Opioid painkiller dependency (OPD): an overview. A report written for the All-Party Parliamentary Group on Prescribed Medicine Dependency.

Summary: • The growth in the use of OP across many western countries and the subsequent rise in OP dependency and overdose has become a major health concern for international agencies and especially in the United States • In the UK, the subject of OP dependency is chronically under-researched. Despite having some of the highest levels of OP use and sales in the EU and a wealth of anecdotal evidence from individuals, patient group representatives and clinicians about OP dependence, the estimate of those who might be OP dependent varies wildly from tens of thousands to nearly a million. But whatever the figure, it is clear that a significant number of people in the UK are battling with an OP dependency while being ‘hidden in plain sight.’ • Home Office figures released in 2015 revealed for the first time, a cohort of people across the age ranges using OP that were not prescribed to them, often for recreational purposes. This potentially heightens the risk of dependency and overdose among naïve users and is a further indication of the overall level of availability in the community. • Until the publication of the All-Party Parliamentary Group on Drugs report An inquiry into physical dependence and addiction to prescription and over-the-counter medication in 2009, little interest was shown in this issue either from government or professional medical organisations. This has begun to change with, for example, guidelines from the RCGP, the development of assessment tools, professional calls for regular reviews on repeat prescriptions and reductions in packet size for OTC painkillers with additional patient health warnings. • Most people will use their OP in accordance with medical instructions and patient leaflet information. But while in theory anybody could become dependent on their medication, research is establishing that some people are more vulnerable to OP dependency than others. • In the main, those suffering from OP dependency are not willing to attend established community drug treatment centres, but find that there are few specialist treatment options. • Research has shown that GPs and pain specialists are often uncertain as to the best way forward in treating OP dependent patients – and have differing perceptions of the groups most at risk - but new initiatives from drug treatment services are pointing the way towards primary care being the most suitable environment for treatment where GPs work in shared care arrangements. • Growing public and professional concerns about OP dependency has resulted in a consequential increase in patient advocacy and help groups demanding action at both a local and national level. • It is encouraging that steps are being taken to address this issue at a local and national level, but there is still much to be done