(Note: For Tramadol information specifically please see the Tramadol factsheet)
An analgesic is a pain-killing drug. There are three main types:
- non-opioid medications such as aspirin, paracetamol and nonsteroidal anti-inflammatory agents like ibuprofen. These are over the counter medicines for mild to moderate pain.
- Compound analgesics such as co-codamol. Some of the milder forms can be obtained over the counter but stronger types are available on prescription only.
- Opioid analgesics such as codeine, tramadol, morphine, buprenorphine, fentanyl, oxycodone and dihydrocodeine. These strong painkillers are for moderate to severe pain and are prescription only medicines. They work by mimicking the effects of the body’s natural painkillers – endorphins – namely by blocking the pain signals sent from the nerves to the brain.
Problems relating to opioid analgesics
Opioid analgesics are now the most commonly prescribed drugs in the United States. According to statistics from the National Institute on Drug Abuse (NIDA), in 2014 U.S. pharmacies dispensed 245 million prescriptions for these drugs.
In recent years misuse of prescribed opioids has become a major problem in the US. Opioid analgesics are diverted from medical supplies and their widespread use has resulted in a national epidemic of opioid overdose deaths and addictions. 37% of the 44,000 drug-overdose deaths that were reported in 2013 in the US were attributable to pharmaceutical opioids – compared with 19% for heroin.
At the same time, according to the SAMHSA’s National Survey on Drug Use there has been a parallel increase in the rate of opioid addiction, affecting approximately 2.5 million adults in 2014.
In March 2016 the US Food and Drug Administration announced new safety warnings were to be added to all prescription opioid analgesics to help inform doctors and patients of the dependence risks of these drugs.
Europe has also seen a rise in opioid analgesic misuse. A paper, published in the journal BMC Psychiatry, questioned people in the UK, Denmark, Germany, Spain and Sweden, and found that Spanish adults were the most likely to abuse prescription painkillers (18.3%), with British adults coming second on 14.6%.
This is backed up by research outlined in the report, Opioid painkiller dependency (OPD) An overview (PDF) which suggests that the UK population is consuming increasing amounts of these painkillers. In 2012, some ten million people in the UK were prescribed an opioid painkiller, more than double the next nearest EU country France at four million.
Estimates of the extent of dependency on these drugs in the UK vary widely. From the number of calls it receives on the issue, the drug charity Overcount extrapolated a dependent UK population of 30,000. The ITV programme ‘Tonight’ (broadcast 10th July 2015) surveyed a cross-section of 2000 people of whom 6% had been using over the counter (OTC) painkillers for more than a year from which the programme extrapolated that around 950,500 people could be dependent on these drugs.
In addition, there appears be a growing cohort of users taking these drugs for recreational purposes. The 2015/16 Home Office survey of drug use estimated that in the last year 7.5% of adults aged 16 to 59 had taken a prescription-only painkiller not prescribed to them: 7.4% (around 2.4 million adults) said they had taken the painkillers purely for medical reasons, while a small proportion (0.2%, or 33,000 adults) said it was just for the feeling or experience it gave them. A further very small number of adults said it was for both. This tendency was also true for young adults aged 16 to 24.
For more information on this topic please see our page on prescribed & OTC drug dependence
Updated January 2017