The Guardian is one of the treasures of journalism. They report news on a vast number of subjects, with a knack for presenting complex issues with clarity, and a reputation for deep research. Last week, The Guardian‘s health and social affairs correspondent, Anna Bawden, dropped a double dose of articles on opioid addiction that paint a grim picture of the future of opioid addiction while also empowering people managing chronic pain to stay out of the trap of substance use disorder.

The first article starts with an analysis of just how many people are currently taking prescription opioid painkillers, such as morphine, codeine and oxycodone; how many of those show signs of being dependent; and how many are fully addicted. Here’s the breakdown:

• 50 million U.S. adults and 15.5 million U.K. adults suffer chronic pain
• One-third of those suffering chronic pain are prescribed opioid painkillers
• That’s 17 million U.S. adults and 5 million U.K. adults with opioid prescriptions
• Two in 10 will show signs of opioid use disorder
• One in 10 will be addicted to opioid painkillers

That means there are over a million U.S. opioid addicts being created right now. Bawden’s numbers come from a systematic review and meta analysis conducted by a team at the Bristol Medical School in Bristol, U.K., and published last week in the journal Addiction. The study looked at 148 other studies involving 4.3 million patients treated with opioid painkillers.

Bawden writes that the U.K.’s National Health Service (NHS) “cut opioid prescriptions by 450,000 between 2019 and 2023.” The numbers have also gone down in the U.S. The Kaiser Family Foundation (KFF) reports a 44% decline in the number of opioid prescriptions used to treat pain between 2016 and 2019. Over the same period, according to KFF, prescriptions to treat opioid use disorder doubled.

One of the measures that has made a big difference in the number of patients with opioid use disorder getting treatment is the Consolidation Appropriation Act passed by the U.S. Congress in 2022.  It removed the requirement for Drug Enforcement Administration certification — the so-called “X-waiver” — for the prescription of buprenorphine and other addiction treatment drugs. According to KFF, this legislation “vastly increased the number of providers authorized to prescribe controlled substance medication treatment to treat opioid use disorder.”

The wider availability of medicine to treat symptoms of withdrawal has not made much of a dent in the dismal rate at which people with opioid use disorder (OUD) receive treatment. KFF estimates that 90% do not. A recent article in Harvard Health pegs the number at 80%. Why do so few seek treatment?

None of these articles address the lack of physician training that surfaced as a major problem in a recent study tracing overdose deaths back to missed opportunities for care. The KFF study says that 70% of the funding U.S. states receive from the National Opioid Settlement is earmarked for “opioid remediation efforts.” Funding the training of medical school students and providers in addiction assessment and treatment should be a priority, based on these findings.

Bawden indicates that one solution to reducing opioid dependency is self-defense. Her second article in The Guardian deals with how to assess one’s dependency on opioid painkillers and how to avoid addiction. Avoiding addiction, however, comes down to only two paragraphs: one about what to do when prescribed opioid painkillers for surgery, and the second about whom to contact if you think you might have a problem: https://www.wearewithyou.org.uk/.

That’s it. Nothing about avoiding cues or triggers. Nothing about substituting with less addictive drugs. Nothing about behavior modification or cognitive behavioral therapy. No telehealth. No contingency management. No community reinforcement. Not even a nod to Narcotics Anonymous. We love The Guardian, but if you want the best coverage of addiction causes and treatments, scan the sidebar at AddictionNews where a wealth of good ideas await you.

Written by Steve O’Keefe. First published August 14, 2024.

Sources:

“Opioid painkillers put millions at risk of addiction or dependency — study,” The Guardian, August 7, 2024.

“Prevalence of problematic pharmaceutical opioid use in patients with chronic non-cancer pain: A systematic review and meta-analysis,” Addiction, August 7, 2024.

“How opioid painkillers work, why they are addictive and how to avoid dependency,” The Guardian, August 7, 2024.

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