Deaths from strong prescription painkillers are on the increase

Action is needed to tackle the increasing number of deaths in the United States and Canada from prescription painkillers known as opioids, say experts in the British Medical Journal today.

Opioids are prescription painkillers that contain compounds derived from the opium poppy.

While they have long been used to control the symptoms of cancer and acute medical conditions, they are increasingly being used to control chronic pain, for example in patients suffering from , say Dr Irfan Dhalla and colleagues at the University of Toronto.

They describe how in the US, deaths involving opioid painkillers increased from 4,041 in 1999 to 14,459 in 2007 and are now more common than deaths from , HIV and . They add that between 1.4 million and 1.9 million Germans are addicted to and that some authorities have suggested that the UK may face a similar epidemic to that of North America in five to ten years time. Indeed, the use of strong opioids for chronic non-cancer pain in the UK has been described as a "disaster in the making" by Dr. Des Spence previously on bmj.com.

Dr. Dhalla and colleagues add that "deaths involving and codeine roughly doubled in England and Wales between 2005 and 2009, while deaths involving heroin or remained unchanged."

In order to tackle the crisis in the US and Canada, the authors put forward several strategies.

They say staff working for drug companies should not get commission for marketing prescription opioid drugs and that regulators should evaluate adverts for them before they are disseminated. Another initiative would be to introduce real-time electronic databases to reduce the frequency with which opioids are obtained from multiple doctors or pharmacies.

Dhalla and colleagues also call for educational outreach programmes for doctors to improve opioid prescribing, as well as more research to guide practice. They note that the evidence for the use of opioids to control chronic pain is very limited and the risks may outweigh the benefits.

In conclusion, they say that maintaining access to opioids for appropriately selected patients while striving for major reductions in overdose deaths must be a major priority for physicians and policymakers.

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