Significant spike found in prescription opiate use due to long waiting lists for clinics

Poor access to specialist pain clinics and an aging population has led to a huge spike in the use of prescription opiate medication according to local doctors.

Two year waiting lists for pain management clinics and lengthy waits for surgery for painful conditions like arthritis mean that patients are left in severe pain for long periods of time.

Research published last week by the Royal College of Surgeons found a sharp increase in the use of prescription pain medication between 2014 and 2022.

Prescriptions for paracetamol rose by 50 per cent, while codeine and stronger opioids increased by even higher percentages.

The prescribing of pain medications by doctors has risen "significantly" in recent years, and is now outpacing England, according to the research.

Dr Marie Scully of Abbey House Medical Centre in Navan said there were a number of factors contributing to this rise.

"An ageing population will have more age related issues mainly spinal and joint pain. Access to timely treatment like hip or knee replacements or injections to the spine is very poor especially in public system. There is very poor access to pain management clinics," she said.

"In primary care, therefore, patients are often left in quite severe pain for long periods of time. While we are aware that opiate type medication is not ideal, simple analgesics will not suffice for many patients.

"The increase in prescription opioids in my opinion reflects the poor access GMS patients have to other non prescription management of their pain. We always try to address usage of opioid analgesics with these patients but sometimes they just need them.

"It is a different story with those addicted to opioid analgesics and codeine based in particular. Often this starts with over the counter medications containing codeine, for example Solpadeine and Nurofen plus. We will address this usage much more proactively. Often we refer to addiction services or for inpatient detox. I don’t see this as markedly increasing however," she said.

Dr Seamus McMenamin of Bedford Medical Centre said there is an issue with limited access to specialist pain clinics. "There are effectively only two, one in the Mater and one in Beaumont. Waiting lists are well over two years. Waiting lists for orthopaedics outpatients in Navan and then for surgery mean a lot of people are waiting in pain"

He said that while an aging population is a good news story it means more people will develop conditions such as arthritis, as they are not dying of heart disease.

"We don’t see a lot of unnecessary taking of pain killers in the practice but these are commonly available on the street and I do see a big issue with street bought tramadol. There are also codeine containing medications available over the counter which is not measured by this research.

"There is limited access to drug treatment for opioids and tramadol in particular and there were cuts to drug treatment centres during austerity which have not been reversed. We shouldn’t rely on voluntary and religious groups to make up the shortfall for the government. They do enormously valuable work but the government need to take responsibility," he said.

The RCSI study looked at figures from 2014 to 2022 for those with a medical card, and compared it with data from GP practices in England.

The use of opioids rose 25 per cent in Ireland in that time, while specific medicines like codeine and oxycodone increased by even higher amounts.

Frank Moriarty, Associate Professor at the RCSI, said this comes with risks. "These medications can when used long-term lead to the development of dependence and other side effects that can have an impact on patients' lives.

"It's really important that in treating pain there are a variety of options available to patients to avail of and potentially reduce use of these dependence-forming medications."