How I became a ‘tramhead’
Prescription opioid use in New Zealand has risen dramatically and doctors are accused of inadvertently creating thousands of addicts. Tony Wall reports.
Ever since she was diagnosed with leukemia as a child, Sequoia King has known pain. ‘‘It progressed from being kidney pain to being unable to move – I couldn’t roll over in bed without feeling like my organs were being crushed,’’ the 23-year-old says from her flat in Miramar, Wellington.
Her body is like a tapestry of her journey – an intricate tattoo on her abdomen signifying her struggle through depression, a dagger on her forearm a gift from a friend when she finally beat her addiction.
She was given intravenous painkillers at 12 or 13 – she believes that’s when her vulnerability to opioids began. As an adult she got hooked on tramadol – a ‘‘weak’’ opioid used to treat mild to moderate pain in New Zealand, for everything from sports injuries to caesarean sections.
She became a ‘‘tram-head’’ – the colloquial name for someone who abuses tramadol – at one point taking 1000mg a day. The maximum recommended daily dose for chronic pain is 300mg. It was easy to get hold of – she’d simply ring her doctor and get a repeat prescription.
King went cold turkey about a year ago – quitting abruptly without any outside help – a process she describes as like being dragged through hell. Now she wants to warn others. ‘‘I want other kids to be aware of what these type of drugs can do to you. ‘‘I was really messed up because of these drugs. I have friends who still take them recreationally; they don’t realise what they’re doing to themselves.’’
MORE AND MORE
Opioid use in New Zealand and other Western countries has soared over the past couple of decades. According to the Opioid Atlas, which collects prescription data from district health boards (DHBs), the number of people dispensed strong opioids such as ocycodone, morphine, methadone and fentanyl rose from 63,000 in 2011 to 77,000 in 2016, a 22 per cent increase.
Pharmac says total opioid prescriptions, including repeats, rose 34 per cent in the past decade. Tramadol and codeine use skyrocketed by 277 per cent and 91 per cent respectively.
A Health Quality and Safety Commission (HQSC) investigation into opioid prescription found almost half those dispensed a strong opioid had a ‘‘trigger event’’ in a public hospital in the week prior, suggesting the prescriptions were generated in hospital.
Strong opioids such as oxycodone and fentanyl – linked to the deaths of musicians Prince and Tom Petty – have received a lot of publicity but experts warn weaker opioids like tramadol and codeine can be harmful and addictive and doctors are advised to prescribe the lowest effective dose for the shortest possible time.
There’s anecdotal evidence New Zealanders are some of the world’s biggest users of tramadol and other prescription opioids. In 2015, a Global Drug Survey (GDS) study of prescription drug use found 38 per cent of more than 2000 New Zealand respondents said they had used opioids in the past year, against
14 per cent globally. This was driven mostly by codeine (33 per cent compared to 10 per cent globally) and tramadol (9 per
cent/2 per cent). Professor Adam Winstock of University College London, founder of the GDS, says the survey is self-selecting so must be viewed with caution. But he says it’s rare for opioids like tramadol to be in the top 10 drugs people report using and suspects Kiwis have turned to prescription medications for recreational use because of the difficulty of getting illicit drugs into the country. ‘‘You go ‘Really? There’s that many people in New Zealand who need chronic opioid pain relief? I wouldn’t have thought so.’ ’’
TROUBLE WITH TRAMADOL
Pharmacist and addiction medicine specialist Carina Walters is doing a PhD on the misuse of prescription and overthe-counter opioids in New Zealand and is looking for participants to study. There’s no good data on how many people are addicted to opioids here, she says, but guesses can be made based on the US National Institute of Drug Abuse’s estimate that between 8-12 per cent of people prescribed opioids over several months become dependent. According to the Opioid Atlas, 9701 Kiwis were dispensed a strong opioid for more than six weeks in 2016 – which would mean around 970 potential addicts.
Walters, formerly senior addictions pharmacist for Community Alcohol and Drug Services in Auckland, says over the past decade or so there’s been a big shift in the types of opioid users presenting for treatment. ‘‘It’s gone from mostly people who’ve come through an illicit pathway to people who’ve developed their dependence through legitimate access – prescriptions or over the counter.’’
With tramadol in particular, Walters says, people underestimate its abuse potential.
‘‘There’s a sense [among patients] that, because a drug is prescription or over the counter, it’s less harmful, less risky and they wouldn’t sell it to you if there was a problem. But all opioids can have the effect of you developing a physiological dependency, because you develop tolerance and when you take them away you get all those withdrawal symptoms – nausea and diarrhoea and the rest of it.’’
King had been abusing tramadol for the better part of two years when she suddenly stopped taking it. ‘‘I was bedridden for about two weeks with fevers and pains and
‘‘... all opioids can have the effect of you developing a physiological dependency ...’’ Addiction medicine specialist Carina Walters