UK researchers investigate alternatives to long-term opioid use

A UK university has been awarded £2.4 million to research overprescribing of opioids, and how to improve treatment of patients with persistent pain without long-term use of these morphine-like drugs.

The government-backed National Institute of Health Research (NIHR) awarded the money to researchers from Keele University and will cover pain caused by a range of conditions, including osteoarthritis and back pain.

Use of opioid painkillers such as codeine and fentanyl has dramatically increased in the UK over the past 20 years, rising by a third between 1998 ands 2016.

The situation is even worse in the US, where over-reliance on highly addictive drugs such as codeine and fentanyl is implicated in tens of thousands of deaths each year.

The NIHR said that people with persistent pain who take long-term opioids tend to have a worse quality of life than those who do not take them, and are more likely to suffer bone fractures, addiction and overdose, especially at high doses.

In most cases patients with persistent pain are managed by their GP – but contrary to national guidelines they are not often reviewed.

Research funded by the NIHR’s Programme Grants for Applied Research will involve developing an intervention for clinical pharmacists to help patients with persistent pain stop taking opioids if appropriate and support self-management of pain.

The research will test this intervention in approximately 1,000 patients to establish whether it leads to less opioid use, without making patients’ pain worse, and whether this results in better use of NHS resources compared to usual GP care.

Keele University’s professor Christian Mallen, director of the Institute for Primary Care and Health Sciences and NIHR Research Professor in General Practice, and Dr Julie Ashworth, senior lecturer and consultant in pain medicine will lead the research.

Professor Mallen said: “Prescriptions for opioid medication continue to dramatically rise, despite limited evidence supporting their use for many painful conditions. By proactively addressing this problem and making better use of the highly skilled primary healthcare team, I hope we can rapidly improve outcomes for patients who too often suffer in silence.”

The research was announced after new allegations in the US that Purdue Pharma, manufacturer of Oxycontin (oxycodone) has been aggressively marketing the product, contributing to the opioid addiction crisis affecting large parts of the country.

Meanwhile pharma companies led by Pfizer and Eli Lilly are developing a new class of painkillers known as NGF inhibitors, which are edging closer to market, initially for osteoarthritis pain.