The agony of the patients turned into drug addicts by their doctors
It’s the scandal that no one talks about — the epidemic of people hooked on prescription pills such as tranquillisers or antidepressants because medics keep handing them out despite the risks. Their lives are in ruins — and there is little help available
THEY are the forgotten victims of medical incompetence, the secret army of innocent addicts hooked on drugs prescribed by their doctors for pain, anxiety, sleeplessness or depression.
They had put their trust in the experts, only to descend into a nightmare of dependence on the very pills that were supposed to help them — and then find themselves abandoned to their fate.
Among those hooked on prescription drugs through no fault of their own are people such as 62-year-old Janet Waterton. For 16 years this grandmother of two battled an addiction to benzodiazepines, tranquillisers prescribed by her doctors to treat hip pain and insomnia.
Benzodiazepines include brands such as Xanax and Restoril, and diazepam, formerly known as Valium, the infamous Mother’s Little Helpers that ‘anaesthetised’ a generation of housewives in the Sixties and Seventies. They are widely prescribed but are so addictive that doctors have been told repeatedly that patients should not be on them for more than four weeks.
Janet tried to wean herself off the pills but suffered severe withdrawal symptoms. But the drugs themselves left her feeling like a zombie and there are whole chunks of her life she simply doesn’t remember.
In desperation — and in the absence of any help from the health service — she and her husband, a mechanic, cashed in their savings to pay for her to go into a drugs detox clinic.
She was strip-searched on admission and put in a dormitory with three heroin addicts. ‘It was hell — there were constant fights, prostitutes having sex in the corridor, another woman self-harming — I wondered if I’d survive,’ she recalls.
As she points out in the full version of her story told on the next page, all she’d ever done was take the benzodiazepines that her doctor had prescribed.
Recent reports have revealed the shocking levels of people who, like Janet, have been left on tranquillisers including diazepam for months or even years. Women are more likely to be taking this kind of medication than men and the biggest users were those in the age group of between 35 and 64. ‘This is a scandal for which there can be no excuse,’ says Dr James Davies.
Diazepam (Valium) and Alprazolam (Xanax) are number 27 and 30 in the list of most prescribed medications in the country. Last year, a report for the Irish Medical Journal discovered there was ‘evidence that inappropriate benzodiazepine prescribing persists in Ireland in both general practice and residential care settings.’
And figures show that an incredible 950,000 medical card prescriptions for benzodiazepines were written in Ireland in 2013 alone.
THE longer you are on benzodiazepines, the tougher withdrawal will be, with symptoms from sleeplessness, agitation, blurred vision and feelings like electric shocks in the limbs, to confusion, hallucinations, even epileptic fits.
But the problem is not just tranquillisers. Dr Davies also found that a third of long-term users of antidepressants ‘have no clear clinical indication for [them] — in other words, they shouldn’t be on this medication’.
Even antidepressants, while not regarded as addictive, can cause crippling withdrawal effects, such as anxiety, mood swings, paranoid delusions, hallucinations and — ironically — depression.
And ‘the longer you are on antidepressants, the worse and more protracted the withdrawal will be,’ says Dr Davies.
Over 450,000 people in Ireland, or roughly one in ten, are on antidepressants. Anti-depressants are one of the most highly prescribed drugs in the State. Twelve antidepressants appear in the top 100 prescribed medicines in Ireland, accounting for 3.5 million prescriptions per annum.
Dr Declan Ahern, Head of Counselling in the University of Limerick, says, ‘As a nation we need to look at whether medication is always an appropriate route to dealing with mental health. Young people are not hammering down my door looking for pills.’
The consequences of staying on drugs such as benzodiazepines can also be harrowing. They can lead to sleepiness, unsteadiness, problems with memory and concentration, depression and anxiety. And these side-effects can be mistaken for signs that the patient’s original problem is getting worse, so the dose is actually increased.
And these are not the only drugs behind the hidden epidemic of prescription pill dependence.
There are also concerns about opioid painkillers such as codeine, tramadol and fentanyl. These medicines are derived from opium or chemical equivalents and are highly addictive.
Addiction to codeine, which can be bought over the counter, is also a growing problem in Ireland.
In the past 20 years, sales of codeine tablets have soared. Codeine is a short acting opiate drug which belongs to the same family as heroin. Its effects are milder but if taken regularly it can become addictive. Codeine is usually combined with paracetamol or with ibuprofen and this is where the problem lies.
Dr Colin O’Gara, a psychiatrist and head of St John of God’s addiction services, said one-quarter of its clients are addicted to either prescription medicines or codeine-containing tablets: ‘There is no one stereotype, no one social demographic. They are young, middleaged and elderly. The vast majority are not people who use illegal drugs but are people seeking relief from pressures and anxiety,’ he says.
‘Typically we are talking about people who have jobs, who have very stressful lives and they have never touched an illegal drug in their lives .... It starts with stress, being unable to sleep, feeling bad all day long, a feeling of general anxiety.’ Codeine addiction appears to be prevalent amongst women, he adds.
The sale of codeine-containing products in Irish pharmacies was restricted in 2010 but it still can be sold over the counter under the supervision of a pharmacist.
‘Codeine-containing products tend to be the top-selling products in pharmacies,’ adds Dr O’Gara. ‘It has been said it should go completely on prescription. It would certainly help.’
And the cost to patients and their families is incalculable, with patients caught in a trap of their doctors’ making: staying on the drugs can leave them unable to function, yet they can’t come off the drugs because of the terrible withdrawal effects. And worryingly, these drugs are being shelled out in record amounts. It must be stressed that these pills can, and do, help countless thousands of patients — and of course, not everyone who takes any of these drugs ends up dependent upon them. But for those who do, there is little support: patients are often left to fend for themselves, coping with a wide range of debilitating side-effects or fighting to withdraw with relatively little support compared to those who abuse illegal drugs..
IN Ireland, services are very limited. The Government claims that there are more than 700 public detox beds available for addicts of all types — a figure strongly disputed by drug rehabilitation experts, some of whom put the true figure as low as 30. Private treatment is an option, but an expensive one. In St John of God’s in Dublin, a 28-day residential programme costs €15,000 without health-insurance cover.
And Janet Waterton found that the detox services that were available to her in the UK were also desperately unsuitable.
‘Addiction services are funded to deal primarily with heroin, cocaine and alcohol problems,’ says Dr Yasir Abbasi, clinical director of addiction services at Mersey Care Trust. ‘The kind of patient I see is a working mother who had breast cancer five years ago and is still on morphine She finds it impossible to go to a drug centre and sit next to a heroin addict.’
And even if middle-class house wives addicted to prescription tranquillisers were prepared to visit drug and alcohol addiction treatment centres, they would struggle to find any with the capacity to help them says Professor Colin Drummond chair of the addictions faculty at the Royal College of Psychiatrists: ‘Prescription drug dependence is the Cinderella of addiction,’ he says.
Even when it’s done properly, withdrawal from benzodiazepines can take ‘months or years’, says the Royal College of Psychiatrists. Withdrawal should be done gradually and only with proper support, add Stephen Buckley, Mind’s spokesper son on mental health problems and their treatments. ‘We hear from lot of people who have been on antide pressants for a long time and want to come off them but with limited time and money and a huge numbe of patients to see, not every GP is set up to help,’ he says.
Indeed, while some GPs are aware of side-effects and withdrawal effects, and understand, for example, the importance of slowly reducing the dose, ‘others deny that the drugs can cause these problems, or insist on rapid tapers which can cause great harm to patients according to one report published last year.
GPs point to a lack of specialist services to which they can refer patients.
What is so shocking is that with benzodiazepines in particular, for 30 years doctors have been specifically warned about the risks of long term use.
Dr Eva Orsmond, whose recent documentary Medication Nation revealed the shocking truth about our addiction to prescribed medications, says alternative treatments for anxiety and depression are not widely offered.
‘It was reported as recently as December 2016 that seizures of drugs such as benzodiazepines and Z-drugs have soared in the past two years,’ she says.
The most recent statistics show that benzodiazepines were the main problem drug of 547 people who sought treatment for substance abuse in 2012, compared to 261 in 2009. However, despite these drugs being generally considered safe and effective in the short term (i.e. 2-4 weeks at a low dose) the risk of overuse, dependence and abuse remains a concern.’
Even though there has been a reduction in the prescriptions written for these medications recently, there were still 1.2 million prescriptions written for antianxiety medication last year.
Barry Haslam, an accountant who lost a decade of his life to medication prescribed for anxiety says: ‘This scandal has been swept under the carpet for decades. In the process they have ignored the suffering of innocent patients who’ve only taken these drugs as directed by their doctors.’