12:23, March 03 90 0 theguardian.com

2019-03-03 12:23:04
Opioids: poverty is the culprit

The healthcare system is unable to address the increase in opioid usage (Editorial, 1 March) because it is dealing with the symptoms rather than causes of a crisis that is obvious to most, but not seriously addressed by our current politicians on either side of the spectrum. As your editorial states, the NHS cannot prescribe money. Poverty results in poor and complex healthcare outcomes. Perhaps we should consider article 25 of the Universal Declaration of Human Rights: “Everyone has the right to a standard of living adequate for the health and wellbeing of himself and of his family, including food, clothing, housing and medical care.”

Much of this poverty in the UK is driven by the lack of availability of good quality housing or accommodation for rental or purchase at affordable prices, resulting in relative poverty and consequent inability to live adequately, pay bills or put decent food on the table. Building good quality accommodation which is affordable to rent (or buy) brings short-term benefits in terms of employment and long-term benefits in terms of health and wellbeing. This would help much more than tinkering with prescribing or the NHS.

Rob Pinnock

Cambridge

Having lived, and earned my living, with chronic pain myself for the last 50 years, I agree that a multi-disciplinary approach is the best way of dealing with the crisis. There has been some excellent research carried out in the field of “pain management”, which means exactly what it says. There is almost never a complete cure for chronic pain and the key to coping with it is to develop a strategy whereby the pain and concomitant exhaustion are accepted, and standard painkillers used as a sort of “volume control” to enable the affected person to live a reasonably productive and enjoyable life, rather than continually hunting vainly for a cure.

Dr Brigid Purcell

Norwich

The poorest people have more chronic pain. GP prescriptions of opioid painkillers are on the rise in England and Wales. There are fewer pain management services in poorer areas. So, what’s new? As someone who has had chronic pain all my life, I can honestly say that I will try anything that might improve my pain. Indeed, most people will try any medication to relieve their pain even if there are side effects and a risk of dependency.

If we seriously want to address chronic pain in the UK, much more research is needed to understand the complex causes, impact and treatment of chronic pain. This research needs to study how the body, mind and social factors all contribute to chronic pain. People with chronic pain and especially those from poorer areas must be active participants in this research. Second we need to have speedy access to pain specialists working within interdisciplinary teams. Education to help us understand and take more responsibility for our own pain must be an essential part of this. Targeting opioid users and GPs is not the answer. We need more interdisciplinary research and more involvement of people with chronic pain in managing our own treatments.

Martin Hoban

Pontyclun, Rhondda Cynon Taf

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