Doctors advised to avoid prescribing opioids for long-term pain due to lack of evidence

Dr Niamh O’Brien: 'Prescription opioids are really limited in the evidence base for using them in any way long-term.' Picture: Shane O'Neill/Coalesce

Doctors have been urged to avoid prescribing opioids for long-term pain by a GP specialist in addiction services who said there is little to no evidence it helps patients.

Drug addiction concerns often focus on illegal drugs, but the Irish Medical Organisation’s annual conference heard there is a wider range of risks.

Dr Niamh O’Brien a GP in Galway and, working with the HSE West drug service, called on doctors to consider harm reduction. Opioids used for pain include codeine, tramadol, oxycodone, and morphine.

“Prescription opioids are really limited in the evidence base for using them in any way long-term,” she said.

"If you’re going to use them, please, please use them for short periods of time.” 

Dr O'Brien focused on the difference between treating acute pain and long-term pain.

“Once pain goes into that chronic, longer than three months, [state], there is no evidence for opioids. Anyone who thinks they need their opioids at that stage is physically dependent,” she warned.

Over-the-counter medication concerns

Dr O'Brien also flagged concerns about some types of over-the-counter pain medication containing codeine.

She has seen this cause acute kidney damage. One woman continued sneaking these tablets while in a hospital intensive care unit.  

“We have people presenting frequently taking 72 [tablets] a day,” she said.

The conference also heard from Irish Internet Hotline chief executive Mick Moran, a former member of An Garda Síochána. 

Mr Moran urged doctors to take account of potential harm suffered online by patients especially young men.

"One of the things that guards are dealing with at the moment is kids who are really good kids, but then go out and do the most bizarre things," he said, linking this to "com groups" or "764 groups" in online communities. 

“[These groups] do things for a laugh, and things they do for a laugh include sex-torting younger kids,” he said.

“They trap the younger kid into sexual exposure,” he said, explaining that this used to lead to requests for more images or money.

Now, he said, it could be "carving the name of the person across their breast, their inner thigh with a bladed instrument, killing the neighbour’s cat, pouring petrol on somebody’s prize flower-bed, cutting off their beautiful locks".

"It’s all filmed and shared with the group," Mr Moran added.