The Hidden Cost of Pain: Understanding the UK’s Opioid Crisis.
Pain affects millions of us, but the medication we turn to for relief can sometimes create a much bigger problem. With opioid-related deaths continuing to cause concern and millions of pounds being spent addressing dependency, is it time to rethink how we manage pain?
Most of us have reached for painkillers at some point. A headache, an aching back, painful joints or a sleepless night caused by discomfort can leave us desperate for relief. When a medicine is prescribed by a doctor, we naturally assume it is safe to take. But when it comes to opioid painkillers, the picture is more complicated.
Opioids are medicines that act on receptors in the brain and nervous system to reduce pain. They include codeine, dihydrocodeine, tramadol and morphine. They can be essential following surgery or a serious injury and may be appropriate for certain other conditions. Codeine is also found in some pharmacy medicines, including co-codamol.
These medicines have an important place in healthcare. The problem is the assumption that, because they are prescribed, they carry no significant risks. Opioids can cause side effects, tolerance and physical dependence, even when taken as directed.
The worrying figures behind the opioid crisis
The scale of opioid use in the UK is concerning. Figures presented at an event examining the country’s pain epidemic put the number of people prescribed opioids each year at more than 5.3 million. The discussion also highlighted an estimate of 40 opioid-related deaths every week.
These are sobering figures, particularly when we consider that many people begin taking these medicines for entirely legitimate medical reasons.
The financial implications are equally striking. Estimates from York Health Economics Consortium, commissioned by ombogesic®, an over-the-counter opioid-free pain relief medicine, put the annual economic burden associated with opioid prescribing in the UK at approximately £1.17 billion, taking healthcare costs and wider societal impacts into account.
Unnecessary opioid prescribing is estimated to cost the NHS around £240 million a year. Figures presented at the event also put annual counselling costs associated with opioid abuse at more than £343 million.
These figures represent more than money. They reflect the pressure on healthcare professionals, treatment services and families, as well as the personal cost to people who find themselves struggling with dependence.
When avoidable harm places additional demands on the NHS and other support services, resources are diverted from other areas of care that also need them. It is a reminder that the way we manage pain has consequences that extend well beyond the prescription itself.
How easily can dependence develop?
One of the most important things to understand about opioid dependence is that it is not simply a question of misuse.
Someone might start taking painkillers after an operation, an injury or because of persistent pain. They follow the instructions and find that the medication helps. Over time, however, their body may become accustomed to it.
Tolerance can develop, meaning the same dose no longer provides the relief it once did. Physical dependence can also occur, with withdrawal symptoms developing if the medicine is reduced or stopped too quickly.
Research highlighted during the event suggested that around one in three people taking opioids for more than three months showed signs or symptoms of dependence. This underlines why longer-term use deserves careful consideration, with regular reviews of whether the medication is still helping and whether its benefits outweigh the risks.
It is important to distinguish physical dependence from addiction. They are not the same thing, and neither should be used to label or judge someone who needs pain relief.
However, patients do need clear information about the potential risks, particularly when treatment continues beyond the short term. If you are concerned about your medication, speak to your GP or pharmacist. Do not stop taking prescribed opioids suddenly without medical advice, as a gradual reduction may be necessary.
Is pain becoming an epidemic of its own?
We cannot discuss opioid use without recognising the other side of the story: people are in pain, often every day, and they need effective help.
Figures presented at the event suggested that around 10 million people in Britain experience pain almost daily, with two in five people reporting daily pain. Much of this was described as mild-to-moderate discomfort, but even pain that appears manageable on paper can have a considerable effect on everyday life.
Anyone who has struggled to sleep because of a bad back, found walking uncomfortable or felt unable to concentrate because of a persistent headache will understand how quickly pain can take over.
There is no single explanation for why so many people experience it. An ageing population means more people are living with conditions affecting their joints and mobility. Obesity can put additional pressure on knees, hips and backs, while a lack of movement may contribute to reduced strength and flexibility.
Stress, low mood and social isolation can also influence how we experience pain and how well we cope with it. Stress-related tension headaches are one familiar example, while persistent pain can itself affect sleep, mood and our ability to manage everyday responsibilities.
For some people, working from home may mean spending more time sitting and moving less during the day. But the wider issue is that pain management needs to consider the person as a whole, rather than simply treating a symptom in isolation.
Does your postcode influence your pain relief?
Another issue raised during the discussion was the variation in opioid prescribing across England.
The figures presented suggested that 12.7% of patients registered in Norfolk and Suffolk were prescribed opioids, compared with 5.39% in West and North London. That is a considerable difference and raises questions about why prescribing rates vary between areas.
Of course, differences in prescribing do not automatically mean that patients are receiving inappropriate treatment. Local populations, individual medical needs and the conditions being treated can all influence prescribing decisions.
However, the figures prompt an important question: could the approach to pain relief depend, at least in part, on where you live?
Patients should have access to appropriate, evidence-based pain management wherever they live. If prescribing rates vary significantly, it is worth exploring whether there are differences in clinical practice, access to alternative treatments or the support available to people living with persistent pain.
Pain relief should be guided by individual need, with patients given a fair opportunity to explore the treatments most appropriate for them.
Could we manage pain differently?
The answer is not to suggest that everyone should avoid opioids. For some people, these medicines remain an appropriate and necessary part of treatment. The challenge is to ensure they are prescribed when they are likely to help, with the right safeguards and regular reviews.
For some people, combining different pain-relieving ingredients may offer another option. Combogesic®, for example, combines paracetamol (500mg) and ibuprofen (150mg) in one tablet. As a result, the unique 3.3:1 ratio in Combogesic® is clinically proven to be 80% more effective than paracetamol alone and 30% more effective than ibuprofen alone. Plus, this product balances greater amplification of pain relief from both compounds (paracetamol and ibuprofen) with the lower dose of ibuprofen (50mg less per tablet)[1] to reduce the risks of gastric side effects. It is intended for the temporary relief of a range of complaints, including headache, migraine, tension headache, muscular pain, backache, period pain, toothache, fever, aches and pain from colds and flu, sinus pain and sore throat.
As with any medicine, it is important to check whether it is suitable for you and follow the patient information leaflet. Combogesic® is intended for short-term use, for no longer than three days unless advised otherwise by a doctor. It is one example of an opioid-free option, although combining painkillers is not suitable for everyone.
As with any medicine, it is important to check whether it is suitable for you, read the patient information leaflet and follow the recommended dosage. An opioid-free option will not be right for everyone, but it is one example of how different approaches to pain relief may help some people manage their symptoms without turning to opioid medication.
There are also approaches that do not rely solely on medication. Physiotherapy, appropriate exercise, improving sleep, psychological support and practical ways to manage stress may all have a role in helping people live with particular types of persistent pain.
Gentle movement and building strength can help with some musculoskeletal conditions, while psychological approaches such as cognitive behavioural therapy may help people manage the impact of ongoing pain.
None of these options is a universal solution, and people living with severe or chronic pain should not be made to feel that their symptoms are somehow less real because they are encouraged to explore alternatives.
The important thing is to consider the full range of appropriate treatments, rather than automatically moving towards stronger medication without reviewing the bigger picture.
A better approach to pain relief
What is needed is a more joined-up approach to managing mild-to-moderate and ongoing non-cancer pain, with appropriate non-opioid options considered where they are likely to be effective.
That means better conversations between patients and healthcare professionals, clearer information about the risks of longer-term opioid use and more support for people whose pain is affecting their quality of life.
It also means recognising that pain is not always just a physical issue. Stress, loneliness, reduced mobility and poor mental wellbeing can all play a part, and some people need more than a prescription to help them manage.
Patients should feel able to ask questions about their medication without fear of being judged or having their pain dismissed. Equally, healthcare professionals need the time and resources to explore the most suitable treatment for each individual.
The financial figures are alarming, but the human cost is what really matters. Behind every prescription is a person seeking relief, and behind every case of dependence is someone who may need help to regain their health, confidence and quality of life.
We should not have to choose between living with pain and risking the consequences of medication that may no longer be the best option.
Perhaps the real question is not simply which painkiller works best, but whether we are giving people the right information, support and range of treatments in the first place.
Poppy Watt
[1] Combogesic® has 50mg less per dose of ibuprofen than other combined paracetamol and ibuprofen medicines