Hundreds of patients could have died from an accidental overdose of prescription opioids, the findings from a recent study have revealed.
Research led by Dr Teng-Chou Chen from The University of Manchester has linked the deaths of 232 people in England, between 2000 and 2015, to a potential accidental opioid overdose.
The findings have been published in the British Journal of Anaesthesia.
The research is the first to study the medication history for opioid-related deaths using 500,000 electronic health records. The research team, based at the Universities of Manchester and Nottingham, used the electronic health records Clinical Practice Research Datalink, representing 8% of the UK population, from 2000 to 2015.
Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically, they are predominantly used for pain relief. The most common types of prescribed opioids include morphine, tramadol, fentanyl, codeine, and oxycodone. Opioid overdose can cause respiratory depression, drowsiness, fatigue, and falls. Respiratory depression is the most common cause of death in opioid overdose.
The study’s findings demonstrated that around 25% of the 232 patients who died from opioids between 2000 and 2015 had not been prescribed the drugs for pain 12 months before their death. The team say that this suggests that the patients either stockpiled previously prescribed opioids or had been given them from people they knew without realising the dangers of taking high combined doses. The research revealed that around 35% of the patients had been prescribed high-dose opioids of 120mg a day in the 12 months leading up to their death.
Most of the overall opioid-related deaths occurred between the ages of 30 to 50. Around 55% of them were men, 30% had a history of substance abuse, and 80% suffered from psychological illnesses. The team argued that, although the data is six years old, the situation is likely to have remained the same today.
Dr Teng-Chou Chen, from The University of Manchester, said: “Our research clearly shows that opioid prescribing could be linked to patient deaths in England.
“This is worrying as we already know that prescribing for these drugs has increased hugely over the past decade.
“Chronic pain, often accompanied by anxiety and depression, is a serious public health problem and makes the lives of millions of people a misery.
“People desperate for pain relief seemingly take whatever opioids they can find whether prescribed or not.
“They may stockpile prescribed drugs or get them from friends or neighbours. Some obtain them online. But the terrible consequences of doing this are now very apparent.
“Psychotropic medicines, such as gabapentinoids and antidepressants, are commonly prescribed for patients with chronic pain.
“Our study also showed an increased risk of opioid-related death when opioids were co-prescribed with those psychotropic medicines, even though, in most cases, people were prescribed opioids with a lower daily dose.”
More guidance needed
Dr Li-Chia Chen, from The University of Manchester who leads the research team, said: “There is actually no evidence to suggest that opioid-based painkillers are able to treat many complex long-term pain conditions, though, if used appropriately for acute pain such as surgical pain, they are extremely helpful.
“We think the guidance for doctors on opioid dosing should be much more detailed. But patients too need more knowledge about the dangers of overdosing on these drugs.
“We also believe better monitoring and systems should be in place for the disposal of these drugs.
“And clinicians should think very carefully about opioids prescribed ‘as required’, because these often stay in the cupboards of patients and are never returned to pharmacies.
“Most importantly, patients need to be offered other alternative options for managing their chronic pain, as the recent NICE chronic pain guidance suggests, and avoid long-term pharmacotherapy as a mainstay for chronic pain management.”