Is the UK facing its own opioid crisis?

Our Principal Research Fellow, Vicki Osborne, writes:

The opioid crisis in the US is well known and the subject of much debate and media coverage; overdoses involving opioids contributed to over two thirds (67.8%) of overdose deaths in the US in 2017 alone, with 47,600 deaths in total (1,2). Currently, 175 Americans die daily from drug overdoses and the majority of these involve opioids (3). In the UK, we have generally not seen the same levels of use which would cause concern in past years, though it would be complacent to assume that we do not have an issue. According to the NHS Business Services Authority, 12.8% of the adult population in England were prescribed opioids in 2017/2018 (4). A review by Public Health England concluded that this is a decrease in prescriptions from 2016, though arguably this does not mean there is no problem to address (4). This figure only accounts for prescribed opioids and does not consider use of opioids obtained without a prescription or illicit opioids such as heroin. It also only presents findings from England, while Wales, Scotland and Northern Ireland should also be considered.

Prescription opioids are necessary and appropriate when used according to prescribing guidelines, but associated risks, especially where not used according to guidelines, are well documented and should not be ignored. The potential adverse consequences of opioid use include dependence, overdose and withdrawal, which are serious and could place a substantial burden on the NHS. It is encouraging that the Medicines and Healthcare Regulatory Agency (MHRA) is taking action to assess the benefits and risks of opioid medications, with the launch of an Opioid Expert Working Group (5). This group has already recommended that the labelling for opioid medicines must carry a warning that informs patients about the risk of addiction, which was accepted by the MHRA in April 2019 (6). With this action, it is likely we will see an increase in research into the risks of opioids in the UK.

  1. Scholl L. Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017. MMWR Morb Mortal Wkly Rep [Internet]. 2019;67. Available from: https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm
  2. Centers for Disease Control and Prevention. Drug Overdose Deaths [Internet]. 2019. Available from: https://www.cdc.gov/drugoverdose/data/statedeaths.html
  3. Christie C, Baker C, Cooper R, Kennedy P, Madras B, Bondi P. The President’s Commission on Combating Drug Addiction and the Opioid Crisis [Internet]. 2017 Nov. Available from: https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-1-2017.pdf
  4. Public Health England. Prescribed medicines review: report [Internet]. GOV.UK. [cited 2019 Sep 10]. Available from: https://www.gov.uk/government/publications/prescribed-medicines-review-report
  5. MHRA. Opioid Expert Working Group meets at MHRA [Internet]. GOV.UK. [cited 2019 Sep 10]. Available from: https://www.gov.uk/government/news/opioid-expert-working-group-meets-at-mhra
  6. Scottish Drugs Forum. All opioid medicines in UK to carry prominent warnings [Internet]. SDF – Scottish Drugs Forum. 2019 [cited 2019 Sep 10]. Available from: http://www.sdf.org.uk/all-opioid-medicines-in-uk-to-carry-prominent-warnings/