The other side of the opioids crisis

Following Andrew Gregory’s article in the Sunday Times on 24th February 2019:

https://www.thetimes.co.uk/article/britains-opioid-crisis-we-are-sleepwalking-towards-carnage-in-our-communities-7tjlzzq7x

And the British Medical Journal’s research that shows that between a third and a half of all UK adults live with chronic pain (defined as pain lasting more than 3 months), with a trend towards increasing prevalence with increasing age from 14% in 18–25 years old, to 62% in the over 75 age group. Hence the proportion of people suffering can be expected to increase, in line with an ageing population.

https://bmjopen.bmj.com/content/6/6/e010364.full

These made me feel the need to write to Andrew – and here is the text from my email:

Dear Andrew –

I felt the need to write to you after your articles on the opioid epidemic that you suggest is hitting the UK, as it has hit the USA. I agree with your concerns. But I think that the other half of the story is one that needs to be told too – our societies are simply are not managing chronic pain and the unintended consequences of not managing this are showing at the moment in opioids, but will move somewhere else if the solution is simply to cut down prescriptions. A friend who is a member of the Police Department in one of the northern states of the USA talks of the significant increase in the number of suicides that he now attends where people killed themselves because they could not find relief from the pain when they were no longer prescribed the painkillers.

Perhaps there is a follow-up feature with case studies of those in chronic pain who could be jeopardised by culling prescriptions and some case studies of the equally sad stories of those whose chronic pain was not addressed (which had outcomes equally, or perhaps even more sad than those featured in this week’s Sunday Times). The goal has to be for a real look at the challenges and potential solutions to this multi-faceted problem – as hopefully my comments below lay out.

My own experience is that I had an accident 15 months ago and have been in debilitating pain. I went from someone who was a keen marathon runner and representing Great Britain for my age group for Triathlon at World and European level to someone whimpering in pain, whilst lying on the floor. I freely admit that in my whole life what I thought was pain was really a little discomfort – for instance, taking ibuprofen for an ear infection, or massaging sore muscles after a marathon. And that is what is hard about pain – you can only know once you have experienced the jagged, searing, burning pains that make you think that your body will die of them (and sometimes lead to extended shuddering of the muscles, an inability to breathe properly and a racing heart-rate that implies that you are running a 10K race flat-out) and then when you realise that your body is not going to die of them, you  wonder if you would prefer that it did – as any quality of thought, life or enjoyment is out of the question. To those who simplistically suggest lighting an aromatherapy candle and practising breathing and mindfulness exercises, they are not talking of the pain that I talk of.

And so painkillers are what give you hope – after lying, shuddering for 16 hours on a bed in A&E counting up to 30 over and over and over, with a perspiration outline around you on the bed and then being told that it will be 5 weeks before you can see a spinal surgeon, it is painkillers that eke you through the sleepless hours, days and weeks to get to that appointment.

Or after surgeries, as you lie alone whilst the world merrily carries on and you try to get through just one hour at a time – sometimes not knowing whether that hour is a daytime hour or a night-time hour. Having sat with others in chronic pain, I know that people turn to alcohol and illegal drugs to escape their personal prison of agony. And sadly some people take their own lives as the ultimate escape. Taking away painkillers will only increase these other unofficial solutions. 

Through all of this the GP is the frontline. In the British medical system they are the lead contact who coordinates the rest of the treatment). The challenge is that with the pressure on the medical system, the waiting times for appointments are very long (even when you are in chronic pain) and the ageing population means that there are more people suffering. So what is the alternate option for the GP to prescribing painkillers? Who will take up the slack in the system to address the gap?

It is fair to say that the current approach with painkillers for chronic pain is a blunt tool. But if that tool is confiscated, what takes its place?

25th February 2019

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