Prevention, especially among young people, is key to reducing the future burden. Our background paper [ https://www.hifa.org/sites/default/files/articles/Opioids-10Qs.pdf ] invites us to consider the following:
- What strategies are most effective for raising public awareness?
- How can risks be communicated without generating stigma?
- What role can schools, the community, the media, and social networks play?
COMMENT (NPW): This question is linked to our previous one (Q3: Do people understand the damage caused by opioid misuse?). We have already had contributions on how to raise awareness among school-children, who are arguably the most important audience. We welcome more comments on this topic.
If we unpick the question 'What can be done to raise public awareness about the harms of opioid misuse?', we should which are the most important aspects of this question, and for whom.
For adolescents in general, it is perhaps especially important that they are aware of how 'experimenting' with opioid drugs can be very dangerous and can wreck lives.
For the adult population in general, it is perhaps most important that everyone is aware of the dangers of becoming addicted to prescription opioid drugs. In the UK alone, millions of people are prescribed opioid drugs every year. Family doctors (GPs) are central to patient education. GPs take the decision to prescribe such drugs and have the responsibility to guide and monitor their use.
A word could be added here about the prescription of opioids for those with chronic pain. A UK study of 700 patients with chronic musculoskeletal pain found that 59% were prescribed opioids:
Ashaye T, Hounsome N, Carnes D, et alOpioid prescribing for chronic musculoskeletal pain in UK primary care: results from a cohort analysis of the COPERS trialBMJ Open 2018;8:e019491. doi: 10.1136/bmjopen-2017-019491
The authors conclude that 'Long-term prescribing of opioids for chronic musculoskeletal pain is common in primary care. For over a quarter of patients receiving strong opioids, these drugs may have been overprescribed according to national guidelines.
It is very likely that patients are often drivers in the decision to (over)prescribe. It is important they understand the limitations of opioid use in chronic pain (and that this is fully understood andd communicated by the prescriber).
In other health settings around the world, such a prescriber-patient interaction may be out of the question. The quality of decision-making on whether and what to prescribe may vary. There may or may not be a trusted central primary healthcare provider.
What about use of opioid drugs without prescription? Across almost all countries non-medical purchase of opioid drugs is illegal.
Awareness of the potential harms of opioids, for the patient and the health worker, is important.
Another issue relating to awareness is public understanding of opioid misuse. Too many people around the world see such misuse as a moral failing that the addict has brought on themselves. This in turn leads to stigma and social isolation. It is perhaps more helpful to understand opioid misuse as a chronic disease, often precipitated by social or economic factors beyond the control of the sufferer. Less stigma, more compassion.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org