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15 January 2020

The BBC documentary Addicted to Painkillers? sent me down a spiral of anxiety

Many people on opioids continue to be in pain even as their doctors increase their doses. In other words, often they don’t even work.

By Rachel Cooke

And so, as we march gravely on into 2020, the ubiquitous Dr Michael Mosley returns with yet more bad news. According to Public Health England, 5.6 million people in England were prescribed opioids between 2017 and 2018, some half a million of whom had been taking these highly addictive drugs, from the same family as heroin and morphine, for more than three years. The numbers may not be so alarming as in the US, where opioids kill more people even than gun crime: 79 deaths were linked to oxycodone, one of the painkillers in question, in England and Wales in 2018. But there is cause for concern. Perhaps the most striking point Mosley made was that many of those taking such pills continue to be in pain even as their doctors increase their doses. In other words, often they don’t even work.

I watched his film, Addicted to Painkillers? Britain’s Opioid Crisis (16 January, 9pm), in a spiral of anxiety, thinking of the moment five years ago when something catastrophic happened to my back – I still don’t know what – and I lay like a stranded beetle for six hours, waiting for an emergency doctor to come and inject me with morphine. I was lucky. The pain passed after three weeks; I made do with paracetamol and six Valium, prescribed later by my reluctant GP. But others are not so fortunate.

Those patients who spoke to him, whether in favour (Brenda has been taking morphine for 15 years for chronic pain, and believes she could not do without it) or against (Karen, who has weaned herself off the opioids she was prescribed for a slipped disc, described how they turned her into a bed-ridden zombie) had all been struck, just as I was, out of the blue, by the excruciating feeling, as sudden as lightning, that a “red hot poker” was being pressed into this or that part of their body. It can happen to anyone, and most of us will try almost anything to put an end to the agony.

Is Mosley reassuring, or a tiny bit smug? Usually, I can never quite decide. Here, however, the good doctor’s televisual ward round was strikingly calm and thorough. He listened sympathetically to patients; he didn’t interrupt his (all female) experts. His visual demonstration of the alarming strength of these drugs, performed in a south London pharmacy, was quite something: a single capsule of diamorphine is, for instance, equivalent to 338 co-codamol tablets – the latter being the most powerful painkiller you can buy over the counter.

Later, visiting a variety of chemists’ shops, he managed to buy, in less than half an hour, 240 over-the-counter painkillers. Taken together, these would be stronger than one fentanyl, the most powerful prescription opioid currently available to doctors. There are no figures for the numbers of people who might be addicted to this kind of pill, but there are certainly an awful lot of them out there. Former addict Vicki told him that, until she went into rehab, she used to take 50 to 70 such tablets a day. How did they make her feel? It was, she said, as if a quilt was being wrapped around her.

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What a cycle of misery. But there is hope. Doctors, having learned the error of their ways, are in some areas beginning to try to wean their patients off such drugs (for a long time, it was generally believed that opioids weren’t addictive; the World Health Organization actively encouraged doctors to use them, and simply to increase doses when they appeared to be ineffective). Even better, in the future, perhaps there will be new alternatives to them.

Research carried out by Professor Irene Tracey at the University of Oxford has shown that the happier people are, the less physical pain they feel. It’s expensive to fund the kind of addiction support groups that ease social isolation – and where jokes are encouraged, however black – but there is no doubt that they help. Such a group helped to return Karen to her husband and children. These days, her bedroom curtains are open, her bed is made, and though she still struggles with her back – she whizzed upstairs on her chair lift – she is drug-free. The pain has not disappeared. But she can live with it, and living is what matters. 

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Addicted to Painkillers? Britain’s Opioid Crisis

This article appears in the 15 Jan 2020 issue of the New Statesman, Why the left keeps losing