Research from University of Derby reveals new insights into painkiller dependence

Research from the University of Derby has revealed new insights into potential screening methods to identify those at risk of dependence on painkillers. The research findings can also guide the design of interventions to help people reduce their use. 

The study showed that the best predictor of painkiller dependence was not misuse or abuse of medication, but the frequency of its use.  

The research was conducted by University of Derby PhD student Omimah Said, and supervised by Professor of Health Psychology James Elander and Associate Professor and Reader in Emotion Science Dr Frances Maratos. It was part-funded by a University Research for Learning and Teaching Fund (RLTF) grant.

Participants included 1,283 people who had pain and had used painkillers in the last month, including 420 in Egypt, 295 in the UK, 138 in the USA, 94 in Australia, 226 in Germany, and 110 in China/Macau/Hong Kong.

The study showed:

• Almost half (49%) of participants had pain for longer than a year, 69% had a medically diagnosed pain condition and 66% were taking prescribed analgesics.
• In the UK, participants in the study had taken painkillers 22 days in the last month on average, in the USA 23 days in the last month, and in Australia 26 days in the last month.
• 44% of UK participants overused painkillers (using them for pain, but for longer or at higher doses than recommended) at least sometimes, compared with 90% in Egypt, 30% in the USA, 53% in Australia, 23% in Germany and 19% in China/Macau/Hong Kong.
• 16% of UK participants overused painkillers at least usually, compared with 56% in Egypt, 6% in the USA, 15% in Australia, 4% in Germany and 4% in China/Macau/Hong Kong.
• 9% of UK participants abused painkillers (using them for reasons other than to relieve pain) at least sometimes, compared with 80% in Egypt, 5% in the USA, 18% in Australia, 5% in Germany and 14% in China/Macau/Hong Kong.
• The degree of painkiller dependence in Egypt was half as high again as in the UK and Australia, twice as high as in the USA, and three times as high as in Germany and China/Macau/Hong Kong.

Professor Elander said: “Painkiller dependence is a major social issue. In the UK, prescriptions for powerful analgesics have risen dramatically in the last few years, from three million in 1991, to 12 million in 2006, 24 million in 2016 and 41.4m in 2017, according to NHS data reported by the Sunday Times. Some of the biggest rises have been seen in oxycodone, co-codamol, tramadol, morphine and fentanyl.

“Chronic pain affects up to 1.5 billion people worldwide, including 7.8 million in the UK. Painkiller misuse regularly makes the headlines: Prince died of a fentanyl overdose after becoming addicted to oxycodone, Tom Petty took fentanyl with oxycodone before his death last October and, in the UK, Ant McPartlyn said his addiction to painkillers almost killed him.

“Our study showed that attitudes and beliefs about pain and pain medication differed in interesting ways between countries. However, the beliefs and attitudes that predicted analgesic dependence were very consistent in the UK, USA, Australia, and Germany – we found that simple questions about how much people felt they ‘needed’ painkillers were the most important predictor of dependence. 

“Psychological dependence is an important influence on harmful use that future interventions should target. The Department for Health has asked NICE to develop guidance for GPs about prescribing opioids and easing patients off opioids, and this research can help in producing those guidelines.”