Rise in use of opioid painkillers likely reflects a 'failing health system'

The study highlighted by the 'Irish Examiner' on Friday suggested long waiting lists for orthopaedic care can leave people with severe chronic pain 'potentially waiting several years to be considered for joint replacement surgery'.

Opioid painkillers are “not being given out like smarties” by medics but an increase in their use likely reflects a failing health system, a leading addiction counselor said.

The Irish Examiner reported recently of a 25% rise in opioid use and a 50% increase in medication containing oxycodone, medications which can be highly addictive.

“Inevitably, where you have a 50% increase in the prescription of something like oxycodone, you're going to have a corresponding but not necessarily proportional increase of cases presenting to addiction services because opioids are addictive,” addiction counsellor Michael Guerin said.

“The root cause of this increase is most likely a failing health system exacerbated by a period of time of nearly two years during the pandemic where no elective surgeries were done and where hospital capacity was basically taken out of action to cater for patients who were suffering from covid."

Addiction to opioid pain killing medication "is something that has been on our radar for years," Mr Guerin said.

It can start with something as innocent as Neurofen Plus.

“But we haven't necessarily seen a spike [in need for addiction services] that would correspond with the 50% increase in prescribing.” 

A new study which included UCC academics found that Irish people use far more pain medication than patients in England.

Long waiting lists for orthopaedic care, such as knee operations, can leave people with severe chronic pain “potentially waiting several years to be considered for joint replacement surgery” and relying on medication in the meantime, the study team warned.

Medicines given to patients with medical cards in Ireland between 2014 and 2022 were examined in the research.

Mr Guerin said that GPs are both responsible and very well aware of the ramifications of prescribing medication like oxycodone or any opioid-based painkiller.

“But when they have a patient presenting with chronic pain long-term due to the fact that they either have a chronic condition or are awaiting some sort of surgery or intervention that there is an inordinately long waiting list for, the doctor has a moral and human responsibility to alleviate that suffering.

If you take something like oxycodone over a period of time you would certainly become dependent on it and if you are somebody who is predisposed to being addicted, you will become addicted.

“So if a doctor prescribed you two oxycodone a day for six months and you were to discontinue them you would suffer withdrawal. Whereas, if you were addicted to them, you'd get your 28 day supply of oxycodone or whatever it was, and you'd have them taken in a week or less.

“They are traded, not to any great extent, but they have been encountered in the black market. And they're something that people need to be very wary of."

Doctors are prescribing them "as a very last line of defence," Mr Guerin said. 

Some 10,000 Americans now die every year from opioid overdoses, many of whose addictions were sparked by poor prescribing practices for  Oxycontin, he said.

What's your view on this issue?

You can tell us here

“I don't think we have a situation with prescribed opioids anything like that here but I suppose there is the danger if somebody is prescribed something like that that they could potentially graduate [to something stronger] or supplement it with over-the-counter opioids."

And supplementing with over-the-counter opioids like Nurofen Plus and Solpadine is extremely damaging because such high volumes of the tablets are taken to get enough codeine (an opioid) to quell the craving, he said.

“So people can end up with all sorts of problems with their internal organs – liver, kidneys, GI tract, stomach, bowels - they can end up with all sorts of problems."