They are valuable for fighting pain, but their consumption carries the risk of addiction. Opioid drugs (tramadol, codeine, etc.) should therefore be prescribed – and taken – with caution. The High Authority for Health publishes this Thursday a series of recommendations to regulate their use. Objective: to allow them to be prescribed to relieve severe pain while avoiding the risk of addiction.
Ten million French people concerned
In 2015, nearly 10 million French people (i.e. 17.1% of the population) were prescribed opioid analgesics. In 2017, the most consumed in France is tramadol then codeine in combination and opium powder associated with paracetamol, according to the Medicines Agency (ANSM). Next came morphine, the first strong opioid analgesic, oxycodone, now used almost as much as morphine, then fast-acting transdermal and transmucosal fentanyl. Between 2006 and 2017, the prescription of strong opioids increased by around 150%, according to an Agency report published in 2019.
Risk of addiction and overdose
Opioids have a major interest in relieving pain. With a risk: addiction to treatment. “This problem mainly affects patients who consume an opioid analgesic to relieve pain, and who develop a primary dependence on their treatment, and sometimes divert it from its initial indication. Thus, the number of hospitalizations linked to the consumption of opioid analgesics obtained on medical prescription increased by 167% between 2000 and 2017, rising from 15 to 40 hospitalizations per million inhabitants. The number of deaths linked to the consumption of opioids increased by 146%, between 2000 and 2015, with at least 4 deaths per week”, notes the ANSM.
Some countries such as the United States or England are also facing a health crisis marked by a large number of deaths attributable to the consumption of these drugs. In France, the situation is not as dramatic, because the prescription of drugs is much more framed. However, the risk remains real.
There is no question of no longer using these drugs which provide effective solutions in the treatment of pain.
At the request of the Ministry of Health, the High Authority for Health has defined a set of indications for doctors in charge of patients treated with opioids: general practitioners, emergency doctors, pain doctors, rheumatologists, addictologists, pharmacists. .
There is no question of depriving yourself of these drugs “which provide effective solutions in the treatment of pain”, notes the HAS. But to have a good use of it to limit the risk of addiction and overdose.
First advice for securing the prescription of opioids: “do not trivialize the use of them. Whatever the potency of the opioid, whether it is said to be weak or strong, precaution is essential: the risks of developing a use disorder or overdose are common to all”.
Limit the duration of treatment
Another key element is the duration of the prescription and the quantity prescribed. The HAS insists: “regardless of the type of opioid drug, too large a quantity prescribed can quickly prove to be problematic”.
In the treatment of chronic non-cancer pain, the HAS specifies that “opioid analgesics should only be considered as a last resort. These drugs cannot be prescribed for chronic pelvic or musculoskeletal pain. Likewise, it is not recommended to use them in the treatment of migraines”.
“When the prescription of opioids is necessary, it is recommended to initiate treatment gradually, with regular reassessments at the start of treatment in order to adjust the dosage and monitor the appearance of adverse effects”, insists the ‘Agency. Beyond 6 months of continuous treatment, the HAS recommends gradually reducing the treatment or even stopping it completely, in order to check whether the treatment is still justified or whether a lower dose is sufficient.