The prescription of opioids has grown in Spain, but with much lower rates than those in North America
In recent years, the USA and Canada have experienced an alarming increase in the use of opioids. Given this growth, last September, the Spanish Ministry of Health published a preventive plan to improve its non-oncological chronic use.
These drugs, which must be prescribed by the doctor and are used as powerful analgesics, are often indicated in post-operative treatments or for chronic pain.
In addition, they are likely to create addiction in prolonged treatments and, although they are well tolerated, they are not exempt from side effects. High doses can decrease heart and respiratory rate, and can even cause death.
A Spanish study, funded within the National Plan on Drugs and carried out by David Pere Martínez Oró, states that “the origin of the North American crisis is the product of the interweaving of political, sociocultural and psychosocial factors that stimulated the use of opioids.”
The scientific literature notes Porter and Jick’s letter, published on January 10, 1980 in the New England Journal of Medicine, as one of the most genuine causes of the current crisis related to opioids. This letter evidenced that opioid addiction was rare. It was widely distributed and contributed to the epidemic of opioid painkillers in North America. When the limitations of the data provided in it were verified -it referred exclusively to hospitalized patients- it was already too late and the idea of the innocuousness of opioids had become generalized, facilitating their abuse.
According to Pere Martínez Oró, “banalizing its use can cause addiction. We must build a social representation that conceptualizes them as drugs with therapeutic capabilities, but without omitting their risks”.
In Spain, the prescription of opioids has also grown, but with much lower rates than those in North America. In relation to opioid drugs, in Spain there is an increase of 83.59% in their consumption in a matter of seven years, from 2008 to 2015.
The most consumed family of opioids is that of “other opioids (tramadol and tapentadol)” followed by ‘phenylpiperidine derivatives’ (fentanyl). The perception of safety and efficacy associated with opioids makes it possible to trivialize them. Its futile use translates into misuse and over prescription. The risk of addiction to opioids, especially immediate-release fentanyl presentations, represents a challenge for Spanish healthcare.
Juana Sánchez Jiménez, head of the Pain Working Group of the Spanish Society of General and Family Physicians (SEMG) and director of the Daroca health center in Madrid, explains that the US and Spain “are very different countries with regard to legislation and to the health system we have. In Spain, the prescription and dispensing of these drugs is highly regulated, with the movement of these analgesics having to be notified to the Spanish Medicines Agency every year. Opioids must always have a single prescriber and it must be a doctor who knows the patient very well (…). Pain is a serious problem in developed societies. Opioids and all drugs have to be administered or supervised by a person who knows that they cannot increase the dose to their liking or free will.”
According to the aforementioned study by Pere Martínez Oró, the main differences between the US and Spain are in their very different national health systems, along with other factors among which it is worth highlighting:
- The devirtualization of the innocuous image of opioids.
- Only drugs authorized by the AEMPS can be marketed in Spain, after confirming the appropriate levels of quality, efficacy and safety. In the US, the mechanisms for drug authorization and control of the pharmaceutical industry are more lax.
- In Spain, the advertising of drugs considered specialties that require a medical prescription for dispensing is prohibited.
- In the US, the patient is treated as a client, within its ultraliberal system, unlike Spain, where healthcare is not a consumer product and there are strict controls on pharmaceutical spending, mostly financed by the state.
- In Spain, knowing that other doctors can access the clinical history of patients serves as a method of self-monitoring.
Julio Tudela and Paloma Aznar
Bioethics Observatory – Institute of Life Sciences
Catholic University of Valencia