The Australian Women's Weekly

One little pill

For Jessica Khachan and Rustie Lassam, one perfectly legal prescripti­on painkiller began a spiral to addiction. Ingrid Pyne investigat­es the opioid epidemic and meets two of its brave survivors.


Around Christmas, the time of miracles, Sydney mum Jessica Khachan was told it was a wonder she was still alive. Her weight had plummeted from 55kg to 30kg, her blood count was dangerousl­y low, her face was an unnatural grey-green, and doctors at Westmead Hospital in western Sydney had just discovered an ulcer on the brink of bursting. “The specialist said to me, ‘That’s the biggest stomach ulcer I have ever seen’,” recalls Jessica, 44. “It’s a miracle you are still here.’”

How Jessica got to this point is a story as mundane as it is horrifying. Two years earlier, in 2010, she had been prescribed the opioid hydrocodon­e to relieve pain from routine wisdom-tooth surgery. When her script ran out, she went to the chemist and bought a pack of Nurofen Plus – then another. Like a growing number of Australian­s, she quickly became addicted.

Two pills a day became six, then eight. Within two years, Jessica was taking 90 Nurofen Plus per day – not in one gulp, but throughout the day, just to keep going. “They made me feel normal,” Jessica tells The Weekly. “They made me feel able to get up and do things. I didn’t feel high on them, but if I couldn’t have them, I’d lie in bed. The minute I swallowed a few pills, I’d be able to get on with the day.”

By Christmas 2012, with her health in crisis for no apparent reason, Jessica’s perplexed family insisted on taking her to hospital. Jessica was scared, ashamed and deep in denial. “I didn’t know I had a problem,” she says. “I knew about people in recovery from alcohol addiction or other drug problems, but I’d never heard of anyone who had a painkiller addiction.”

Experts warn that Australia’s addiction to prescripti­on opioids is reaching crisis point. Our use of opioid-based painkiller­s has quadrupled in the past decade, levels of prescripti­on opioid overdose are at record levels, and prescripti­on drugs account for almost three-quarters of all accidental drug-related deaths.

At last count, in 2013, 11.4 per cent of Australian­s admitted to misusing prescribed drugs, up from 7.4 per cent in 2010. Surprising­ly, the two groups with the largest increase in misuse are women in their forties and men in their thirties.

The majority of them are “everyday people” like Jessica who have become unwittingl­y addicted to the drugs, according to Dr Hester Wilson, a general practition­er and drug addiction specialist.

“The people I see are mostly middleaged men and women. They have started on opioids, not to get high, but to cure their pain – be it endometrio­sis, a motor vehicle accident or back pain,” she says. “But once they start on them, they find they cannot stop. When they try, they experience withdrawal symptoms such as nausea, vomiting, insomnia, the shakes, goosebumps. Plus there is this overwhelmi­ng craving to use the medication again.”

Rustie Lassam knows that feeling all too well. At 16, in the grip of puberty, she went to a doctor for back pain, and was prescribed Panadeine Forte and Valium. To her, the drugs felt like heaven. She started having a few more pills each day. And so began a downward spiral into prescripti­on drug abuse that would last more than three decades and utterly derail Rustie’s life. By 32 she’d been married and divorced twice. At the peak of her addiction she was was taking nine 80mg tablets of opioid Oxycontin and five 5mg tablets of Valium a day, while also getting Pethidine injections from her doctor. “And this is from someone who grew up in a nice, middle-class

Prescripti­on drugs account for threequart­ers of all accidental drugrelate­d deaths.

family, went to church every Sunday and did Meals on Wheels with Mum,” says Rustie, dispelling the stereotype of an opioid addict.

Her “rock bottom” moment was when she found herself in the shower rubbing her pregnant belly, and apologisin­g to her unborn son for all the damaging drugs she was putting into his bloodstrea­m.

“I know what a baby needs for healthy developmen­t, yet I couldn’t stop myself,” Rustie, now 56, tells The Weekly. “It was horrific. The drugs came first, second and third.”

Bee Mohamed is the chief executive of ScriptWise, a not-for-profit organisati­on dedicated to preventing prescripti­on drug misuse. She says many of us take a casual approach to painkiller­s because a trusted medical profession­al typically gives us the script. “But up to 30 per cent of people who use opioids for more than 10 days are at serious risk of becoming dependent,” she warns.

With dependency comes addiction and, in some cases, death. According to the Penington Institute, there were 1137 fatal accidental drug overdoses in Australia in 2014, up 61 per cent on 2004, with prescripti­on painkiller­s (like oxycodone, morphine and codeine) responsibl­e for 411 of those deaths and prescripti­on relaxants (like Valium or Xanax) killing 438 people. By contrast, ecstasy and amphetamin­es were linked to 188 of those deaths.

To put the problem into context, the number of people dying accidental­ly from prescripti­on drug overdoses surpasses the road toll in Victoria. “If this many people were dying from asthma or acute appendicit­is we would be calling it a national emergency,” says Dr Wilson.

Yet the volume of opioid scripts written by our doctors keeps growing as the drug is prescribed for an ever-increasing range of conditions, such as endometrio­sis, back pain or osteoarthr­itis (despite limited evidence of efficacy). About 20,000 doses of prescripti­on opioids are prescribed for every one million people every day in Australia, putting the country at eighth among the world’s top 30 users of prescripti­on opiates. This compares with 50,000 doses of opioids prescribed per one million people every day in the US, where a staggering 142 people die daily from accidental overdoses of prescripti­on opioids.

“The doctors give them out like lollies,” says Rayleen Fagan, a mumof-five from Melton in Victoria, her rage crackling down the phone line. “Just last week, I had surgery for a back problem and the doctor prescribed me [the opioid] Endone. Had I listened to him, I would have a back problem and a drug addiction. But luckily I have the knowledge.”

Rayleen’s knowledge is hard won. For 25 years, she watched her sister, Anne, battle a chronic addiction to codeine, an active ingredient in Panadeine Forte and Nurofen Plus. Anne would spend her days doctor shopping, she would feign headaches in order to raid her friends’ medicine cabinets, and her relationsh­ip with Rayleen and other family members broke down as they begged her doctors to stop prescribin­g the drugs. The battle ended six years ago.

“My sister went to sleep on the couch on Christmas Eve and never woke up,” says Rayleen. “Her body was full of prescripti­on medicines.”

Today, Rayleen will take only half a Panadeine Forte when the pain from her back surgery becomes unbearable. “I won’t even take a full one,” she says. “I feel they are toxic. It wasn’t just losing my sister, it was everything I went through with her before she died. These drugs are evil.”

Opioids have been in use for thousands of years and are essential to medicine, particular­ly in the management of cancer and acute pain from surgery and injury. “But the benefits of these drugs tend to be overstated and the risks of addiction grossly understate­d,” warns Dr Wilson. She argues that addiction should be classified as a predictabl­e side-effect of opioids, in much the same way as rashes, vomiting and diarrhoea are.

“Addiction is not an indication that the individual is a bad person or immoral. It’s just the way our biology interacts with this medication,” says Dr Wilson. “We need to remove the stigma and know that this could happen to anyone. It could happen to you, it could happen to me.”

In an opinion piece in The Lancet medical journal last year, Stanford University’s Keith Humphreys urged developed countries like Australia to learn from the mistakes of the United States, where about 60,000 people die each year from prescripti­on opioid abuse – more than the number who died in the Vietnam War.

“Countries should immediatel­y strengthen all available safeguards against the globalisat­ion of the prescripti­on opioid addiction and overdose epidemic,” Humphreys said. “Central to such efforts should be the formulatio­n of prescripti­on practice guidelines, the developmen­t of relevant legislatio­n and regulation, the training of medical profession­als, the creation of putatively public health-orientated activist groups and the certificat­ion of heathcare facilities.”

Yet much of what has been done so far in Australia to arrest the opioid epidemic has merely tinkered around the edges of the problem.

Tasmania and Victoria have both committed to introducin­g a system of real-time prescripti­on monitoring which allows doctors to check a patient’s immediate prescripti­on history, preventing the practice of doctor shopping. ScritptWis­e’s Bee Mohamed says these are important first steps, and that other state government­s need to see prescripti­on monitoring “as a long-term investment

“We need to remove the stigma and know this could happen to anyone.”

that will relieve pressure on the hospitals, and therefore costs”.

Yet drug monitoring programs cover only part of the problem. Dr Wilson, who has worked with coronial authoritie­s, says she is increasing­ly seeing accidental opioid overdoses in mums and dads who’ve either mixed their prescripti­on drugs, taken the pills for longer than advised, or consumed alcohol while on the medication.“We all have this image of ‘doctor shoppers’ but in most cases, people are taking their medication as directed, and these drugs can still cause overdose that leads to respirator­y arrest and death,” she says. Indeed, findings from the Coroners Court of Victoria show that in seven out of 10 pharmaceut­ical drug overdose deaths the deceased had been to see only one GP.

Meanwhile, citing the increasing incidence of over-the-counter codeine dependency, the Therapeuti­c Goods Administra­tion (TGA) ruled that, from February this year, pharmaceut­icals containing codeine would be available only on prescripti­on. And in March, the Australian and New Zealand College of Anaestheti­sts (ANZCA) and its Faculty of Pain Medicine called on 34 leading medical colleges and associatio­ns, including the Royal Australian College of General Practition­ers and the Royal Australasi­an College of Physicians, to review their approach to pain management.

“The community is being flooded with prescripti­on opioids,” ANZCA President Professor David A. Scott tells The Weekly. He believes that rather than hand out painkiller­s, “doctors need to take a multidisci­plinary approach to pain management, which could include physical therapy, exercise, behavioura­l or psychologi­cal counsellin­g”.

As in the United States, Australia provides the ideal environmen­t for excessive opioid prescribin­g. For one, we have a consumeris­t culture which demands a quick fix from our doctors. Second, general practition­ers are encouraged to run short, sharp medical consultati­ons.

“GPs are not incentivis­ed to spend time with patients looking for alternativ­es,” admits Dr Wilson. “Accessing counsellin­g, getting patients to do more physical activity, attend hydrothera­py or acupunctur­e, or see a physiother­apist – particular­ly in rural areas – is much harder and more expensive. And the Pharmaceut­ical Benefits Scheme gives us a great rate on medication­s.” In January, the TGA announced it was considerin­g barring GPs from prescribin­g stronger opiates, leaving that job to specialist­s.

The other problem is the hospital system, where patients are regularly discharged with more opioids than they are likely to need. “Long-term opioid use often begins with treatment of acute pain,” says Professor Scott. “Many patients prescribed an opioid for pain management will still be taking an opioid one or two years after discharge.” He says that it is the responsibi­lity of doctors to give patients a strict time frame for use and an appropriat­e weaning schedule. “If we have a role in starting this problem, we have to take a role in stopping it,” he says.

Mum-of-two Jessica Khachan believes that without her family’s support and interventi­on, she would not be here today.

“There’s a lot of shame and fear and a lot of people get embarrasse­d about substance abuse issues,” admits Jess. “I remember I felt like I was the only one going through this. I felt like I couldn’t tell anyone what was going on. I was really scared to even mention it to my doctor.”

The message brave women like Rustie, Jessica and Rayleen want to get out is if you believe you have an opioid addiction, help and support exist.

“You are not alone,” says Jessica. “Many, many people have gone through this. There are recovery services and there is help out there. You don’t need to feel ashamed.”

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 ??  ?? Rustie (left) was prescribed opiods at 16. Rayleen (right) lost sister Anne to codeine.
Rustie (left) was prescribed opiods at 16. Rayleen (right) lost sister Anne to codeine.

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