London School of Economics and Political Science: UK is highest per capita consumer of opioids globally

The UK has the highest consumption rate of prescription opioids for pain management per capita in the world, despite declining rates globally, according to new research published by The Lancet EClinicalMedicine.

Although consumption has slightly declined in the UK since 2016, drastic decreases in the consumption of opioids in the United States, Germany and Canada have left the UK leading the world in the use of these prescription drugs.

The UK consumed at a rate of 1353 morphine milligram equivalents (MMEs) per 1000 inhabitants per day in 2019, compared to 1104 in Germany, 1101 in the US, and 1039 in Canada.

Dr Charlotte Johnston Webber, co-author of the report and Senior Policy Associate in LSE Health, said: “Although concerns have been raised regarding high use of opioids in the UK, it may come as a surprise to many that in 2019 our consumption per capita was the highest globally. The International Narcotics Control Board (INCB) had previously ranked us 19th in the world, however, the INCB database only includes substances regulated by the Single Convention on Narcotic Drugs which doesn’t include drugs like tramadol, codeine, buprenorphine and tapentadol.

“Our research shows that these drugs make up about 53 per cent of the UK’s overall consumption of opioids which is alarming because it is now recognised that they have high addictive potential. However, it is worth bearing in mind that the UK’s high level of opioid consumption may be partially explained by our long-established and well-developed pain and palliative care services.”

Opioid consumption rates in Germany, the US and Canada all decreased dramatically between 2009 and 2019 with reductions of 58 per cent, 48 per cent and 37 per cent respectively.

The fall in opioid use in Germany was partially linked to the decreased usage of tramadol due to the introduction of a guideline in 2010 recommending non opioid painkillers as a first-line treatment for back pain.

Reductions in the United States and Canada were linked, in part, to tightening up on the use of the strong painkiller oxycodone and efforts to stamp out ‘pill mills’ in the US – doctors, clinics, or pharmacies which were indiscriminately issuing hundreds of prescriptions for opioid pills a day.

US pharmaceutical companies have also been called to account, with the manufacturer of oxycodone, Perdue Pharma admitting, and being heavily fined for, the criminal charge of enabling the supply of drugs “without legitimate medical purpose”.

The analysis found much lower and relatively stagnant opioid consumption rates in Low and Middle-Income Countries (LMICs) over the study period despite international calls for increases in pharmaceutical pain management.

Professor Elias Mossialos, co- author of the report and Brian Abel-Smith Professor of Health Policy at LSE, said: “It is very difficult to balance providing adequate access to pain relief and having an oversupply of it, because these drugs are so addictive and potentially dangerous.

“What we’re seeing in Low and Middle- Income countries is the under use and lack of access to care. But in trying to improve this, it is important that lessons are learned from countries like the US, and now the UK.

“This is particularly important as pharmaceutical companies look to exploit new markets, such as countries in South America, India and South Africa, where adequate drug controls may not yet be in place.”

According to the paper, reports suggest that the pharmaceutical industry is, “using aggressive marketing practices similar to those that precipitated the opioid epidemic in the US. Notably, the use of oxycodone has increased in Upper Middle-Income Countries and is now the third most consumed opioid in these countries after tramadol and codeine.”

It also notes that there are very different opioid consumption patterns, even between high-income countries, which may reflect social and cultural attitudes towards opioids and pain management. This highlights the challenges involved with providing adequate access to opioid treatment while preventing misuse.