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Who’s really to blame for the opioid addiction crisis?

26 Mar 2018

The mainstream press would have us believe that pharmacists and GPs have inadvertently caused increasing dependence on opioids. But the truth is probably far more complex, writes The Pharmacist’s GP blogger Dr Livingstone

So now you know. The prescribed opioid addiction crisis that currently grips the nation is all our fault. As in, it’s down to you and me, GP and pharmacist. I prescribe them, you dispense them.

We are, according to certain factions of the media, ‘creating drug addicts’, ‘feeding people with pills’ and ‘using funnels to pour tramadol down people’s throats even if they’ve only got an ingrowing toenail’. And I only made up one of those three quotes.

Which is odd. Because I seem to spend lots of my time declining patient requests for escalating strengths of opioids, despite the abuse and/or complaints this provokes. And you pharmacists give customers dire warnings of addiction potential even if it is just placebo-strength co-codamol you’re flogging.

Besides, if there is an opioid crisis, the explanation is bound to be rather more nuanced than prescription/dispensing-happy GPs and pharmacists. For example, our options are somewhat limited given that alternatives such as oral NSAIDs, gabapentin and pregabalin are also viewed as drugs of the devil.

Plus, the ‘pill for every ill’ culture raises expectations to the point that patients believe they shouldn’t have to put up with the least ache or pain. And limited resources mean that non-pharmaceutical options like physiotherapy, joint replacements and pain clinics entail long waits and, of course, ‘something must be done’ in the meantime.

All of which isn’t to say that there’s no problem, nor that GPs and pharmacists aren’t in some way complicit. But to suggest it’s all down to evil health professionals making victims out of an innocent public is facile and will just further entrench attitudes. True, some news stories on the topic do acknowledge that GPs are under pressure and patients sometimes demand strong painkillers. But often that’s in the very last sentence, and how many of our drug addled patients are likely to get that far?

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