Opioids are currently plagued by bad press – either related to the opioid epidemic at large, or the Sackler family themselves, better known as an “evil bunch”, according to one patient. Also, the NHS is currently in crisis, so it’s hard for doctors and other healthcare staff to find the time to sit down with patients and explain the ins and outs of their opioid prescription. On top of all that, concerns about overprescription have grown, as the UK has recently become the largest opioid consumer globally. Given all this, it can be difficult for the average patient who is prescribed opioids after surgery to know what to do with them. Currently, our understanding of patients’ experiences with opioids after surgery is really lacking, which means that it’s difficult to know where to start when it comes to improving prescribing practices.
In order to investigate this, we just… asked them. Over the course of March, we recruited and interviewed 20 patients who had recently undergone surgery at University College London Hospital (UCLH). We wanted to interview those who didn’t experience long term opioid use in order to capture the experience of the average patient – only around 4% of patients use opioids for more than 4 months after surgery.
Some patients told me that they didn’t receive enough information and support from healthcare staff, and then had to look elsewhere. For some, this meant that they ended up managing their pain themselves: “They didn’t offer anything else other than that. I think I probably said to them my plan is to take paracetamol and ibuprofen on a two hour cycle, and they said, yes that’ll work, and, you know, that’s what I did.” Thankfully, this patient was able to manage their pain and didn’t end up with further complications, but this isn’t always the case. This lack of care is likely because doctors and other medical staff in the UK are more overworked and underpaid than ever, leading the Royal College of Nurses to strike for the first time in decades. This is a major issue, as the lack of care towards healthcare staff leads to a lack of care towards patients, as staff simply don’t have the time or resources to care for patients at their best standard.
“I had a friend who had a mental breakdown due to opioid addiction. So, I was very keen to finish my treatment.” This patient, and many others, had personal experiences of addiction that either made them stop taking opioids quickly, or made them avoid them altogether. Other patients were worried about addiction, but did not have personal experience, and therefore avoided opioids. On the other hand, some patients reported a lack of concern about addiction. This often coincided with implicit othering of addicts, and the implication that medicinal use of opioids was inherently different to recreational use. As one patient put it: “But this is medicinal. With illegal matters it is a different issue entirely.”
Another major factor affecting patients’ opioid use was the physical effects. Many patients described how the side effects either prevented them using opioids in the first place, or made them stop using them quickly. Patients said that they felt that the pain relief from opioids did not outweigh the negative impact of the side effects: “I did not feel the pain was bad enough, so I did not want to risk the side effects.”
Also, some patients said that they felt that they weren’t in enough pain to take opioids in the first place: “I don’t think the pain… I don’t know if I necessarily needed them.” 8 patients told us that they weren’t in enough pain to really need opioids, and 6 patients didn’t take opioids at all. This suggests that opioids may be being overprescribed after surgery. This is concerning, as the UK is now the largest consumer of opioids worldwide. Whilst many of the factors contributing to the US opioid epidemic aren’t present here in the UK, including a lack of centralised oversight and a consumerist approach to healthcare, concerns about a potential opioid epidemic here are very real. We need more investigation into what factors are contributing to high rates of opioid prescription here, and whether opioids are being overprescribed.
That said, it should be noted that this study relied on an opportunity sample of patients recruited over the phone. Given the time restraints of when we could call, it is likely that we didn’t manage to include many participants who work full time, which also means that the role of working, and employment wasn’t captured well by the study. In addition, people who weren’t very technologically literate, and those who weren’t fluent in English also couldn’t be included in the study. On the other hand, the use of structured interviews limits the potential for the researcher’s biases to affect the interviewee’s responses. However, bias could still affect the thematic analysis of the data, which is why awareness of one’s own biases is so important.
Overall, we found major factors, including pain, concerns about addiction, and relationships with healthcare providers, impacted patients’ opioid usage. A key aspect of this is how healthcare providers either left patients feeling reassured and prepared, or like they were left in the dark, leading patients to seek information and pain management strategies elsewhere. Unfortunately, there is no current standardised procedure for opioid prescribing practices in the NHS, so patient care can vary wildly. The negative impacts of understaffing likely also contributed to this, as staff often don’t have enough time to properly discuss patients’ prescriptions. In addition, the findings of this study indicate that opioids may be being overprescribed, so new guidelines should be developed to reduce opioid prescription. Hopefully, the findings of this study will encourage the development of clear, standardised prescribing practices for opioid prescriptions. More importantly, it emphasises the importance of healthcare staff, and the detrimental effect that underfunding has on workers’ ability to provide care at their best.