

1. Increasing the availability and use of data on the prescribing of medicines that can cause dependence or withdrawal to support greater transparency and accountability and help ensure practice is consistent and in line with guidance.
2. Enhancing clinical guidance and the likelihood it will be followed.
3. Improving information for patients and carers on prescribed medicines and other treatments, and increasing informed choice and shared decision-making between clinicians and patients.
4. Improving the support available from the healthcare system for patients experiencing dependence on, or withdrawal from, prescribed medicines.
5. Further research on the prevention and treatment of dependence on, and withdrawal from, prescribed medicines.

Note: While findings regarding any category of prescription drug dependence should be of interest to the United Kingdom medical community, the review’s findings regarding opioids merit particular attention, not least because the review reportedly “was ordered by ministers amid fears of a US-style opioid crisis.”  According to The Sunday Times, Matt Hancock, the United Kingdom’s Secretary of State for Health and Social Care, described the inquiry’s findings as “shocking.”

Previously, The Sunday Times had reported “a huge rise in the number of opioid prescriptions, which had rocketed to more than 40m a year, and inexplicable differences in prescription rates between the north and south of the country.” It also found

that GPs are doling out the drugs to patients for chronic pain — for which they are often no better than a placebo — and failing to review vulnerable patients left on the drugs for years. One patient was on opioids for 15 years.

Other factors in the crisis include the use by drug firms of US marketing tactics in an apparent effort to boost NHS prescriptions of their pills, and rogue online pharmacies that sell opioids, making it easier to access the drugs.

More recently, The Times disclosed “that a review by the Organisation for Economic Co-operation and Development had found opioid use is now falling in the US, while the UK has the world’s third fastest-growing rates of opioid use.”

If these reports are accurate, they closely resemble the reported patterns of behavior that prompted some 2,000 individual plaintiffs, as well as nearly all of the state attorneys general, to sue multiple pharma firms for fostering the opioid crisis in the United States.  How the United Kingdom Government will respond to the PHE report and to these reports about opioid abuse will be of great interest well beyond the borders of England.