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Opioid safety



Recent reports have sounded alarms about the inappropriate use of prescription opioids but pharmacists should lead intelligent and sensitive education about these essential drugs
There is evidence of a growing problem with opioid prescription drugs and experts believe that it should now be considered an urgent public health issue.
In the US, the number of women dying from overdoses of opioid painkillers increased fivefold between 1999 and 2010, according to recent data from the US Centers for Disease Control and Prevention. In fact, deaths due to prescription drugs have overtaken deaths due to cocaine and heroin. As a result, the Food and Drug Administration (FDA) has now invoked its authority to require stronger safety labelling for extended release and long-acting opioid analgesics. New labelling will also include a warning that chronic maternal use of these products during pregnancy can result in neonatal opioid withdrawal syndrome.
In the UK, there is growing concern over the increasing number of tramadol-related deaths. The number of doses of precribed tramadol increased from approximately 5.9 million in September 2005 to 11.1 million in September 2012. The numbers of deaths linked to tramadol use appear to be increasing sharply and these are almost invariably associated with ‘non-prescribed’ tramadol. Tramadol is not currently classed as a controlled drug and can be obtained over the internet for personal use. Experts believe that its complex pharmacology is not widely understood and the potential for harm is underestimated. Consideration now being given to the reclassifcation of tramadol so that it would be a criminal offence to possess it without a prescription.
In the US, more people now seek treatment for dependence on prescription opioids than for dependence on heroin. The International Narcotic Control Board recently noted that dependence on prescription opioids is a problem in almost all countries, including the UK.
The most important factor in this changing pattern has been an increase in opioid prescriptions for chronic pain with causes other than cancer. In the UK, the number of opioid prescriptions increased from approximately three million in 1991 to more than 15 million in 2009.
What does all this mean for pharmacy? There can be no doubt that chronic pain must be treated adequately and opioids remain an important treatment option. However, the benefits of appropriate opioid use need to be balanced with the risk of dependence – and this needs to be done in an intelligent and sensitive way. One of the dangers of heavy-handed publicity about the dangers of opioids is that the use of any opioid can be stigmatised.
Part of this process must also include educating patients and the wider public about the safe and appropriate use of opioid analgesics. In his keynote address at last year’s American Society of Health System Pharmacists’ Clinical meeting, former US President, Bill Clinton, drew attention to the rising number of deaths due to prescription opioids. He said that many people were unaware of the respiratory depressant effects of opioids and the potential for ‘accidental’ death. He called on pharmacists to help to educate people about these dangers.
For many people, the pain relief that opioid analgesics can bring is essential for meaningful living, and hospital pharmacists have an important role in helping patients to use this treatment effectively. We believe that this topic is so important that we have invited Professor Arthur Lipman, a distinguished pharmacist with well-published expertise in pain management, to give the opening address at the forthcoming
HPE Live congress on 29 October in Birmingham ( We look forward to seeing you there.

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