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Many doctors in the United Kingdom (U.K.) are reluctant to prescribe painkillers, CNN reports. Patients in the U.K. take less than half the pain medication consumed by American patients, according to the Drug Control and Access to Medicines Consortium, a U.K. research group.

Patients in the United States consume about 80 percent of all prescription pain medication, although they make up less than 5 percent of the world’s population, CNN notes. British doctors say by prescribing fewer opioids, they have helped their country avoid the prescription drug abuse crisis confronting the United States. Treatments such as physiotherapy, acupuncture and massage are widely used to treat pain in the U.K.

British Pain Society guidelines state, “In most situations, for most patients and most pains, opioids should not be considered as first-choice treatment.”

U.K. patients must be referred to pain clinics by their primary care doctor. On average, it takes 18 weeks for a patient to be referred to the long-term pain clinic at London’s Royal Free Hospital. In extreme cases, clinic founder Dr. Anthony Ordman may be able to see patients as soon as the next day.

Opioids are not the only painkillers that are tightly restricted in the U.K. The largest bottle of ibuprofen or acetaminophen on a pharmacy shelf contains only 16 pills. With a pharmacist’s approval, a person can buy 32 pills.

“We have to protect the patient,” London pharmacist Howard Silver told CNN. He noted a moderate overdose of Tylenol can cause liver damage and even death. He called a bottle of 400 acetaminophen pills, readily available in U.S. drugstores, “a bottle of death.”

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