Hooked on le­gal drugs

Irish Examiner - Feelgood - - Feature -

ANT McPartlin of Ant and Dec fame has re­cently been in the news for all the wrong rea­sons. The Bri­tain’s Got Tal­ent pre­sen­ter checked into re­hab for his ad­dic­tion to the pre­scrip­tion painkiller tra­madol.

McPartlin, right, isn’t the only one hooked on painkillers. Golfer Tiger Woods has con­fessed to be­ing ad­dicted to vi­codin. Pop icons Prince and Michael Jack­son both died from over­doses of the painkiller fen­tanyl.

Ac­cord­ing to phar­ma­cist Caitri­ona O’Rior­dan, a mem­ber Ir­ish Phar­macy Union ex­ec­u­tive, this prob­lem isn’t con­fined to the rich and fa­mous. “A drug ad­dict is no longer a junkie with a nee­dle,” she says. “Or­di­nary peo­ple like you and me can find them­selves ad­dicted to painkillers.”

The sta­tis­tics are wor­ry­ing. In the US, 45 peo­ple die ev­ery day from opi­oid pre­scrip­tion painkillers. In Bri­tain, more than 192,000 peo­ple are said to be ad­dicted to the drugs.

Last year, the state pathol­o­gist for North­ern Ire­land Pro­fes­sor Jack Crane re­ported that there had been 33 deaths from tra­madol alone in the North in 2015, a fig­ure that amounted to more than the deaths caused by heroin and co­caine com­bined.

Here in the Re­pub­lic, there were 354 deaths from over­doses in 2014. Three out of ev­ery four of those in­volved pre­scrip­tion drugs, in­clud­ing painkillers.

Dr Colin O’Gara, con­sul­tant psy­chi­a­trist at St John of God’s Hospi­tal, con­firms that there’s a prob­lem. “Ten years ago in Ire­land, peo­ple who had an is­sue with sub­stance abuse were ad­dicted to al­co­hol, heroin, co­caine or ec­stasy,” he says. “Now the pre­scrip­tion drug prob­lem is much big­ger. It’s set to ex­ceed il­licit drug use.”

Many peo­ple are in­tro­duced to pre­scrip­tion drugs in the same way as Ant McPartlin was. He was pre­scribed tra­madol when he was re­cov­er­ing from an op­er­a­tion to his knee.

“Tra­madol, codeine and mor­phine are opi­oids, which means they are the same fam­ily as heroin,” ex­plains Dr O’Gara. “Th­ese drugs are very ef­fec­tive at killing phys­i­cal pain but they kill emo­tional and men­tal pain too and can bring about a feel­ing of eu­pho­ria.”

The sci­ence be­hind this is based on a chemical known as GABA. This chemical con­trols the re­lease of dopamine in the brain but opi­oids pre­vent it from be­ing re­leased. When it is not present, dopamine floods the brain and cre­ates feel­ing of well­be­ing.

“Th­ese drugs of­fer a phys­i­cal and psy­cho­log­i­cal re­lief from pain,” says Maebh Leahy, CEO of the Rutland Ad­dic­tion Treat­ment Cen­tre in Dublin.

“Peo­ple can be naïve about how quickly they can build up a tol­er­ance to the ac­tive in­gre­di­ent and may not recog­nise that they are be­com­ing hooked.”

Even painkillers on the lower end of the scale such as codeine can be ad­dic­tive.

“Codeine may be a weak opi­ate but when taken in the doses that we see — up to 100 tablets a day — it’s cer­tainly not weak,” says Dr O’Gara.

The fact they cause you to re­lax makes driv­ing dan­ger­ous. In the longer term, side ef­fects can in­clude dam­age to the heart, stom­ach, kid­neys and liver.

A study car­ried out in 2009 recog­nised the se­ri­ous­ness of the sit­u­a­tion. It found that 97% of phar­ma­cists in Ire­land be­lieved there was a mis­use of over- codeine prod­ucts. This led to the PSI plac­ing re­stric­tions on how codeine was sold.

“It can no longer be dis­played in phar­ma­cies,” says Caitri­ona O’Rior­dan, who runs a phar­macy in En­niskeane, Co Cork.

“The cus­tomer must ask for it and this means the phar­ma­cist gets to as­cer­tain if they really need it.”

In some in­stances, O’Rior­dan says that they don’t, in which case she rec­om­mends other treat­ment.

“If they do need it, I feel pro­fes­sion­ally and morally obliged to warn that th­ese are drugs you should only take if you need to and that you should only use them for a short time, cer­tainly not longer than three days,” she says.

If she sus­pects a de­pen­dency prob­lem, she does her best to help.

“Phar­ma­cists share in­for­ma­tion with each other in or­der to pre­vent cus­tomers from be­ing given med­i­ca­tion elsewhere,” she says. “But we don’t just present a bar­rier. We also tell them that there is sup­port avail­able, whether that’s go­ing to see their GP or ap­proach­ing a spe­cial­ist fa­cil­ity.”

Not ev­ery­body is re­cep­tive to this ad­vice. Many don’t see them­selves as drug ad­dicts be­cause they don’t con­form to the stereo­type of the junkie on the street. “Th­ese are peo­ple who haven’t fol­lowed a tra­di­tional route into sub­stance abuse,” says Dr O’Gara. “A doc­tor was ini­tially in­volved in pre­scrib­ing the medicine and then they got hooked to what made them bet­ter.”

Maebh Leahy has seen many pa­tients who are in de­nial. “Be­cause they don’t see them­selves as the same as a home­less per­son on the streets, they con­vince themthe selves they don’t have a prob­lem,” she says. “They won’t con­sider the idea that they might be ad­dicted un­til a cri­sis emerges.”

There are spe­cial­ist re­ha­bil­i­ta­tion cen­tres, self-help groups such as Nar­cotics Anony­mous, lo­cal treat­ment cen­tres and com­muthe-counter nity ad­dic­tion schemes.

“Even go­ing to your GP is a good first step,” says Dr O’Gara. “It will in­evitably lead to re­cov­ery.”

Ad­dic­tion to painkillers is a real is­sue.

“No­body wants to frighten peo­ple into not tak­ing painkillers that they need to take,” says O’Rior­dan. “But at the same time, peo­ple need to be aware of just how ad­dic­tive th­ese drugs can be.”

“It’s a se­ri­ous med­i­cal is­sue,” adds O’Gara. “Peo­ple end up ad­dicted with­out want­ing to and they need and de­serve help.”

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