Opioids: HAS wants to avoid trivializing the use of these painkillers

in collaboration with

Dr. Marc Lévêque (Neurosurgery – Pain)

What are opioids?

Originally, opioids are substances extracted from the poppy seed, a flower cousin of the poppy. These opium derivatives are synthesized or semi-synthesized by pharmaceutical laboratories in order to manufacture drugs. As explained by the World Health Organization (WHO), opioids have the ability to interact with brain opioid receptors. These are involved in the response to pain, but also to stress and the control of emotions.

Opioid medications are therefore used to treat and relieve pain, especially chronic pain. This is why the prescription of opioid drugs is common.

Nevertheless, there are side effects associated with taking these medicinal substances, such as nausea, contraction of the pupils, digestive disorders or even difficulty concentrating. On the other hand, there is a risk of addiction to these opiates.

Preventing the overconsumption of opioids in France

This opinion follows an observation established in 2015 already. Nearly 10 million French people, or 17.1% of the population “have been prescribed opioid painkillers, a figure that is believed to be on the rise in recent years.” The problem is that “all analgesic opioids can, however, induce a high level of physical dependence and be subject to disorders of use – with significant consequences that can go as far as overdose, or even death by respiratory arrest”.

Indeed, these drugs are overconsumed in some countries, such as the United States and England, causing a health crisis in these territories. This crisis is marked by a significant number of deaths attributable to the consumption of these medicinal substances. This is also the opinion of Doctor Marc Lévêque, neurosurgeon and pain specialist, who describes this crisis as “a health disaster and a real concern for public health”.

In France, “the trend is quite clear” compared to prescribing opioids, but “This situation is hardly comparable to that of the United States”. Nevertheless, to avoid this phenomenon in France, the Haute Autorité de Santé gives, in its opinion issued on March 24, 2022, its first recommendations regarding the use of opioid drugs. Experts want to secure the use of these drugs, because they fear overdose due to the aging of the population as well as the increase in chronic pathologies resulting in the multiplication of pain.

Today, HAS addresses all healthcare professionals (general practitioners, rheumatologists, addictologists, pharmacists, etc.) in order to promote “a just prescription” as well as a good use of opioids. The assessment of the risk must be measured, it is a question of finding the balance between the duration and the quantity of the prescription. The objective is above all to avoid the misuse of this drug in order to limit overconsumption. It is therefore essential, according to the authors, to “do not trivialize the use of it”. As the neurosurgeon points out, morphine has “its place in acute and non-cancer pain, but it remains highly disputed in chronic pain”.

In addition, they recall that opioids can be prescribed in very specific situations:

• Treatment of chronic non-cancer pain (as a last resort);
• Treatment of acute pain;
• Treatment of pain related to cancer or in pregnant and breastfeeding women.

Their prescription is, however, not recommended in the event of:

• Chronic pelvic pain;
• musculoskeletal disorders;
• of migraines.

Finally, the dosage of opioids should be introduced gradually and the occurrence of potential adverse effects should be monitored. Regarding the duration of treatment, “Beyond 6 months of continuous treatment, the HAS recommends gradually reducing the treatment or even stopping it completely.”.