Conclusion
There is compelling logic to treating pain with analgesics including using opioids. However, for chronic pain, this logic does not fit with the evidence which shows that opioids are often ineffective and can cause significant harm. Most prescribing for long-term conditions is done by primary care, most consultations about chronic pain are with GPs, they are often difficult consultations 6, there is significant time pressure and there is a lack of guidance to support GPs 5. Developing a shared understanding with the patient requires sufficient time to discuss complex ideas, it requires trust, regular follow-up and continuity of care all of which are under threat from a shortage of doctors, growing demand and the prioritisation of access over continuity. In many areas, specialist services are not easily accessible or are not available at all. In the absence of sufficient resources to meaningfully assess and manage the large number of patients with chronic pain, pharmacological management including opiates is likely to remain the default response, deprescribing is unlikely to be prioritised and the NHS is at risk of a growing opioid epidemic.