Europe: Are we also facing an opioid crisis?

Opioid use among European rheumatism sufferers continues to rise, according to recent figures from Catalonia, Spain. The USA opioid crisis comes to mind. Are we sleepwalking into a catastrophe?

An increasing number of patients are taking opioids as painkillers

Opioid use among European rheumatism sufferers continues to rise, according to recent figures from Catalonia, Spain. The USA opioid crisis comes to mind. Are we sleepwalking into a catastrophe?

According to a Spanish study, the consumption of opioids in patients with osteoarthritis rose from 15% to 25% between 2007 and 2016. The survey was based on the health data of 80% of the Catalan population, which corresponds to about six million patients.

Limited prescription

Opioids are very effective painkillers, and about 70% of those prescribed in Germany are for patients with chronic non-tumor pain. According to guidelines in the country, opioids can be considered for a four to twelve-week treatment period for chronic osteoarthritis (arthrosis) pain, among other applications. "For this indication, there is a sufficient scientific data basis for efficacy and safety," said Professor Dr. Ulf Müller-Ladner, Medical Director of the Department of Rheumatology and Clinical Immunology at the Kerckhoff Clinic, Bad Nauheim, Germany. The statement was made during an online press conference that served as a prelude to the EULAR 2020, which will be a digital event this year.

However, after this period of up to 12 weeks, the patient should definitely discontinue the drug, as opioids have sometimes strong side effects. These include most critically nausea, vomiting, and constipation, but also dizziness and general fatigue. The greatest danger, however, comes from the central nervous effects of these drugs. "Opioids have an extremely strong addictive potential. Psychological withdrawal from the drugs is therefore often very difficult," Prof. Dr. Müller-Ladner added.

Women, the elderly and the socially disadvantaged are at the highest risk of addiction

According to the data from the Catalonia study, the risk of becoming opioid-dependent is particularly high among women (4% more than men), older patients (10% more than younger patients), and socially disadvantaged people (up to 6% more affected than financially-secure people). Contrary to what might be assumed, the problem of long-term opioid use is even greater in rural areas than in urban areas (+1%).

Opioids are often not discontinued after pain has been managed

A further study from Iceland also showed that even after the cause of the pain has been successfully solved, opioids are not discontinued, and most critically, in many cases, a higher intake takes place even.

For example, patients with inflammatory joint diseases did not stop taking opioids after more precise treatment with effective anti-inflammatory drugs had been initiated. Instead, they increased the opioid dose further.

Implications for medical practice

"There is an urgent need for action, immediately", says EULAR President Professor Iain McInnes from Glasgow, UK. Opioid addiction has become a significant problem. However, the risk of physical and mental addiction is low when opioids are used as directed.

"We, therefore, want to raise awareness of responsible use on the part of both prescribers and users," concluded Professor John Isaacs from the University of Newcastle, UK, who holds the scientific chair of the EULAR. In order to relieve chronic pain, he believes that medication should in any case “be only part of a wider treatment program in which physicians, psychologists, and physiotherapists work together".

Source: EULAR 2020, online press conference of 27.05.2020

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