Current UK data on opioid misuse

Office for National Statistics Data 

• Poisonings involving some prescription and other opioids used to treat pain increased dramatically in 2014 but this is thought to be, in part, a factor of how the data is reported
• Changes in deaths from one year to the next are unreliable for detecting trends, which relies on longer-term analysis
• There is an underlying pattern of increasing deaths in which an opioid pain medicine (OPM), especially tramadol, is mentioned as present on the death certificate. In the latest data set, deaths related to tramadol have risen to 240 per annum.
• Deaths have largely mirrored prescribing levels but in recent years there have been some significant increase in rates of death per prescription
• Available data only reports on substances “mentioned” on death certificates – it is unable to distinguish deaths caused by the substance or substances and those where the substance is present but did not contribute to the death, and does not identify whether the substance was legitimately obtained on prescription or over-the-counter or obtained illicitly.
• Not all substances are tested for in post-mortem toxicology. There is variability both across the coronal system and over time as to which substances are tested for and how their contribution to a death is interpreted.

The Office for National Statistics (ONS) publishes annual data on drug poisoning and drug misuse deaths. It does not distinguish between prescribed, over-the-counter and illicitly-obtained medicines. The drug misuse figures only include drugs controlled under the Misuse of Drugs Act but, as additional drugs are controlled under the Act, the data is  backdated. The published data only breaks down poisoning (and not drug misuse) deaths by substance so it is data on these poisoning deaths that is presented here.

ONS figures are based on deaths registered (rather than occurring) in a particular calendar year. Many deaths involving poisoning (especially those involving drug misuse) will be investigated by the coroner so may not be registered until some time after they occurred.
Significant rises in 2013 and 2014 are thought to result, in part, from changes in reporting by coroners.

Crime survey for England and Wales

Drug Misuse: Findings from the 2014/15 Crime Survey for England and Wales examines the extent and trends in illicit drug use among a nationally representative sample of 16 to 59 year olds resident in households in England and Wales. In 2014/15, for the first time the survey included questions relating to misuse of prescription painkillers (use of prescription analgesics by those for whom they are not prescribed). Findings include:

• Overall, 5.4 % of adults aged 16 to 59 years had misused a prescription-only painkiller not prescribed to them

• Painkiller misuse is more common in younger ages

– 7.2 % of 16 to 24 year olds had misused a prescription-only painkiller in the last year, while 4.9 % of 25 to 59 year olds had done so. 
The decline in misuse with age is less for prescription painkillers than other drugs

– While the misuse of prescription-only painkillers in the last year declined with age (8.0% of 16 to 19 year olds compared with 3.0% of 55 to 59 year olds), the decline was shallower than the decline with age seen for illicit drugs.

• Painkiller misuse is less likely to be associated with misuse of other drugs

– 25% of the 16 to 59 year olds who had reported misuse of prescription-only painkillers reported having taken another drug in the last year
– More than 83% of  users of new psychoactive substances had used another illicit drug in the last year

• Association of painkiller misuse with alcohol misuse

– The misuse of prescription painkillers did not vary by frequency of alcohol consumption, with similar levels across all categories (4.6% of those who drank alcohol three or more days a week in the last month reported misuse of prescription painkillers, compared with 5.5% of those who drank alcohol less than once a month)

• People with a long-standing illness or disability were more likely to have misused prescription-only painkillers and to have used an illicit drug in the last year.

– Among those with a long-standing illness, 8.5 per cent had misused prescription-only painkillers in the last year (compared with 4.8% without an illness) and 11.9 per cent had taken an illicit drug in the last year (compared with 8.1% without an illness).

• Misuse of prescription painkillers is distributed more evenly across the general population than the use of illicit drugs

– Misuse of painkillers was similar in both rural and urban areas (5.4% of those in urban areas reported misuse of prescription painkillers, compared with 5.3% in rural areas) whereas the use of illicit drugs is higher in urban areas (9.1% of those in urban areas reported use of illicit drugs, compared with 6.5% in rural areas).

National Drug Treatment Monitoring System (NDTMS)

NDTMS is a national database that collects trend and activity data from publicly-funded substance use disorder  treatment services in England. It collects detailed information on the treatment people receive, their presenting need and the outcomes of treatment. Analysis of these data is  used to monitor drug treatment provision and due to the readily available access to drug treatment provision in England has become a useful indicator of illegal drug trends.

One of the key data items collected by the NDTMS system is information on the problem substances that people present to treatment with. NDTMS collects data on an extensive list of medicines that are available on prescription or over the counter. While the national focus of drug treatment has historically been primarily on the illegal drugs evidenced to cause the most harm, local partnerships configure the drug treatment system to best meet local need. It is expected that people who develop problems in relation to prescribed and over the counter medicines are able to access treatment services, in areas where there is evidence of need.

Analysis of NDTMS data gives  a picture of misuse of prescription opioids in patients presenting to drug treatment services. These data are likely to underestimate the prevalence of addiction to medicines as not all individuals who have developed an addiction to prescrib

This data identifies two populations presenting to drug services: patients addicted to prescription opioids as their sole drug of dependency and those who use prescription opioids as part of a polysubstance misuse (ie, in combination with illicit drugs). It can be seen from this figure that. while the number of patients using prescription opioids in conjunction with illicit drugs has remained relatively stable, the proportion of individuals who use prescription opioids as their sole drug has increased and this group represents an increasing proportion of presentations to drug dependency and recovery services.

Further Reading

Office for National Statistics Data

• Office for National Statistics: Deaths related to drug poisoning in England and Wales. 2014. 
• Novak SP, Håkansson, Martinez-Raga J, et al. Nonmedical use of prescription drugs in the European Union. BMC Psychiatry 2016; 16: 274.

Crime Survey for England and Wales

• Lader, D. Drug Misuse: Findings from the 2014/15 Crime Survey for England and Wales. (Second Edition Statistical Bulletin 03/15). 2015.
• Lader, D. Drug Misuse: Findings from the 2015/16 Crime Survey for England and Wales. (Second Edition Statistical Bulletin 06/16). 2016.