If you have ever spent time in a clinical waiting room or scrolled through discussions on LBC, you’ve likely heard the debate: "Why would anyone keep taking these tablets if they make them feel so sick, foggy, or constipated?" It’s a question that sounds logical from the outside, but it misses the fundamental biology of what happens in the brain when we talk about dependency-forming medicines.
In my 14 years working in substance misuse pathways—often bridging the gap between high-security settings and community recovery—I have learned that the "bad choices" narrative is not just unhelpful; it is factually incorrect. To understand why people persist with opioids despite debilitating side effects, we have to look at the mechanics of the dependence cycle.
[Note: If you’re short on time, click the ‘Listen to this article’ audio player at the top of the page to hear this post read aloud.]
The NHS landscape: A high-volume issue
The NHS faces a complex challenge. Opioids remain a vital tool for acute pain—think major trauma or post-operative care—but they have historically been over-prescribed for long-term chronic pain. Data from the NHS Business Services Authority (NHSBSA) regularly highlights the sheer volume of prescriptions dispensed annually. When we look at the numbers, the "cost burden" isn’t just financial; it is a human cost involving long-term physical reliance.
According to the 2019 review commissioned by Public Health England on dependence-forming medicines, approximately one in four adults in England were prescribed one of these classes of medicines in a single year. While not all of these are opioids, the trajectory for long-term users is often remarkably similar.
Stage Patient Experience Clinical Reality Initiation "The pain has finally stopped." Acute analgesia achieved. The "Sweet Spot" "I can manage my life again." Tolerance begins to develop. The Side-Effect Wall "I feel foggy, tired, and unwell." Dependence cycle kicks in. Withdrawal Avoidance "I have to take them to feel normal." Physical dependence dominates.Why "Stopping" isn\'t a simple choice
People often ask: "Why not just stop?" The answer lies in the biology of withdrawal avoidance. When you take opioids consistently, your brain downregulates its own natural pain-relieving systems (the endorphins). If you stop abruptly, you don't just return to your original pain; you enter a state of systemic hyper-arousal. This includes severe muscle aches, anxiety, insomnia, and sometimes profound physical pain that feels worse than the initial condition being treated.
The patient is effectively trapped. They are taking the medication not to "get high," but to ward off the agonizing physical experience of withdrawal. At this stage, the medication is no longer treating the pain; it is treating the medication itself.
Opioid-related deaths and the overdose risk
We cannot talk about this without mentioning the risk. The danger increases significantly when opioids are mixed with other substances—like benzodiazepines or alcohol—or when a patient experiences a lapse in tolerance. If someone stops for a few days and then takes their usual dose, their body’s tolerance has dropped, significantly increasing the risk of respiratory depression (where the brain stops telling the lungs to breathe).
We have seen tragic trends in opioid-related deaths over the last decade. It is rarely a "lifestyle" issue; it is a medical pathway that spiraled. Policy needs to shift from blaming the patient to providing better, slower, supported tapering pathways.
What to ask your GP
If you or a loved one are concerned about long-term opioid use, don't feel like you are being "difficult" by questioning it. GP surgeries are busy, but medication reviews are a core part of their service. Here is how to start the conversation:
- "How long have I been on this medication, and is there a planned date to review its effectiveness?" "I’m experiencing [side effect X]; is this a common side effect of this specific dose?" "If we decide to reduce this dose, what is the plan to ensure I don't go into withdrawal?" "Are there non-pharmacological alternatives—like physical therapy or pain management programs—that I could transition to?"
The path forward
Addressing the dependence cycle requires patience and a multidisciplinary team. It isn't about "getting off" pills as fast as possible; it is about managed, safe reduction. It is about acknowledging that the medical system helped create this dependency, and the medical system has a duty to help undo it.
If you found this helpful, consider using the Facebook share link below to pass this on to someone who might need to see the clinical reality behind the headlines. We need to stop viewing these patients as "addicts" and start viewing them Click here as individuals caught in a loop that requires compassion, time, and structured clinical support.
Disclaimer: This blog post provides general information and does not constitute individual medical advice. Always speak with your own GP or pharmacist before making any changes to prescribed medication.