NHS England estimates that approximately 14 million people in the UK  suffer with chronic pain and each person must find a way to manage their pain to enable them to continue with work, social and family life. Individual differences in sensory experiences are of profound importance in the treatment of pain and consequently there can be no one-size fits all approach.
Some people will seek help through medication and for those whose pain is severe or long-term, opioids may be recommended. Opioid painkillers range from weak ones such as codeine, which (in low doses) can be bought over-the-counter, to stronger ones such as morphine, tramadol, diamorphine and fentanyl, which require a doctor’s prescription.
Opioids have unique properties that make them both indispensable for pain management and potentially very dangerous if used incorrectly. They are capable of inducing a physical and/or psychological dependence. 
Opioid painkiller dependence (OPD) is a serious and sometimes fatal medical condition that has a devastating impact on the lives of many patients, and in turn on their family members too.
Providing care for patients with OPD can be a serious challenge for families and clinicians and can have a significant impact on GP time and NHS resources. In addition, where people with OPD are either unable to work or are unreliable at their place of work, there will be significant and relatively unknown economic implications.
Estimates show that 9.5 million people in the UK are believed to have an opioid prescription and a 2013 study of prevalence of OPD in Europe estimated that the number of people in the UK who may be dependent on opioid painkillers is more than 190,000. Despite these huge numbers, there are surprisingly few services in place to identify, manage and treat patients most at risk of OPD.
People with opioid painkiller dependence come from all occupations, educational levels, ethnicities and backgrounds. According to a 2013 study, 56% of OPD patients were educated to degree level or higher.
Distinguishing between patients whose use of opioid analgesics is relatively low risk and those who are already harmfully dependent or at risk of becoming so, is very challenging. This is partly because pain is an entirely subjective experience, with no test or objective measurement for pain.
OPD develops gradually and many patients may be unaware that they are affected. Training, tools and other support should be available to GPs so that patients who are dependent on opioid painkillers are swiftly and proactively identified.
Currently those patients whom a GP thinks may have developed a dependence on their painkiller may be referred to local drug and alcohol services. These services are primarily designed for, and dominated by, people misusing illicit substances such as heroin and are seldom suitable for people with OPD. Evidence suggests that patients with OPD do not attend or engage properly with existing drug services and that likewise these services do not have the capacity or expertise to accommodate OPD patients.
With totally inadequate systems in place to manage the risks presented by increasing levels of opioid prescribing, the human and societal cost of OPD will continue to rise.
In addition to increasing levels of opioid prescribing, there is a trend towards more overdose deaths. In 2013 there were 757 deaths from opioids not including methadone or heroin in England & Wales, which continues the general upwards trend in such deaths since 2008, as shown below. The 2013 level is just less than the number of people that died from a heroin or morphine overdose that same year (765).
There are certainly an enormous number of people who have become dependent on their painkillers, and while there may only be a relative few that are at high risk of dying, there are thousands more whose lives are dominated by their dependence. As these patients are likely to be heavy users of a number of health and social services, the net cost of not treating their dependence may amount to tens of thousands of pounds per patient.
Lack of awareness, understanding and treatment of opioid painkiller dependence amongst patients, clinicians, commissioners and policymakers needs to be addressed urgently. The Opioid Painkiller Dependence Alliance is being formally launched straight after the General Election to lead this campaign. Whoever forms the next government will need to address these issues head-on. We are calling on politicians, health care professionals and policymakers to improve services for people with opioid painkiller dependence by providing timely screening, diagnosis and access to treatment in a way that meet the needs of this large and growing patient population.
For more information about the OPD Alliance please visit opdalliance.org
 Alho, H. and Strydom, M. (2013). “Prevalence of prescription opioid-dependency in Europe and risk factors for abuse.” Presented at the International Society of Addiction Medicine Annual Meeting 2013. Kuala Lumpur, Malaysia. 21–23 Nov 2013
 ONS, (2014) Statistical Bulletin; Deaths related to drug poisoning in England & Wales 2013