Opioid over prescription and over reliance remains a major problem for the NHS

21 June 2018

The Gosport War Memorial Hospital independent inquiry has found that inappropriate use of painkillers led to the unnecessary deaths of over 450 patients. While the approach of the families must be commended the response of the Government concerns me. Jeremy Hunt, Health Secretary, has said that this could not happen today because the NHS is a much more open and candid service where cover ups can no longer occur. Unfortunately that is not correct.

There remains an unacceptable blame culture in the NHS where errors cannot be openly admitted to and patient safety is sometimes secondary. This does not arise from guidance from clinicians but rather bureaucratic decisions which determine it is in the interest of the NHS body to not be as frank with the patient about the error that has occurred, due to the criticism and adverse publicity this causes.

Opioid over prescription and over reliance by doctors remains a major issue in the NHS. This was a major element of the Gosport scandal. This continues to be seen particularly in primary care pain management when delays in referral of patients with pain syndromes such as Complex Regional Pain Syndrome (CRPS) occur routinely because GPs in particular do not fully understand pain conditions. The solution reached in almost all cases is to blast the problem with heavy doses of painkiller medication. Most frequently combinations of tramadol and codeine or codeine and morphine are provided. Very rarely do such painkillers do anything in CRPS cases. All that happens is the over prescription of opioids and the failure to review the prescription leads to addiction. A recent study of chronic pain patients indicated that perhaps more than a quarter of the patients receiving strong opioids receiving dosages but were overprescribed according to national guidelines.

Given the findings and the evidence that must have been heard over the last four years in the Gosport inquiry it is unsatisfactory and shocking that this very week I have been instructed by a family on behalf of their late husband/father who passed away due to complications that arose from prescribed opioid dependency for a pain condition.

It cannot be said by the NHS that they were not aware of the risks. Studies have been published particularly in the USA and Canada for a number of years particularly concerning overuse of prescriptions of tramadol and its addictive and damaging impact.

What the Gosport scandal should be providing is an opportunity to reform and review the position of openness. It is therefore totally unacceptable that the Draft Health Service Safety Investigations Bill currently proposes that investigations into clinical incidents should be ‘safe spaced’ and not disclosable to the patients. As with many Bill’s the impact is rarely properly disclosed to society. Until a proper observance of the duty of candour is established it is a shocking inevitability that once every 5 to 10 years a scandal will rock the NHS.

Jerard Knott The Catastrophic Injury and Clinical Negligence team at Curtislaw is led by Jerard Knott, Senior Associate and APIL Clinical Negligence SIG Coordinator. Follow at @Curtislaw; @ClinNegCLS