(Note: For Tramadol information specifically please the DrugWatch Tramadol factsheet DrugWatch are an informal online professional network established by a group of professionals working in the UK and Irish drugs sector, including DrugWise.)
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
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. According to statistics from the National Institute on Drug Abuse (NIDA)’s 2020 Misuse of Prescription Drugs Research Report 3.3% (or about 9.3 million people) reported misusing prescription pain relievers in the past 12 months in the United States. The 2020 National Survey on Drug Use and Health reports that among people aged 12 or older in 2020, an estimated 0.8% (or about 2.3 million people) had a prescription opioid use disorder in the past 12 months. Data from Centers for Disease Control and Prevention shows that overdose deaths in the US involving prescription opioids more than quadrupled from 1999 to 2019, and in 2020 approximately 16,416 people died from an overdose involving prescription opioids in the US (CDC WONDER Database).
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.
Opioids are widely prescribed in the UK. An ‘opioid epidemic in the UK’ is often referred to with the number of prescriptions issued by GPs in England for opioids more than doubling from 1998 to 2016.In September 2019, PHE published a report on the evidence for dependence on, and withdrawal from, prescribed medicines, including opioid analgesics.
PHE’s analysis shows that, in 2017 to 2018, 5.6 million people (13% of the population) received a prescription for an opioid pain medicine. After a long increasing trend, the annual number of prescriptions for opioid pain medicines has slightly decreased since 2016 in the UK.
In 2018 the Evening Standard published an investigation revealing that there were 20,130 cases of admissions to hospitals in England involving overdoses from opioid painkillers other than heroin, this was a rise of 85% in the past decade.,In recent years there’s been a campaign to reduce the amount of opioids that are prescribed. Trialed in West Yorkshire, the researchers say over a year, it resulted in 15,000 fewer patients being given opioids – and a net saving to the NHS of £700,000. If it were replicated across the UK, it could lead to 406,000 fewer patients taking opioid medications (The University of Manchester). The latest numbers for opioid prescribing can be found on OpenPrescribing, a website where you can search for drugs to see how many items are prescribed in the UK over time.
Opioid analgesics can be misused for recreation, for example taken in a way or dose other than as prescribed, taking someone else’s prescription and/or taking the drug for the effect it causes. The 2018/19 Home Office survey of drug use estimated that in the last year 6.4% of adults aged 16 to 59 had taken a prescription-only painkiller for “medical reasons” in the last year. This was similar to the estimate of 7.0% in the 2017/18 survey. A further 0.2% of respondents to the 2018/19 survey said that they had taken a prescription-only painkiller solely for the feeling or experience it gave them, the same proportion as in 2017/18.
For more information on this topic please see our page on prescribed & OTC drug dependence.
Updated March 2022