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In terms of European cocaine usage, half of the top ten cities are Swiss. Swiss cities take five of the top nine slots for European consumption. The cocaine comes mainly from West African networks, reports Addiction Switzerland. Heroin, meanwhile, is imported and sold mainly by Albanian groups, with the quantity in circulation estimated at 1. But even the cheap options result in high social costs. Every year problems linked to dependency — either of substances or gambling — result in more than 11, deaths and social costs of around CHF14 billion. Tobacco is responsible for almost 9, deaths a year in Switzerland, where 9. Cannabis remains the most consumed illegal substance. Given reforms of cannabis law internationally, for example in North America External link , Addiction Switzerland urged the development of regulation adapted for Switzerland. Dear Swiss Abroad, what difficulties did you encounter when your foreign spouse applied for Swiss nationality? Tell us your experiences. Swiss food regulations do not allow raw milk to be sold for direct consumption. However, a loophole allows raw milk vending machines to do just that. Is Swiss neutrality misunderstood? Or has the Swiss model of neutrality now become obsolete? More: SWI swissinfo. You can find an overview of ongoing debates with our journalists here. Please join us! If you want to start a conversation about a topic raised in this article or want to report factual errors, email us at english swissinfo. This content was published on Oct 21, An overview of patient statistics from shines new light on the dependency of Swiss on legal and illegal drugs. This content was published on Jul 11, Men should drink no more than two glasses of alcoholic beverages a day, the new government guidelines have recommended. During the week it is second only to Barcelona, finds a wastewater study. This content was published on Feb 4, Tens of thousands of patients in Switzerland regularly use cannabis to relieve pain and discomfort. Most of them do so illegally, however. SWI swissinfo. Swiss perspectives in 10 languages. Search Close. Menu Close. Search Search. About us. International Geneva. Foreign affairs. Swiss Politics. Multinational companies. Swiss Abroad. Switzerland: How To. Special reports. This content was published on February 6, - Other languages: 5 EN original. External Content. Popular Stories. More Swiss Abroad. Most Discussed. Next Previous More Debate. Hosted by: Emilie Ridard. Join the discussion. Sep 25, More Debate. Hosted by: Anand Chandrasekhar. Should raw milk sales be banned or should consumers decide? Oct 8, Hosted by: Giannis Mavris. What is the future of Swiss neutrality? Sep 13, More Debates. In compliance with the JTI standards. Read more. More Swiss experts recommend lower alcohol intake This content was published on Jul 11, Men should drink no more than two glasses of alcoholic beverages a day, the new government guidelines have recommended. Read more: Swiss experts recommend lower alcohol intake. Follow us. Data Privacy Statement. Terms of Use. Rights to content and liability. Play SWI. External Content Your subscription could not be saved. Please try again. Almost finished We need to confirm your email address. To complete the subscription process, please click the link in the email we just sent you. Discover our weekly must-reads for free! Sign up to get our top stories straight into your mailbox. I consent to the use of my data for the SWI swissinfo. Subscribe See all newsletters. Manage my profile Log out Close. My Profile. Delete profile. Our data protection notice provides you additional information concerning data processing. More on our terms and conditions.

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You stagger to your GP, who has already given you a prescription for one of the big five opioids — fentanyl, oxycodone, tramadol, buprenorphine or morphine sulfate. Your GP ups the dose. You and millions of other chronic pain sufferers. But would you take these drugs if you knew what medical science knows? Today, we expose the facts Big Pharma would prefer you were not acquainted with. The BMJ revealed that in a review of randomised trials involving thousands of people suffering from the two most common types of chronic pain — lower back pain and osteoarthritis — prescription opioids had a failure rate of 90 per cent. The scientists applied the standard definition of failure as an inability to achieve at least 50 per cent pain reduction. The results for the opioid oxycodone were even more damning. Unlike acute pain, which is caused by a single event such as breaking a rib, chronic pain can be hard to pin down and is difficult to treat. This extraordinary revelation — that a hot water bottle is probably more useful than packs of prescription opioids — threatened to eviscerate the massive profits made by drug corporations targeting their pills at millions of chronic pain sufferers. Purdue convinced doctors its drug had a low addiction rate but this turned out to be false. The pill is stronger than morphine and, with other prescription opioids, is said to have helped trigger a crisis that has killed , people in the US from to , according to the Centres for Disease Control and Prevention. There is not one answer. The Food and Drug Administration, the regulator in the US, has directed industry to do more studies, but at the end of the day, the FDA has approved our drugs for long-term use. Purdue nevertheless faces a blizzard of lawsuits. More than 60 US counties and cities are suing it, as well as other drug makers, alleging that they played a central role in fuelling the opioid epidemic. But it too fails to take on board the findings of medical science. This blanket statement fails to distinguish between acute and chronic pain. It is a claim the MHRA rejects. Our role is not to protect industry interests. Nevertheless, the labelling standards they impose on drug companies are — as we reveal later — dramatically more lax than in the US. With 90 per cent of all opioids being prescribed for chronic non-cancer pain, the intervention marked a potential watershed. Did it work? The numbers tell the story: prescriptions for opioids have risen 80 per cent to Buprenorphine surged per cent to 2. Prescriptions of fentanyl, a synthetic opioid up to times more potent than morphine, increased by more than 80 per cent. In all, new data shows that 3. The UK has become the biggest consumer of painkillers in Europe, with almost a third of all prescriptions for opioids across the EU written here. Ninety per cent of these prescriptions are dished out by GPs. The financial waste is mind-boggling. WE OFTEN hear about the horror story unfolding in America, where 16, people died from overdoses related to prescription opioids in , but alarms are ringing in the UK, too. The Evening Standard can exclusively reveal that admissions to hospitals in England involving overdoses from opioid painkillers other than heroin surged to 20, cases last year. This is a rise of 85 per cent in the past decade, according to a bespoke data set run by NHS Digital for our investigation. Even more alarming is the rise in poisoning from synthetic opioids: tramadol, fentanyl and buprenorphine. This is logged under a separate category that includes other synthetic narcotics and which has soared per cent to 5, admissions. Together it amounts to more than 60 hospital admissions a day. Opioid fatalities have been creeping up here too and have now hit a record of 2, in England and Wales, a 58 per cent increase in four years. The US narrative continues to make headlines, with Donald Trump declaring a public health emergency. The musicians Prince and Tom Petty died from accidental overdoses in and respectively, having become addicted to analgesics prescribed for their chronic pain. This has yet to be confirmed by an inquest. All this, and the surge in prescriptions, recently prompted the Government to announce a review into prescription drug addiction that will report back early next year. However, many experts worry that problematic use of opioids has long been spiralling out of control and that we are now sitting on a timebomb. Each addict has a horror story and they mostly start with innocently taking painkillers dispensed by a doctor for a medical injury. Dan not his real name , a year-old IT expert privately educated at City of London School and NYU in Manhattan, was prescribed oxycodone after tearing a disc in his back while carrying a sofa up a flight of stairs. The drug worked a treat, he said, taking away his pain as well as other stress. But after a while he felt worse than before, and so he started to request higher doses from his doctor, tripling his intake to 90 milligrams a day. Eventually, his GP grew so alarmed that he cut him off. Dan went into a terrifying state of withdrawal. In desperation, he turned to a street dealer who offered him relief by way of a similar but illegal opiate — heroin. The road from prescription painkiller to heroin is unfortunately well travelled, according to the American Society of Addiction Medicine, which says that opioids are the gateway drug for 80 per cent of people who try heroin in the US. The whole pain industry is sick and it has completely ruined my life. What is the extent of opioid addiction in the UK? The answer is surprisingly hard to pin down. We know from a meta-study published in the BMJ that chronic pain affects 28 million adults in the UK, of whom eight million suffer pain severe enough to be disabling. Of this group, 3. If we apply addiction rates in the US of eight to 12 per cent, that translates into , UK addicts. Experts say it is important that the government review gets a grip on the numbers so that adequate and dedicated treatment can be provided for problem users. But there is also the issue of how to warn patients in order to curtail future addiction. Addicts spoke of getting hooked on pills initially prescribed to them for post-operative pain or medical injuries. At a vulnerable moment in their lives, they had not been adequately cautioned about the potential of these drugs to leave their world in ruins. The Standard investigated this charge of lack of transparency by scrutinising the warning information they reveal about their product on the box and in the detailed patient information leaflet PIL , which has been a legal requirement in the UK since Yet, to our knowledge, our simple study is one that had never before been carried out in the UK. We focused on the five most potent and potentially addictive opioids typically prescribed for chronic pain — fentanyl, tramadol, buprenorphine, morphine sulfate and oxycodone — as well as two milder ones, codeine and dihydrocodeine, which collectively account for 98 per cent of prescription opioids. As most opioids are off-patent, there are many brands so we selected particular products based on a combination of two things: NHS Digital data on the most commonly dispensed brands and a visit to a large London pharmacy to observe products it typically dispenses. We examined the external box and the PIL for mention of two things chronic pain sufferers need to know — the risk of addiction and the efficacy in tackling long-term pain. Our results — which you can find in full in our appendices at the bottom — shocked the experts. This is what we discovered:. We therefore have a bizarre situation in which none of the packages or PILs of the most potent opioids prominently warn of their addictive potential or limited usefulness for chronic pain. How can this be? It is because the regulatory regime in this country is so weak. We put this to the MHRA. However, there do have to be clear warnings about known side-effects, including risk of tolerance or dependence. In Britain it is left to the discretion of the drug company, which typically says nothing. We asked each of the drug companies cited in our investigation why it did not include prominent addiction warnings on the package or in the PIL, as it would in the US, and why it targeted opioids at chronic pain sufferers when they have such limited efficacy. Janssen, Napp, Takeda and Boehringer Ingelheim replied. It is absolutely wrong. Each of these opioids are highly addictive and the more potent the drug, the greater the risk. How hard is that? The public should be made aware. That is what is called informed consent. It would seem a logical, sensible and easy thing to do with zero cost and only upside potential. There is a complete absence of grip — by the regulator, by the Government, by anybody. None of these experts argue that stricter labelling is a sufficient factor on its own to curb addiction or inappropriate prescribing by GPs, but they say that transparency from drug companies is an important first step if we are to change behaviour. We have an NHS that is stretched to breaking point, addiction treatment services that have suffered huge cuts to budgets, GPs with no time to properly assess and monitor patients and prescription rates going through the roof. Do we have a problem with how opioids are prescribed in the UK? It is time to change course, pain specialists and medical scientists are telling us. But how? And what are the millions of chronic pain sufferers to do when their opioids fail? The married father of five seemingly had it all. But Philip, 56, had a secret. It was an illicit drug deal in plain sight. Oxycodone is a class-A opioid and acquiring it without a prescription carries a seven-year prison sentence, but Philip had become too addicted to care. He was taking a potentially fatal dose of milligrams a day, 10 times the amount he started on. Little did he know that oxycodone, along with other potent prescription opioids such as fentanyl, was responsible for 16, deaths in the US in and a growing number of fatalities in the UK, where oxycodone deaths have doubled in the last four years to 75 in Five years ago his appendix burst and after an operation to remove it, he was hospitalised and put on a morphine clicker to address the pain. Opioids, it must be said, are highly successful in providing relief from post-operative and acute pain, as well as to ameliorate cancer pain. I asked him to get me more. He began taking four pills a day, switching between MST and oxycodone. The only thing that relieved the symptoms was more pills. You think to yourself: these are given out by GPs every day of the week, how bad can they be? Philip hid his habit from his wife and children, citing overwork and stress for his increasingly detached behaviour. I had no desire for sex and became emotionally cut off. My marriage of 20 years started to crumble. But instead of cutting down, Philip ramped up. The Crime Survey for England and Wales reports that one in 13 adults has taken prescription painkillers not prescribed to them, with an increasing number bought online. He switched instead to the dealer who would arrange to meet him on Oxford Street. Within a year he had upped his daily dose to the potentially fatal mg. He knew he was in deep trouble but felt powerless to stop it. Then last May Philip had a breakdown. I finally told my wife about my addiction. She threatened to leave unless I got help, so I went to see my GP who advised me to go into rehab. Philip prevaricated, but things came to a head in the summer when he took his family to Turkey and his wife found his stash of oxycodone and threw it out. He started to get hideous withdrawal symptoms and panicked. My family were devastated. Ukat says that admissions for prescription opioid addicts at its six treatment centres have risen by 30 per cent in the past two years, indicating a growing opioid addiction problem in England. On the day Philip met the Standard, he was a Ukat out-patient, three months clean and attending daily Narcotics Anonymous meetings. He looked smart and rested, nothing like a dishevelled drug addict. I would never, ever have got through it on my own. But the fallout has been devastating. He is living as a lodger in a shared east London bed-sit, a far cry from his five-bedroom barn in Harlow. He looked stricken. He paused. I want to warn people how easy it is to ruin your life. I want to send a wake-up call to the Government. This is a growing problem right here in the UK. Prescription opioids are essentially heroin in pill form in a blister pack. Get hooked and they will take a flamethrower to your life. For years the source of the Sackler wealth was not widely known. However, after recent American court actions claiming that Purdue and other distributors played a key role in the opioid crisis that has killed more than , Americans, turning a blind eye is no longer possible. What do the beneficiaries say? We understand that none have turned away Sackler money or returned donations. Each gift is assessed on a case-by-case basis and where necessary, further information and advice is sought from third parties. Asked whether the grant has been held up because of an unrelated delay or because of a need to re-evaluate it in the light of recent criticism of the Sacklers, the gallery declined to comment. About half the respondents, including the Royal Opera House and the National Gallery, where Dame Theresa Sackler is respectively an honorary director and a patron, declined to answer either question. Of the rest, none said it planned to erase the Sackler name from its public space. At present, there is no intention to reconsider the Sackler family and trusts. Currently we will not be terminating the association. They are subject to charity law and we would accept their philanthropy in the future. For the other non-profits, there was a less enthusiastic response. What do the Sacklers say in their defence? The three brothers who founded Purdue in the Fifties — Arthur, Mortimer and Raymond — are dead but their descendants have conflicting views. But the OxyContin-rich branches of the family have remained silent. We asked the Purdue spokesman: does Purdue, and by extension the Sacklers, acknowledge the opioid crisis and a role in it? Purdue is contesting the lawsuits that blame it and other drug firms for triggering the opioid crisis. That said, the opioid crisis is deeply concerning and it is our job to have serious conversations about the risk of addiction and overdose and to address all these issues as proactively as possible. They point to the failure to fund any rehab facilities to help the thousands of people whose lives have been ruined by OxyContin. The Sacklers continue to draw millions every year from their shareholdings in Purdue and Napp, the British arm of their pharmaceutical empire. At the very least they should be honest about the source of their funds. They can no longer turn a blind eye. Fourteen non-profits told us they will no longer accept donations from funds deriving their wealth from tobacco, electing to turn away the money despite the clear social benefit it would bring. Will they now face a similar conundrum with respect to grants from the Sacklers? Whether Sackler money will ever be seen as clean again is a matter that will be decided in US courthouses and the court of public opinion. In the meantime, the debate over whether to accept or reject their money is set to intensify. Mortimer had seven children with three wives. His third marriage, in , was to Londoner Theresa Rowling, 34 years his junior. He reaped billions from opioids and became a major philanthropist, for which he was awarded an honorary knighthood in He died in at the age of She divides her time between her mansion in London and Rooksnest, a property in the Berkshire Downs set among 10 acres of gardens created by award-winning designer Arabella Lennox-Boyd. She received the Prince of Wales medal for arts philanthropy in and has three children, Marissa, Sophia and Michael. Born and bred in London, Marissa went to boarding school in Wiltshire before founding Beespace in Manhattan in Michael founded film production company Rooks Nest in Soho Square in She married a coffee entrepreneur and was on the board of Napp until she resigned last year. FOUR clicks of the mouse. I opened my browser and typed a few simple words into the search bar. Up popped lists of websites of rogue pharmacies around the world offering me as many morphine sulfate tablets and other prescription painkillers as I wanted. I could have been 12 years old. I could have been an addict. I could have been a drug dealer. As long as I had a credit card or bitcoin — for which some sites offered me a 10 per cent discount — they wanted my business. The opioids I was offered were among the most dangerous available, with some times stronger than morphine. Many were class-A drugs that carried a jail sentence of up to seven years if bought without a prescription. Yet according to Philip Hopwood, a former opioid addict who used to buy the drugs online — and was guiding me through the process — these websites are an unregulated zone where anything goes. The websites get away with it because they acquire and ship the drugs from countries such as India and Pakistan where the medicine is not controlled in the same way. The situation is causing deep concern in UK government circles. When Public Health England announced an inquiry into addictive prescription medication this year, it noted that one in 13 adults in England and Wales have taken prescription-only painkillers without a prescription, with a growing number acquiring these drugs via the online black market. The minimum order was for 60 pills but, amazingly, there was no upper limit. This is the reason it is strictly directed by the Drug Enforcement Administration, which implies that they are strict guidelines for getting and utilising this medication. Not complying with these principles, such as purchasing them without a remedy, can prompt extreme punishments. No problem!!!! You do not need a prescription as we work under the laws of the countrys \[sic\] we ship from. Your order will be delivered within 21 days. Philip has bought from some of these sites, with the opioids delivered to his office in anonymous bags or boxes within 48 hours. Surely he worried about getting sent rubbish or an empty box? Typically regulators distinguish between three types of online pharmacy: legitimate outlets such as Boots that process orders online on proof of prescription; those that claim to have a virtual doctor and will provide you with a prescription on the basis of you filling in a questionnaire; and rogue websites that will sell you anything without asking for a prescription. They just go online and shop for what they want. I have heard of people buying online because their GP stopped prescribing and they got desperate because of withdrawal or addiction. You cannot be sure what you are swallowing. The MHRA was alerted to suspicious websites by the public last year and has shut 9, illegal online pharmacies in the past three years. If the website is hosted outside the UK, we work with partner regulators and law enforcement to disrupt trade. Hers was an excruciating pain that began in her belly, radiated out across her back and spread through every muscle in her body. But in her hand, Cathryn held hope: a prescription for fentanyl. This synthetic form of opium, times more potent than morphine, is one of the strongest painkillers invented. Little did Cathryn, 46, know that this legally prescribed painkiller would almost kill her. That instead of solving her pain problem, it would create an even greater addiction problem that would last more than two years and leave her feeling as bad as ever. Today, when Cathryn meets me in a cafe in the Strand, she is smiling but not quite pain-free. Cathryn recalled how the fentanyl initially provided relief and helped with her acute pain. But over the next couple of months the agony returned and one day, two months after leaving hospital, Cathryn tried to deal with her pain by taking a single extra lozenge. There was nothing in the fentanyl patient information leaflet to warn her that opioids are rarely effective for chronic pain. Soon, instead of taking eight lozenges a day, Cathryn was on 12, all obtained legally on prescription. Did it ease her torment? I refused to contemplate that I was addicted. Twenty minutes later I would take another six. If I waited an hour, the drug would start to leave my system and I would experience opiate delirium. I heard orchestras coming out of plug sockets, I saw images of devils in the roof beams of my cottage. I would lie there, curled up, curtains shut, in the dark, alone and utterly desolate. Cathryn tried to conceal her addiction from her parents, hiding her fentanyl supply in boxes of tampons. She quit her job as a writer because she was too ill to work. Her doctor tried to help. I would cry and scream and bully him. It was like a monster came over me. Eventually he had enough and cut me off. I was left with a supply of fentanyl for one week. She put her cottage on the market, borrowed money from her parents and bit the bullet. I had to make it work. But withdrawal was a brutal business — I was nauseous, sweating, trembling, vomiting, unable to sleep, hallucinating and I had diarrhoea. I stuck it out and came off fentanyl. That was eight years ago. Cathryn has since married, resumed her writing career as a ghostwriter, and four years ago became a mother. She wrote a book, Coming Clean, about her experience. They are desperately struggling with addiction to their opioids prescribed by their GPs, an addiction they feel ashamed of and try to hide from their loved ones as I did. But how has Cathryn managed her chronic pain since ditching the drugs? The pain I live with ebbs and flows and, at its worst, it is not dissimilar to the pain I was medicating against. Have alternative therapies helped? I see an acupuncturist, do yoga and do breathing work. It all helps. She paused to collect her thoughts. I can cope. I am lucky that my job as a writer allows me to work from my bed because there are days when I am too sore to leave it. I have learnt to pace myself. In order to get it, I had to have an appointment with a consultant who talked me through the side effects — peeling skin, dry eyes and suicidal thoughts — and asked if I really wanted it. Fast-forward six years and, after an accident at work, I had disabling chronic pain in my right arm, up to my shoulder and neck and across my back. During the four years it lasted, I was repeatedly offered prescription painkillers by everyone from GPs and primary carers to pain specialists and consultants. These were drugs that can lead to dependency, addiction, increased pain, dramatic side effects and again suicidal urges — yet not once was I talked through the ramifications of what I was entering into. The pregabalin, which wiped my shortterm memory five years later, it has yet to recover and gave me truly frightening suicidal urges. The diclofenac, which has since been banned from over-the-counter sale due to a risk of stroke and heart attack. Some of the pills made it tricky to string a sentence together. Most made me feel lobotomised. All sealed my bowels for weeks at a time. I was lucky. Although I took a series of prescription painkillers for over a year, my body overreacted to each drug, throwing up side effects severe enough to make me stop taking them. Unlike many other patients, I never became dependent. Never mind that painkillers tend not to work on chronic pain. Of course, everybody is different and there are many patients who swear by their prescription medication. Painkillers work best for acute pain. And managing pain in its early days makes it less likely to turn chronic. But those drugs I was prescribed? I was offered them three months after my accident, once my pain had officially been labelled as chronic. When I had the accident, I was dispatched with a suggestion to take the rest of the week off work. It was a Wednesday. Chronic pain is incurable, doctors told me. Instead, we can use neuroplasticity, the process in which the brain rewires itself, to send it back the way it came. Most chronic pain develops after an injury: the nervous system becomes hyper-sensitised and fails to switch off the pain signals once the tissue has healed. I studied the mind-body connection — because pain stems from the brain — and went in search of cultures and traditions that might have a better handle on it than Western medicine. I went to South Africa where, under the guidance of a traditional healer, I bathed in the blood of a freshly slaughtered chicken, mixed with my vomit. Finally, after four years of suffering, my pain disappeared in Brazil under the guidance of a faith healer called John of God. On a purely physical level, after almost two years, I know that the neural pathways it carved out have faded. Why am I pain-free, and not my friend who suffers worse than I ever did? When I set out to write a book about chronic pain, I wanted to find a cure that would work for everyone. Finding something inexplicable that only worked for me feels like I failed the eight million Britons who currently suffer disabling chronic pain. Chronic pain patients are 14 times more likely to take their own lives than the average person. That, too, is part of the science. Prescription opioids have had a bad press recently. The messages have focused on their addictive nature. The US is experiencing the tragedy of prescription opioid misuse but there are protections in our healthcare system that make a problem on the same scale less likely here. However, there is a less told and more important story, relevant for opioid users everywhere: the limited effectiveness of opioids for helping long-term pain. When opioids are used to manage short-term severe pain, for example after an operation, they work well. Opioid prescribing has almost doubled over the past 10 years — and nearly 90 per cent of the 24 million opioid prescriptions issued annually are for long-term so-called chronic pain, despite the fact that scientific evidence tells us that they are rarely successful in the treatment of chronic pain. Why is chronic pain so hard to treat? Chronic pain is distressing, disabling and can ruin quality of life. It is really tough to live with. Opioids provide pain relief by acting in the nervous system to block transmission of pain signals in nerves. However, when pain persists for a long time, pain nerves and their connections become over-sensitised and damping down signals becomes more difficult. Clinical trials of opioids show they help fewer than three out of 10 people with chronic pain. In everyday practice the chances of opioids not working are about nine out of Around four per cent of the population are prescribed opioids for chronic pain. Are they the lucky ones who are benefitting? Sadly, no, because chronic pain is complicated. Lack of options tends to bring doctors who are trying to help back to opioids because they work well for severe short-term pain time and again. A patient starting opioids who says they still have pain is likely to have the dose put up in the hope that it will help. It almost never does. Patients are anxious about stopping in case the pain gets worse. People may have tried stopping and had nasty withdrawal symptoms: everyone feels stuck. Statistically, most people taking them will notice little if any benefit. About 80 per cent of people taking opioids will experience at least one side effect. Taken long-term they can cause fractures, falls, night-time breathing problems and cardiac problems. Opioids disturb hormones so they reduce sex drive. They do cause addiction in a small proportion of people and occasionally opioids can make pain worse. We have been prescribing opioids for chronic pain for 20 years. Thinking about them has changed because of improvements in how we interpret evidence. Clinical trials of medicines can be unreliable or misleading and we are better at recognising this. A website, Opioids Aware , written by prescribers and policy makers, includes all the information doctors need to make opioid-prescribing decisions as well as tips for people thinking about starting opioids. In Gloucestershire, we have used information from Opioids Aware to improve the way we prescribe painkillers. Our opioids bill has gone down by half a million pounds in a year, in a county with a population of just , people. If you stop your opioid medicines gradually you should avoid withdrawal effects. Pain can sometimes feel worse at first — this may be due to the changing levels of opioids in your body so try to take things steadily and stick with the scheme you and your doctor or pharmacist have agreed. Second, if you have chronic pain, think about things that may be making it worse. The more your healthcare team understands about you and your life, the more effectively we can work with you to improve your quality of life. Drugs that work at first are often disappointing after a few weeks: again this is normal and again you can discuss with your doctor or pharmacist how to come off safely. We all need new conversations about how we use medicines. Yet this is what we put up with when acquiring drugs for our chronic pain. When it comes to opioids and chronic pain, specialists believe the harm outweighs the good. It is time, they say, to hit the reset button. Dr Martin Johnson, lead for chronic pain at the Royal College of General Practitioners and a contributor to Opioids Aware, said the web guidelines failed because they never became mainstream. Today, having garnered the views of experts, we distil them for readers and project the essence of the Opioids Aware guidelines to build on the conversation about the treatment of chronic pain. Unlike acute pain, the cause of chronic pain is unclear and often involves multiple factors. Yet the prize of progress would be huge: improved quality of life for millions, fewer side-effects, fewer opioid-dependent Britons and a big boost to our economy. Then we pay millions more again to treat the side-effects and impacts of addiction. There has been no official update since, despite a quadrupling in prescriptions and the fact that chronic pain accounts for one in five GP appointments. Ultimately it is about changing behaviour. With 90 per cent of opioid prescriptions for chronic pain written by GPs, getting the message into doctor surgeries is the key. Dr Roger Knaggs, co-editor of the Opioids Aware guidelines, believes it is about empowering, not blaming, doctors. We need to educate our doctors and the public to encourage better choices to be made under pressure. Where to begin? Perhaps with a surprising acknowledgement from pain specialists. They say that there is no way of knowing whether we will be among the 10 per cent of people who respond well to opioid painkillers. Dr Cathy Stannard, who chairs and is co-editor of Opioids Aware, has proposed two golden rules when it comes to treating chronic pain:. Patients who do not achieve useful pain relief within two to four weeks are unlikely to benefit in the long term and their opioids should be discontinued. Short-term efficacy does not guarantee long-term efficacy and so even initial responders must be continually assessed. We are currently running a pilot in Gloucestershire in which patients taking high doses of opioids for a long time are having their cases reviewed to ensure the drugs are working and if not, to help them off. There needs to be similar audits taking place in every GP surgery across the UK. Alternative therapies such as cognitive behaviour therapy, mindfulness, meditation, acupuncture and exercise based therapies including water-based programs to build fitness may have more benefits than hardcore medical treatments. Exercise and movement will be good, but also important is to understand the role that psychological factors play in long-term pain. Dr Amanda Williams, clinical psychologist at University College London and an expert in persistent pain who is writing European guidelines on best practice, built on these suggestions. She proposed the following five-step programme for patients:. Some might find this approach too defeatist, she acknowledged. Eventually, say experts, the rewiring and retraining of your nervous system that got your pain stuck in the acute phase can begin to reverse itself and change back with self-management. But that can only begin, they agree, when patients, supported by their GPs, come off opioids that fail to provide pain relief or give them a normal life. The growing problem. Pain physician Dr Cathy Stannard. A hot water bottle is more effective than Opioids More than 60 hospital overdose admissions a day. Rising death tolls. How Britain is getting a glimpse of America's nightmare WE OFTEN hear about the horror story unfolding in America, where 16, people died from overdoses related to prescription opioids in , but alarms are ringing in the UK, too. This includes a threefold rise in deaths from fentanyl and a doubling in deaths from oxycodone. We cannot be complacent. Health crisis: A police officer attends to two passed-out addicts who had opioids in Ohio. Drugs companies don't tell you full dangers The PILs for buprenorphine and oxycodone products marketed by Napp refer once to addiction but it is buried deep within the text and not drawn to your attention. It is also random, with other brands making no direct reference to the addictive potential. The PILs of the two weakest opioids, dihydrocodeine and codeine, mention their addictive quality prominently — upfront and in bold — and repeat it several times. None of the PILs of the five most potent opioids cautioned users of their limited efficacy for long-term pain, but the PILs of the two weakest opioids did contain warnings about using them continuously for more than three days. What do pain experts make of our findings? It reminds me of the willy-nilly prescribing of valium and how it took 50 years for the message to get through. The way in which we fail to warn people on the label defies logic. I had it all I was not the sort of person who took drugs I became alarmed at how quickly it had escalated and tried to stop I felt like hell. Prescription opioids are essentially heroin in pill form The Sacklers How an opioid fortune helps bankroll London arts. We sent all 33 non-profits the same key questions including: Will they rename their public space as some organisations have done when issues arose regarding former benefactors? And will they accept future Sackler philanthropy? Sackler family members have a year history of supporting causes across London The money that built these public spaces comes from a drug that is killing people and ruining lives. Mortimer Sackler. Dame Theresa Sackler. Marissa Sackler. Sophia Sackler Dalrymple. Michael Sackler. Samantha Sackler Hunt. Jonathan Sackler. Who are the London Sacklers? Scroll through to discover more about the London branch of the family Dame Theresa Sackler, Marissa Sackler, Sophia Sackler Dalrymple, Michael Sackler, Samantha Sackler Hunt, Jonathan Sackler, Rogue online pharmacies Dangerous drugs are just a few clicks away on the web. A few clicks, no questions asked and 1, pills are at my fingertips — the rogue online pharmacies where drugs are sold without prescriptions to anyone with a credit card FOUR clicks of the mouse. One of the first websites I looked at boasted: Order pain reliever morphine online without prescription — cheapest price, safe deliver at your door. I don't want anyone to face what I have Victim Cathryn Kemp's story. Cathryn Kemp was in agony from pancreatitis. She was prescribed fentanyl. Soon she was taking 60 hits a day. I would wake in the morning and crawl on my hands and knees to the bathroom and take the first six of my 60 lozenges. When I got to rehab, they said I had three months to live if I carried on. I can cope Are there alternatives? Crippled by chronic pain, Julia Buckley abandoned Western medicine and set out on an international quest for a cure WHEN, in , I first moved to London and developed terrible skin, I asked my GP for Roaccutane, a drug that can cause birth defects and depression, but nails acne. The consultations often lasted 10 minutes, with a prescription dashed off at the end. In a fog of pain, desperate to return to work, I took the drugs unquestioningly. The amitriptyline, which made me pass out after meals. The tramadol, which turned my brain to cotton wool. I went to South Africa whereI bathed in the blood of a freshly slaughtered chicken, mixed with my vomit. In Haiti, I underwent a voodoo exorcism. The expert's view Dr Cathy Stannard. Only patients who truly benefit from painkillers should be prescribed them Prescription opioids have had a bad press recently. Lack of options tends to bring doctors who are trying to help back to opioids. What is the solution? Painkillers that barely work and more users than ever. Can doctors get us out of this mess? Dr Cathy Stannard, who chairs and is co-editor of Opioids Aware, has proposed two golden rules when it comes to treating chronic pain: Patients who do not achieve useful pain relief within two to four weeks are unlikely to benefit in the long term and their opioids should be discontinued. Become more physically active by doing things you enjoy, be it walking the dog, swimming or yoga. Challenge your mental barriers by avoiding the tendency to catastrophise and instead give yourself realistic messages about what you can pro-actively do to manage your pain. Pace yourself, be kinder to yourself, by all means try different alternative remedies such as acupuncture and meditation, and seek for things to improve gradually over time. Appendices Our analysis of pill packaging and the responses of organisations about receiving money from the Sackler family. What's on the packaging Fentanyl. Morphine Sulfate. Codeine Phosphate. Dulwich Picture Gallery. The Design Museum. Natural History Museum. National Gallery. National Portrait Gallery. The Garden Museum. National Maritime Museum. Museum of London. Royal Academy of Arts. Old Vic. Royal Opera House. National Theatre. Shakespeare's Globe. Royal Court Theatre. University of Oxford. University of Sussex. King's College, London. The Francis Crick Institute. Royal College of Art. The Courtauld Institute of Art. Royal Ballet School. Imperial College London. Old Royal Naval College. Royal Botanic Gardens, Kew. Moorfields Eye Hospital. The London Library. The Prince's Trust. Westminster Abbey. Royal Hospital for Neurodisability.

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