Chronic pain and painkiller addiction
Problematic painkiller use
• Misuse (when painkillers are used incorrectly in an incorrect manner)
• Abuse (when they are used for reasons other than to relieve pain)
• Addiction – but defined how?
• Pseudo-addiction – when untreated pain causes behaviour that looks like addiction
When self-management and self-medication go wrong, eg in April 2016
Post-mortem confirms Prince died from an accidental overdose of a potent painkiller”
“Medical examiner reports singer had taken fentanyl …”
“Investigation now focused on who supplied the drug …”
Undertreated pain and ‘pseudoaddiction’
Patients’ reports of pain are not accepted or believed
They resort to exaggerated or manipulative pain behaviours to obtain pain relief
Those behaviours are perceived by staff as signs of drug addiction
Trust breaks down and pain is not properly treated
, Drug overdose deaths in England and Wales, 2020 (ONS, 2021)
4,561 drug poisoning deaths in England and Wales in 2020 (3.8% higher than in 2019)
2,996 (two-thirds) related to drug misuse
2,263 deaths involved an opiate:
1,337 heroin and morphine 212 codeine
516 methadone 203 tramadol
102 oxycodone
96 dihydrocodeine
57 fentanyl
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/
deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2020
Deaths related to opioid analgesics, England and Wales, 2000-2020 (ONS, 2021)
300
Number of deaths
250
200
150
100
50
0
Tramadol Codeine Dihydrocodeine
Oxycodone Fentanyl
Europe vs USA
Rates of death by drug overdose: Seven times higher in the USA than in Europe
Factors related to differences:
• Cultural perceptions of pain
• Perception and treatment of opioid use disorder
Problematic painkiller use
• Misuse (when painkillers are used incorrectly in an incorrect manner)
• Abuse (when they are used for reasons other than to relieve pain)
• Addiction – but defined how?
• Pseudo-addiction – when untreated pain causes behaviour that looks like addiction
When self-management and self-medication go wrong, eg in April 2016
Post-mortem confirms Prince died from an accidental overdose of a potent painkiller”
“Medical examiner reports singer had taken fentanyl …”
“Investigation now focused on who supplied the drug …”
Undertreated pain and ‘pseudoaddiction’
Patients’ reports of pain are not accepted or believed
They resort to exaggerated or manipulative pain behaviours to obtain pain relief
Those behaviours are perceived by staff as signs of drug addiction
Trust breaks down and pain is not properly treated
, Drug overdose deaths in England and Wales, 2020 (ONS, 2021)
4,561 drug poisoning deaths in England and Wales in 2020 (3.8% higher than in 2019)
2,996 (two-thirds) related to drug misuse
2,263 deaths involved an opiate:
1,337 heroin and morphine 212 codeine
516 methadone 203 tramadol
102 oxycodone
96 dihydrocodeine
57 fentanyl
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/
deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2020
Deaths related to opioid analgesics, England and Wales, 2000-2020 (ONS, 2021)
300
Number of deaths
250
200
150
100
50
0
Tramadol Codeine Dihydrocodeine
Oxycodone Fentanyl
Europe vs USA
Rates of death by drug overdose: Seven times higher in the USA than in Europe
Factors related to differences:
• Cultural perceptions of pain
• Perception and treatment of opioid use disorder
