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Which drugs are opioids?

Opioids are a class of drugs that includes heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone, hydrocodone, codeine, morphine and tramadol. Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent.

Another important group of drugs are the Nitazenes. The Nitazenes were developed for pain relief but were not approved for human consumption due to their risks. This highly potent opioid can be up to 50 times stronger than fentanyl and heroin.

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Opioids for treating chronic pain

It might be thought that Opioids would be ideal drugs for the treatment of chronic pain. But the American Centre for Disease Control (CDC) has estimated that Opioids have claimed more than 400,000 American lives since 1999. Drug overdoses now kill more people in the United States in a single year than the total number of American soldiers who died in the Vietnam war.

Opioid related deaths are also up sharply in the UK. In England and Wales opioid prescriptions have doubled over a decade, driven mainly by the dispensing of tramadol. Also two million Britons had taken a painkiller that was not prescribed for them. Deaths involving opioids have more than doubled since 2012 in England and Wales driven by a surge in heroin use.

CDC guidelines

In the last few years there have been a number of important developments regarding recommendations on the use of Opioids. Although some of these relate specifically to developments in the United States, they also have implications for the use of such drugs in the UK.


In 2022 and again in 2023 the CDC updated its 2016 guidelines for clinicians and patients on the use of prescription opioids to treat both short term acute and long term chronic pain. The updates came as drug overdose deaths had risen dramatically over the previous three years. However the majority of the deaths have resulted from illicit synthetic opioids, such as fentanyl and not prescription drugs.

The guidelines shifted away from the more stringent 2016 guidelines around prescribing that some experts said led to “unintended consequences” for patients with pain. The update has more of an emphasis on clinicians and patients already receiving ongoing opioid therapy working together to assess the risks and benefits of long-term opioid use.


Is England facing an opioid epidemic?

The UK had the world’s highest rate of opioid consumption in 2019 and opiate – related drug poisoning deaths have increased by 388% since 1993 in England and Wales.

The crisis in the US began in the mid-1990s with the excessive prescribing of opioids. This led to a death rate of 20.7 per 100,000 people in 2020. In England the opioid death rate has been substantially lower at 4.0 per 100,000 in 2020, yet the prescribing of high -dose and long acting opioids increased by 457% from 1998 to 2018. The difference in death rates may be driven by the contrasting healthcare systems.

Although the opioid death rate is lower in England than the US, England is still experiencing higher than expected rates of mortality and morbidity from opioids. Opioid related hospitalisations increased by 49% from 2008 to 2018 and the number of people receiving treatment for prescription and over the counter (OTC) drug misuse also increased between 2009 and 2016.

Factors that contributed to the increased opioid mortality and morbidity in England may include the socio-economic from the 2008 financial crisis, higher unemployment rates and deprivation and the increasing aging population that puts more people at risk of developing chronic non-cancer pain.

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Opioids aware website

The Opioids AWARE website is a comprehensive guide to the use of opioids in the UK. Although currently in need of updating the website is still a very useful resource.

Nitazene related deaths in the UK

Deaths linked through post-mortem toxicology from June 2023 to February 2024 (National Crime Agency).

Yorkshire and the Humber
East of England
South East England
South West England
East Midlands
North East
North West
Northern Ireland
West Midlands
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