It is not easy to get a comprehensive picture of the overall situation regarding the prescribing of OP and the purchase of codeine-containing OTC formulations, but piecing together the evidence from various datasets reveals that the UK population is consuming considerable and increasing amounts of OP:
In 2012, some ten million people in the UK were prescribed an OP, more than double the next nearest EU country France at four million
In 2013, the UK had the highest sales of morphine by volume than any other country in the EU
In 2013, the UK had the highest sales of opiates like codeine by volume than any other country in the EU and between 2010-2013 the UK had a 6% growth in sales, against the next largest margin increase in the EU.
In 2011, Northern Ireland has highest annual prevalence of prescription opioid use in the world (8.4%)
In the period 1994-2009, Tramadol prescribing increased tenfold and all OP showed significant increases in level of prescribing during this period with the exception of dihydrocodeine. Just in England, the number of prescriptions rose from around three million in 1991 to 23 million by 2014.
Defined Daily Doses for Tramadol in England have increased from 5.9 million in 2005 to 11.1 million in 2012.
Between 2001-2011, prescription for co-codamol almost doubled from 8.8 million to 15 million
Since the early 1980s, the extensive professional, political and media discourse about drug misuse and addiction has centred on the use of a wide range of illicit drugs such as heroin, cocaine, cannabis, amphetamine, and ecstasy. There is also a public and professional awareness about the dependency potential of tranquillisers and antidepressants highlighted, for example, by class actions brought against pharmaceutical companies, media reports and articles, popular and medical books, TV documentaries, and guidelines produced by the medical profession to advise against over-prescribing. That said, the very existence of this APPG indicates continuing and very real concerns not only about the startling level of prescribing of tranquillisers and antidepressants3, but also the lack of specialist help underlined by the recent closure of some of the few charitable helping agencies that do exist.
In recent years too, there has been a growing awareness of the dangers of OP, most notably dependency and overdose. The evidential base is most developed in the USA where celebrity revelations including Michael Jackson, Burt Reynolds, Melanie Griffiths and Jamie Lee Curtis have served to foreground the risks demonstrated by the epidemiological evidence and clinical case reporting.4 It has been suggested that much of the problem has derived from the progression from only prescribing OP for acute pain and cancer treatment to more generalised chronic pain conditions which has led to more widespread misuse and rising mortality in many Western countries.
In the UK, public and professional awareness in the UK of the potential dependency and overdose risks of OP has been patchy. Despite some sporadic press coverage going back into the 1990s, the subject really didn’t hit the headlines until 2009 with the publication of the All Party Parliamentary Group on Drugs report, An inquiry into physical dependence and addiction to prescription and over-the-counter medication. The remit covered tranquillisers, anti-depressants and OP and MPs took evidence from campaigners, doctors, clinical researchers, government agencies and the pharmaceutical industry.
Opioid painkiller dependency (OPD): an overview.
A report written for the All-Party Parliamentary Group on Prescribed Medicine Dependency by Harry Shapiro