So let's start off by defining what an opioid is. An opioid medication is essentially any
medication that works on the morphine receptors in our body. Some people may be alarmed to
learn that some of the drugs they're taking for their pain management actually fall in
this category. We generally define opioid drugs as weak or strong medication preparations.
The weaker ones include codeine phosphate, dihydrocodeine and tramadol.
The stronger morphing preparations include morphine as a tablet itself or as a liquid,
oxycodone, buprenorphine and fentanyl. The number of people using opioids in the United
Kingdom at any one time is largely an unknown, but what we do know is that the prescribing
trend over the last ten years for these types of drugs for non-cancer pain has increased
dramatically. This is a particular problem as we're starting to learn that long-term
use of these drugs cause real harm and problems for the majority of individuals.
So generally speaking, opioids are prescribed for the management of pain of some sort. There
are certain conditions where doctors might consider using opioid medications, but these
are very rare and these include the management of certain respiratory disorders or cardiovascular
issues. In general, as I mentioned, opioids are prescribed for the management of pain
and this pain could be what we term acute pain, end-of-life or cancer pain, or for chronic
long-term mechanical pain.
So let's start off by defining a few of the terms in the question. Acute and chronic are
terms often used by patients to try and define the severity of their symptoms. Medically,
we use these terms to define time. So an acute episode or acute pain is pain that lasts up
to about three months and if it lasts longer than three months, we define as chronic.
With regards to use of opioid medications, there's very good evidence for the use of
these medications in an acute episode. So an example of that would be after trauma or
a broken bone, for example or after surgery.
Interestingly, there's very little evidence that these drugs are helpful in chronic long-term
pain management, but what we do know is that the use of these drugs in the long-term can
be extremely harmful indeed.
Nobody truly understands how addiction occurs to a substance or a drug. We do know that
patients bring with them certain behavioural characteristics that might predispose them
to developing addiction. That includes known addiction to certain substances such as alcohol
or smoking.
Other elements are important such as a background of anxiety or depression and these traits
do predispose an individual to developing addiction to drugs such as opioids. We also
know that complex neurological changes occur, such as an increase in the development of
certain neurotransmitters or changes in the brain circuitry that predisposes an individual
to development of addiction.
The important message here is that even if you don't believe that you have these behavioural
traits, these neurological changes means that everybody is at risk of developing addiction
when placed in front of these drugs for a long period of time.
So the fact that an individual has chronic pain, so that's pain lasting more than three
months, means that there's no simple mechanical fix for their pain. Often patients bring baggage
with them. So their thoughts about their pain changes, their behaviour changes, the way
they walk or partake in activities, all change. So when dealing with an individual with chronic
pain, we look at all of these elements to try and help that patient manage their pain
better.
So the kind of tools that we use to help patients with chronic pain include psychological strategies,
physical therapies, looking at alternative drugs especially discussing around the subject
of opioids and for a group of patients injections may also form a part of their management strategy.
The first thing is to identify that you are a high-risk individual for addiction and that
can be simply you've noticed you've been taking these drugs for a long period of time or you've
changed your behaviour around the use of these drugs. For example, you start to become anxious
about going away on holiday or making sure you have enough tablets.
The good news is that for the majority of people, a slow weaning programme is enough
to remove yourself from these drugs very safely. For a very small percentage of people, we
may need to bring an additional help to try and withdraw these medications without the
development of withdrawal side effects and that may even require the use of substitution
drugs to help bring you off these medications safely.