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All opioid painkillers to carry prominent addiction warnings this year

Codeine-related deaths in England and Wales almost doubled between 2008 and 2018
Codeine-related deaths in England and Wales almost doubled between 2008 and 2018

All opioid medicines in the UK will carry “prominent” addiction warning labels as part of a government crackdown, the health secretary has announced.

The government decision comes after data showed the number of opioid painkillers dispensed in the community increased by more than 60% in the past decade, from 14 million in 2008 to 23m in 2018, according to the Department of Health and Social Care.

The number of codeine-related deaths in England and Wales almost doubled over the same period, while co-codamol-related deaths also increased.

Health secretary Matt Hancock said yesterday (April 28) he is “incredibly concerned” about a rise in people addicted to opioid drugs.

“Painkillers were a major breakthrough in modern medicine and are hugely important to help people manage pain alongside their busy lives – but they must be treated with caution.

“We need to place a greater focus on making sure that these medicines are used appropriately and for pain management alone, and make sure people are fully aware of the risks,” he added.

Warning labels expected by end of the year

The Medicines and Healthcare products Regulatory Agency (MHRA) told C+D today it will be seeking “voluntary compliance from industry” and, “if necessary, the changes will be mandated”.

Warnings are expected to appear on product labelling by the end of the year, and will state that the medicines “can cause addiction” and “contain opioids”, the MHRA said.

Director of the MHRA’s vigilance and risk management of medicines division Dr June Raine said the decision is an “important first step to help minimise the risks of addiction associated with opioid medicine, while helping patients to get the right information at the right time to support their care”.

RPS: Good idea “in principle”

The Royal Pharmaceutical Society’s spokesperson on pain medicine Professor Roger Knaggs told C+D: “In principle, it seems like a good idea to draw attention to the addictive potential of opioid medicines, and brings them in line with additional warnings on over-the-counter codeine and dihydrocodeine-containing medicines”.

“It’s essential for prescribers and pharmacists to discuss both the benefits and harms associated with opioid medicines with patients on a regular basis,” Mr Knaggs said.

“Opioids should only be continued when they provide sufficient pain relief to allow a person to be more active.”

In 2018, pharmacy minister at the time Steve Brine commissioned Public Health England to review the rise in prescribing of addictive drugs, including benzodiazepines, Z-drugs, opioid pain medication and antidepressants. The report, due in “early 2019”, has not yet been published.

17 Comments
Question: 
Do you agree with plans to introduce warning labels for opioid medicines?

Leon The Apothecary, Student

Causes Addiction.

Comes in Pack Sizes of 100.

Richard MacLeavy, Non Pharmacist Branch Manager

They need to make co-codamol a POM. Any crackdown on prescribing opiod based medicines will result in more over the counter purchases of co-codamol. In that curcumstance all responsibility will be shifted onto the pharmacy in a situation which is harder to control at the pharmacy end. 

N O, Pharmaceutical Adviser

Are you aware of the CCGs asking GPs to reduce prescribing Co-Codamol and ask the patients to buy??? 

Richard Binns, Primary care pharmacist

Thats just kicking the problem under the bed, all that will achieve is a small decrease in prescribing budget, while the problem goes unchecked. Just looking at the problem from a NHS financial perspective (neglecting the harms longterm opioid use causes patients), the real cost burden is in frequent appointments/hospitalisations associated with opioid addiction, so this at face value appears very short-sighted.

 

David Moore, Locum pharmacist

Wow! That's really going to stop the addicts buying more codeine.

Adam Hall, Community pharmacist

Shall we 'crack down' on bad and inappropriate prescribing by GPs? Nah, let's just stick a few more warnings on the box!

Richard Binns, Primary care pharmacist

I think this is a good opportunity for community pharmacies to question the practice of 'auto ordering/managed repeat ordering' of prn opiates every month. Not taking responsibility away from the prescribers, but if some pharmacies are ordering on behalf of patients without questioning the need for meds and counselling regarding risks then they are contributing to the issue.

Not tarring everyone with the same brush, but theres a lot of evidence this is happening out there.

N O, Pharmaceutical Adviser

Does it really matter who orders the scripts, when the final authority of issuing the script lies with the GP practice??? Why we always put the blame on end point when the problem can be nipped at the bud?? What do the MURs (I mean the frequent rebiews) at the surgery acheiving?? Why not stop/ weane off the opoids and completely remove from patients ordering system?? OHHHHH forgot that the GPs are very busy and the Clinical Pharmacists are too. So put the blame back on over ordering. Laughable.

Richard Binns, Primary care pharmacist

its really not a case of appointing blame;

1. as previously discussed, you as a pharmacist are a highly skilled professional, you are accesible to the public without an appointment. As a professional you take a high level of responsibility for your actions and are held accountable for the wellbeing of patients under your care, this is why we are all against remote supervision, deregulation to pharmacies being supervised by techs, cut price pharmacists through apprentaships.

2. You feel that your skills are overlooked by the powers that be and funding is diverted away from your sector to pay for primary care pharmacists, which you evidently feel agrieved by, and as previoulsy posted you feel that you could perform the role of a clinical pharmacist given this funding and/or opportunity.

Then why when a problem which is clear public health risk is presented to you is your reaction to state that the responsibilty lies elsewhere and you resent playing a part in tackling the issue. is this not playing into the hands of the close as many pharmacies as possible/let amazon deliver everyones meds/lets deprofessionalise pharmacy brigade?

To clarify I was not pinning the problem on community pharmacy (and particularly yourself), the problem with opoiod prescribing is wide spread and complex, with  large social care as well as healthcare problems influencing it.

Is it not down to each sector to do their bit? theres evidently no quick fixes to the problem.

Do you not accept there is a problem with the current 'auto orderring', where we are indirectly endorsing opioid usage by ordering the meds every month whether the patient  needs them or not.

Locally we recently performed a medicines amnesty, one patient retruned serval grands worth of sched 2 CDs (as a result of meds being ordered that werent required.), do you not accept the risk of these meds being diverted and falling into the wrong hands.

 

N O, Pharmaceutical Adviser

"""""Do you not accept there is a problem with the current 'auto orderring', where we are indirectly endorsing opioid usage by ordering the meds every month whether the patient  needs them or not.""""""

Auto-ordering or not, if a patient is addicted he/she will question if an item is not in their bag when they collect their meds every month. Now the issue is again the blame game. In this scenario, if the patient says that he/she needs it every month then the Pharmacist cannot stop ordering on their behalf "AUTOmatically" along with other regular meds. If they don't and the surgery simply puts the blame back (when the patient calls the surgery to know why the item was not issue) by saying "Sorry it was not on the Order". So either the Pharmacy loses the patient forever or will be reported for not doing the job properly. ---- This is where the smart GP practice comes in the picture. If they are not supposed to have an item so frequently or not at all, then just say so directly to the patient.

"""" you resent playing a part in tackling the issue""""

So, so so wrong. We have all the responsibilities in the world as mentioned by you and we do execute those to the last drop. We have a buisiness to run, families of us and the staff to feed and pay taxes. When it comes to people buying these opoids from the pharmacy, we keep our EYES WIDE OPEN and then make sure the message (already printed on the boxes) is not only clear to the buyers but also a message that YOU WON'T GET ANOTHER BOX FOR A WHILE NOW. But, the problem is when these items are given on prescriptions. Our responsibility is restricted to politely reminding them of not overusing. ----- Again, this is where the smart GPs have to intervene, if they think a patient is either over-ordering or over using.

Over to you.

Richard Binns, Primary care pharmacist

when I referred to 'AUTOmatically' ordering, thats exactly what I was referring to, medications being ordered every month without any input from the patient. 

I can confirm from experience this practice does occur to various I have exerienced this practicce happening on several levels(I can think of one large multiple which asks the patients to tick what they will need a month in advance whenever they collect a script, and Ive had numerous conversations with patients regarding the issue), I am not implying this is a practice that you yourself undertake and I hope that is clear if you reread my comments, I would stress that you appear to take wide spread issues very personnally when they are not directed at you.

With regards to restricting the sale of OTC opioids I can only commend you, not everyone does and it can be very unpoplular with patients when OTC sales are declined.

Richard Binns, Primary care pharmacist

Can I just touch on something Ive picked up on aswell, you have on a couple of occasions stated that x,y,z is not your responsibilty as a pharmacist and the ultmate responsibility lies with the prescriber.

When I went into the pharmacy profession I was taught that our role/responsibilty was to add an safety net to the prescribing/meds supply chain.

we need to be very careful about talking ourselves out of jobs by talking down the responsibility we do have to ensure meds supply is safe. Theres plenty of people out there wanting to make the meds supply chain more 'cost effective' by doing away with the necessatiy for a professional to oversee the supply of meds

N O, Pharmaceutical Adviser

You are either delusional or confused. I don't recollect saying ANYWHERE that It is not my responsibility, even when it was clearly NOT.

Let me put it clear to you. All i have always said is, why pass on the blame to the last one in the chain of reponsibilities (blame) when it is clear where the problem is originating.

In this case, the WARNING WORDINGS are now being placed on POM packs and not on P/GSL packs (which have been on for ages now) So, if the source of prescription generation can be tightened then why push the Community Pharmacists to do things beyond their control.

Eg. 

Patient X comes in to collect Co-Codamol everymonth on his repeat prescription. The Pharmacist always advices the risk of addiction and to use only when needed. The patient smiles takes his bag and leaves.

Now tell me what more do you expect from the community pahramcist or THE WARNING on the box??? Do we put our foot down and say he/ she is addicted and should not order it every month? Or should we stop ordering at all and every month refer the patient back to the Sugery?? 

It is easy to sit in chamber/ room away from direct patient interactions and say YOU SHOULD BE MORE RESPONSIBLE in making sure they don't get addicted. But in practice, nahhhhhh. 

We are not running away from any jobs (even when most of these jobs are unpaid) especially when it comes to supplying medicines. But, it is the view, people like you take when we point out how silly your suggestions are. There may be many who want to sell medicines un-superwised (some call them peddlers) but have you thought of what will then happen if these people were allowed to do so??? 

Just stop scaremongering and make some sensible suggestions. We just dont sit on our bums and sell anything and everything without being responsible. We do talk to loads of people about their health but, then it is in their hands whether to take it or leave it.

Richard Binns, Primary care pharmacist

I dont understand, whos passing 'blame'? why is the term is appropriate in this context?

can you please clarify?

Richard Binns, Primary care pharmacist

can you please  stop to read what  I have actually written, I would like to think that it is clear I very much against deregulating the supply chain from my posts.

Can I also ask, why the need to use !!!!!! and ????? at the end of every point you make. Are you trying to imply you're shouting?

Bob Dunkley, Locum pharmacist

Well warnings on packets wouldn’t have stopped me....

 

N O, Pharmaceutical Adviser

Reminds me of the WARNING on Cigarette packs !!! The very reason for the use/ overuse is they can't do without it (call it addiction or otherwise) So, only way to stop the so called addiction is to not have them available at all. But then, who will face the corporates???

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