Opiate Dependence in the UK – from Prescription to Addiction

If you’re in pain or injured, it’s natural to wish for effective pain relief. You want a medication to reduce unpleasant sensations. Perhaps you buy a packet of codeine at the pharmacy – you take a dose and your pain subsides. Or maybe you’ve tried over-the-counter opiates already and they don’t work anymore. Your doctor prescribes a drug such as tramadol or you buy stronger opioids online. When you first take them, it seems a bit easier to cope again – but within weeks or months, your pain gets worse. Plus, there are new mental and physical symptoms that you didn’t have before – are these part of your original condition or are they signs of addiction?

This is an example of how opiate tolerance progresses to a physical and psychological addiction. It can be a subtle process with symptoms of addiction being wrongly ascribed to a longstanding chronic pain condition. Understandably, patients want an end to their suffering – whether it’s persistent pain after an operation, a disabling back problem, nerve damage or muscular pain. Initially, opiates can seem like the answer – relieving physical soreness and even inducing euphoria or emotional relief. However, there is little evidence that opioids are effective in treating long-term pain and they can be addictive. [1] 

Jason Shiers, Psychotherapist at UK Addiction Treatment said: ‘Whether you’re taking opiates on prescription or purchasing them online or over-the-counter, these drugs carry a high risk of dependence if used regularly. Of course, opiates have an essential place in treating acute pain and in end-of-life care, but for patients with chronic pain there are more effective treatments. Non-addictive painkillers, talking therapies and opiate detox and rehab for people struggling should always be offered or sought out.’

The Risk of Opiate Addiction

Opiate-based medications include codeine, dihydrocodeine, tramadol, morphine, diamorphine, fentanyl, oxycodone and hydrocodone. With continued use of any opiate drugs, your risk of addiction increases.

Over the medium to long term, opiate use causes changes to the brain. Opiate receptors become less responsive to the drugs (tolerance). This means you need to take higher doses or stronger medications to get the same effect. 

When opiate dependence sets in, moderate to severe withdrawal symptoms kick in after the last dose wears off. This sets up a vicious cycle of using more opiates to relieve the effects of withdrawal. 

Opiate addiction is the inability to stop taking opioid drugs, despite increasing evidence of harmful consequences to health, relationships and life prospects. You may have tried to quit and found it too difficult to sustain. Or you might never have attempted to stop, fearing what life will be like without opiates. In the advanced stages of addiction, usually most of the pleasurable effects have long gone.  

Physical and Psychological Signs of Opiate Addiction

The physical and psychological signs of opiate addiction are most obvious in the withdrawal phase. For most long-term opiate users, abrupt cessation triggers intense cravings to use more, to relieve their distress or pain. This is why it’s essential to seek medical help to detoxify safely from opiates – most importantly to reduce the risk of relapse, accidental overdose and severe withdrawal symptoms.

Physical symptoms of opiate withdrawal include:

  • Muscle aches and pains
  • Runny nose
  • Loss of appetite
  • Insomnia 
  • Fatigue
  • Stomach cramps
  • Nausea
  • Vomiting
  • Diarrhoea
  • Changes to heart rate and blood pressure
  • Changes to body temperature/ fever
  • Blurred vision
  • Sweating
  • Shaking

Psychological symptoms associated with opiate withdrawal include:

  • Anxiety
  • Irritability
  • Poor concentration/ brain fog
  • Restlessness
  • Depression
  • Paranoia
  • Loss of interest in other areas of life
  • Craving another addictive substance or behaviour 
  • Despair 
  • Suicidal thoughts or actions

The Steep Rise in Opiate Prescribing 

In England and Wales, prescriptions for opiate painkillers have increased by more than 60% in the past decade. In 2008, there were 14 million opioid prescriptions issued. In 2018, there were 23 million. [2]

Public Health England found that 5.6 million adults (13% of the population) had been prescribed opioids between 2017 and 2018. Of these 500,000 had been taking opioids continuously for at least three years. [3]

The high incidence of chronic pain may be one reason why opiates are being prescribed at record levels. In 2016, a study published in the British Medical Journal found that chronic pain affects between one third and one half of the UK population – just under 28 million people. [4]

Opiate Detox and Rehab

If you think you’re addicted to opiates, the first step is to have an assessment with an addiction treatment professional. This can be done in person or over the telephone. The assessor will ask questions about your opiate use, as well as physical and mental health symptoms, other illnesses you have and whether you want to stop using opiates entirely. 

A medical detox is the safest way to clear your system of physically addictive opiates. Rehab treatment usually takes the form of intensive therapy in a residential setting, through which you discover the root causes of your addiction and you learn how to live life in recovery. 

[1] https://www.england.nhs.uk/south/info-professional/safe-use-of-controlled-drugs/opioids/

[2] https://www.bbc.co.uk/news/health-48082736

[3] https://www.nhs.uk/news/medication/1-4-people-take-addictive-medicines-finds-review/

[4] https://bmjopen.bmj.com/content/6/6/e010364

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