Health tries to stop the skyrocketing use of opioid painkillers due to their addictive risks

One in three adults suffers some type of pain in Spain. Chronic disease has an estimated incidence of between 11 and 17%, according to the data contained in the document, to which elDiario.es has had access, sent to the health advisers. Osteoarthritis, lumbar, neck or headache pain are the most frequent ailments in the Spanish population from 15 years of age.

Data from the Ministry confirm that the use of opioids "has increased significantly in recent years." The number of doses consumed per 1,000 inhabitants per day (DHD) has grown by 53% between 2013 and 2020, "going from 3.57 to 5.48". Health pays special attention to fentanyl, the active ingredient most consumed: it accounts for 50.2% of the use of all opioids. "In nine years the dispensed containers of fentanyl (nasal and oral) have increased by 78%", recalls the document.

Fentanyl is not authorized by the EMA to treat chronic non-cancer pain, but Spain is the third country with the highest consumption of this substance behind the United States and Germany, according to data from the 2020 annual report of the International Board of Control of Narcotics (INCB) published this year. The trend continues to rise, compared to the two leading countries in use with notable decreases, includes the plan drawn up by Health, which also warns, taking as a reference a report from the European Monitoring Center for Drugs and Drug Addiction (EMCDDA), that deaths associated with fentanyl and its analogues have been underestimated.

Several scientific societies published in 2017 a guide to the proper use of pain relievers due to the increase in the number of addiction cases in Spain. Now, Health, after having consulted with these bodies and approved a draft in the Permanent Pharmacy Commission, puts on the table a plan that seeks to put an end to the use of these drugs. The objective of the plan is "to optimize the prescription and avoid possible situations of inappropriate use".

In the United States it is a recognized public health problem, but only two years ago the OECD warned that it is also beginning to do so in Europe. The report Addressing Problematic Opioid Use in OECD Countries, published in 2019, warns that "the misuse and over-prescribing of opioids are the most important causes of the opioid crisis. And it urges countries to take action.

A preventive approach

The plan seeks, with a "preventive approach", to avoid situations such as those occurring in other countries such as the United States or Canada. How? Among the most urgent measures are the creation of a decalogue of recommendations for the treatment of chronic pain at the national level; a tool to stratify patient risk; a protocol to withdraw drugs from patients; the design of consumption and clinical indicators; and a communication strategy with patients that informs about the risks of consumption. The plan also includes analyzing, if appropriate, "the review of the financing conditions of drugs with opioids", such as ultra-fast acting fentanyl.

"The use of opioids is well established in clinical practice for the treatment of severe pain in cancer patients and in palliative or terminal care. However, the scientific literature describes the controversy that exists in the use of these medications for relief. of chronic non-cancer pain, given that the expectation of total pain elimination by patients and professionals encourages an escalation in the use of different drugs at increasingly high doses that can lead to harm to the patient and risk of addiction without achieving the desired therapeutic objective ", recalls the document that Health has already sent to the autonomous communities.