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Opioid Analgesic (painkillers) Dependence


Opioid Analgesic Dependence (OAD) is becoming a major healthcare problem all over the world. Most people become dependent on painkillers after being prescribed following a medical procedure. Once craving sets in, it is often too late. When opioid painkillers are taken for longer than prescribed, in higher quantities, or for different indications than the original one, addiction is likely to be developing.

Codeine, oxycodone, hydrocodone, morphine, pethidine, tramadol and other opioid analgesic painkillers can help manage pain when prescribed for the right condition and used properly. But when misused, they can cause serious harm, including addiction, overdose and death.

Opioid Analgesic Dependence may be the result of pain treatment, or using opioids bought on the street or dark web, the latter usually related to underlying mental health problems such as anxiety. Affected populations and clinical management are different from treating heroin dependence.

Once painkiller dependence has developed, it creates a range a of serious problems for the person affected, their family and the treating clinicians.

Some of the patterns that may suggest painkiller addiction are related to:

  • Adverse consequences or harm due to misuse, such us being intoxicated, somnolent or over sedated, declining activity, irritability, anxiety, unstable mood, increasing sleep disturbances, pain complaints and relationship problems.

  • Impaired control overuse or compulsive use. Sometimes patients report lost or stolen prescriptions or medications, request frequent early prescription renewals, urgent calls or unscheduled doctor visits, abusing other drugs or alcohol, suffering from withdrawal signs noticed during clinic visits.

  • Preoccupation with use due to craving. Frequently missed appointments unless opioid renewal expected, refusal when offered non-opioid treatments, intolerance to most non opioid medications, requests for medications with high addictive potential, reports of no relief with anything except opioids.

Treating pain and addiction is very complex. Clinical expertise in both substance misuse and pain management is vital.

The OAD Clinic pain management programmes are led by two of the most senior specialists in the field. Dr Arun Bhaskar, MBBS MSc FRCA FFPMRCA FFICM FIPP President of the British Pain Society and Dr Oscar D’Agnone, MD, MRCPsych one of the best regarded addiction psychiatrists in the UK with more than 30 years of experience as academic and clinician.


Consultant in Pain Medicine, Anaesthesia and Intensive Care

Dr Arun Bhaskar is a leading consultant in pain medicine in London, who holds a special interest in complex pain, including neuropathic pain, cancer pain, visceral and pelvic pain, pain interventions and neuromodulation. He also holds a particular interest in opioid management in complicated cancer pain and opioid dependence and its management in the pain patient population.

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