18 December 2019

Opioid addiction is a major social problem across the world. 

In the vast majority of cases, addiction begins after medical prescription when it is prescribed as a painkiller. 

According to the US Department of Health and Human Services, 10.3 million people misused opioid prescriptions in 2018, with 47,600 deaths from opioid-related drug overdoses1

Although the problem is most severe in the United States, it’s becoming an ever-increasing issue in the United Kingdom, too. 

In England, prescriptions for opioid-based painkillers have increased by more than 60 percent in the past decade2

At the same time, the Office for National Statistics recently reported that there were 4,359 deaths from drug poisoning in 2018, the highest figure since records began in 19933. More than half of these deaths involved an opiate.

As well as addiction, opioids have other serious side effects such as lethargy, confusion and breathing difficulty. 

Additionally, there is some research that suggests opioids may reduce a patient's immune response and therefore they may be related to an increased risk of post-operative cancer recurrence.

However, opioids – such as morphine or the more powerful fentanyl – are useful and have been used in surgery for decades to treat patients with severe pain following surgery. The medical community is therefore looking at how best to strike the right balance between reducing opioid dependency and safely treating patients. 

In thoracic surgery, which is one of the most painful types of operation and therefore the most in need of strong painkillers, surgeons and anaesthetists at Royal Papworth have begun a programme of opioid-free anaesthesia.

In the past two years, almost 200 patients have been treated using this novel technique of avoiding opioids in thoracic anaesthesia. Instead, the approach to pain management now involves a combination of nerve blocks and analgesic medication.

Opioid-free patients have since been found to suffer fewer complications and had a shorter hospital length of stay.

“Since our first patient under this scheme back in January 2018, we’ve found that patients are more alert, active and their overall length of hospital stay has reduced by more than a day,” Dr Chinmay Patvardhan, Consultant Anaesthetist at Royal Papworth Hospital NHS Foundation Trust, said.

“Patients have been of the same quality of pain control compared to when we were using the traditional anaesthesia, but with a reduced risk of developing long-term addiction to painkillers and a reduced risk of the side effects associated with the drugs,” added fellow consultant anaesthetist Dr Guillermo Martinez.

Some research into the use of opioids has found that, even with a single exposure to the drugs, up to 30 percent of patients remain on opioids six months after treatment while 15 percent will develop an addiction.

Mr Giuseppe Aresu, Consultant Thoracic Surgeon at Royal Papworth, is one of the pioneering surgeons involved in the opioid-free programme. 

“It also has the added benefit of reducing the detrimental effects of opioid-based medication on a patient’s immune system. There is anecdotal evidence that opioid use can increase risk of cancer recurrence in certain types of cancers.

“We are now receiving interest from consultants abroad who are eager to learn about our opioid-free programme and want to come replicate those practices across the globe.” 

A team of doctors at Royal Papworth chose to use this novel technique during thoracic surgery because the operations are extremely painful and therefore opioids are normally essential.  

“Anaesthetic practice over the years has dictated that opioids should be used, but we are trying to change that mentality,” Dr Patvardhan added.

“At this stage we are in the process of conducting further studies, but the early signs are encouraging. 

“There are a multitude of positive impacts to this approach, including; reducing a patient’s length of stay in hospital; removing the possibility of addiction; and preventing unwanted side effects of opioids, which indirectly saves the NHS money.”

1 https://www.hhs.gov/opioids/about-the-epidemic/index.html