Drink and Drugs News DDN September 2018_V2 | Page 9

painkiller addiction
No quick fix
I
We need to rethink our relationship with pain, says Dr Simone Yule
t’s becoming a well-told and oft-repeated story: a
patient that either had an accident or injury or a
major illness is started on high dose opioids for
pain relief in hospital, and is discharged with a
prescription of something like the highly
addictive liquid oramorph. They are offered little
explanation of how to treat this drug and then have
an expectation that they need it and will be prescribed
it until the pain stops.
Because of how opioids work, the body builds up a
tolerance and if the prescription does not facilitate
that pain relief then patients will take more and more
to reach the same level of relief. This can then result in
patients seeking the medication through alternative
sources such as buying illicitly or online. Wherever
there is demand, there is supply.
Unless we rethink how we tackle pain
management and pain relief we will hear this
narrative more and more. It has become a regular
story in my work with Action on Addiction, with the
number of patients at our treatment centre seeking
help from prescription medication addiction now
matching those seeking help from illicit drugs.
This is not one person’s fault – not the surgeon, the
GP, the patient, the outpatient care nor the treatment
centres. But every part of this chain needs to come
together to create a healthy and holistic solution to
pain management that quickly gets patients off drugs
and back to living a realistic pain-managed life.
DRUG EDUCATION
We have seen many more patients, particularly
orthopaedic patients, prescribed high-dose opioids
such as the fast-acting liquid oramorph, with no clear
guidance of how long they should be on this
medication and no clear understanding of what it does
and how powerful it is. In my experience, patients are
often discharged with a significant amount of
medication and no direction given to the primary care
team as to what the ongoing treatment plan is.
We need better education for the patient, and
better planning and communication between
hospitals and the primary care team regarding the
patient’s discharge, so the whole team including the
patient are part of the process and understand the
required outcome.
PRESCRIPTION MANAGEMENT
GPs could improve methods for policing repeat
prescriptions. In our surgery group we have strict
monitoring of opioid prescriptions and we now have a
warning on our computer, for anybody on a long-term
prescription to be reviewed.
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I saw a patient recently who had previously suffered
a major road traffic accident and was quite debilitated
and on high-dose opioids. It was highlighted that he
was requesting more than he should be, so I brought
him in. It turned out that he was desperate to get off
medication, but because he had not had the support
from physiotherapy and the rehab service following his
accident, he had no alternative other than to continue
taking painkillers. Without a warning system it could
have been many more months of repeat prescriptions
before his desperate situation was clinically managed.
BETTER ACCESS TO REHABILITATION
I fully believe in the holistic approach to pain
management. The drugs are a quick fix and should
only be used in the immediate aftermath of an
accident or illness. I think true rehab, where you are
looking at the psychological aspects and physical
rehabilitation to manage and help alleviate the pain, is
not nearly accessible enough.
I have one patient, in significant pain, who has to
travel 25 miles to their nearest rehab centre.
Taking the time and considerable effort
to make that journey once a week for
him was not possible and so his
recovery time extended, meaning
his time on high dose painkillers
also extended. In some parts of
Britain the distance is much
further than 25 miles.
DE-STIGMATISING TREATMENT
There is still a public perception that drug treatment
centres are for illicit drug addiction and somehow
patients should be able to come off prescribed drugs
without help. We need a lot more publicity about
prescribed medication treatment and how you can
access it, and the long-term benefits of seeking this
treatment.
At Clouds House, the treatment centre run by Action
on Addiction, we are seeing considerably more people
coming in addicted to not only opioids, but drugs like
pregabalin, a prescribed non-opiate medication. The
fortunate ones who seek help, or are guided to that
help by a GP or family member, come to realise that this
addiction is serious but with the right treatment it can
be overcome.
Obviously, to create healthier planning around pain
management, making it accessible for all patients,
requires funding. The pressure to discharge patients
quickly, to reduce waiting times in GP clinics and to cut
outpatient services, all means we reach for the quick fix
and we will all pay the price somewhere else
down the line. The only
winner is the drug
company.
Dr Simone
Yule is an NHS
doctor and
Action on
Addiction’s
clinical lead
‘The number
of patients at
our treatment
centre seeking
help from
prescription
medication addiction now
match those seeking help
from illicit drugs.’
September 2018 | drinkanddrugsnews | 9