IS IRELAND HOOKED ON PRESCRIPTION PILLS?
‘A drug addict is no longer a junkie with a needle’
They’re tablets you can get from your doctor but should only be used under medical supervision. Now gardaí are finding an increasing number of these legal drugs on the streets – proving we’re in danger of suffering from the same deadly opioid epidemic that has wreaked havoc in the US
LAST week, 39-year-old Richard Rattigan was jailed for four years after he was caught with more than €80,000 worth of drugs at his home in Drimnagh, Dublin. That a moderately large drug seizure was made by gardaí and a man was arrested, convicted and jailed, is nothing new in the ongoing battle against the dealing of illegal substances in this country.
What is interesting, not to mention worrying and worth exploring, is the kinds of drugs that were found at Rattigan’s home. The haul was entirely made up of prescription tablets — just over 40,000 of them. There were two types, Zopiclone, which is a sleeping tablet prescribed to deal with particularly bad bouts of insomnia, and Alprazolam, from the benzodiazepine family, often sold under the trade name Xanax, used to treat anxiety and panic disorders.
Rattigan pleaded guilty to possession for the sale or supply of the drugs found at his house in September 2017. He had no previous convictions for similar offences.
It may well have been Rattigan’s first foray into the dark world of illegally dealing prescription drugs, but it was just the latest incident in a long run of seizures of illicit substances that are outside the usual drug caches found in Ireland: namely heroin, ecstasy, cocaine and marijuana.
Last September, four men were arrested after gardaí stopped and searched their car at Grannagh in Co. Waterford. They discovered two buckets full of suspected benzodiazepines with an estimated street value of €52,000.
At the beginning of November, a Dublin pharmacist was suspended from working in Ireland as gardaí investigated allegations that he was involved in the illegal distribution of prescription drugs.
The man, who is in his 40s, owns several pharmacies in the Leinster area. His home had been raided by gardaí in August, where they found about €5,000 worth of Xanax and Ritalin, which is used to treat attention hyperactivity disorder, and a small amount of cocaine.
In October, it was reported that more than 90,000 fake and illegal prescription medicines were seized during an operation mainly targeting online sales. The stash, valued at over €375,000, included large quantities of anabolic steroids, sedatives, painkillers and erectile dysfunction products.
They were recovered during a week-long operation which involved the Health Products Regulatory Authority (HPRA), the Revenue’s Customs Service and the gardaí.
Earlier in the year, in mid-April, the HPRA released shocking figures that revealed close to one million units of illegal medicines, intended for supply in Ireland, had been seized in 2017.
They told how its enforcement section apprehended 948,915 different tablets, capsules and vials of falsified and other illegal medicines in 2017, compared with 673,906 units in 2016 — an increase of more than 40%.
While the majority of the drugs found were anabolic steroids (47%), almost a quarter of them were sedative products.
‘We know from our investigations and prosecutions that those who seek to profit from illegal medicines have little regard for the health of the end users of the medicines they are supplying,’ the HPRA’s director of compliance, John Lynch, warned. ‘It is of continuing concern that members of the public would use potent prescription medicines without medical supervision.’
It would seem that Ireland’s criminal gangs, while still trading in the usual suspects of cocaine, heroin and marijuana, have also turned their attentions to the lucrative black market of prescription pills. Benzos, Sticks, D10s, D5s, Yellows, Blues — there is a dizzying array of names and nicknames for these drugs, which are now being abused by every strata of Irish society.
From middle-aged men and women who were first prescribed pain relief or sleeping tablets to help them deal with legitimate health concerns, but then found it too difficult to function without them; to heroin users who have found there are pills that help their high get even higher or their comedown a little less bumpy; to kids experimenting with the latest drugs that their friends are taking, the proliferation of prescription pills has seen Ireland’s drug abuse landscape change dramatically.
In many ways it has been simply catching up with what has been happening in the US over the past decade or so. Most of those who work on the frontline of drugs services — counsellors and GPs, for instance — agree that Ireland is generally about five years behind the US in whatever drugs trends are popular.
If this is the case, we should be very worried indeed.
The latest figures from the US show that an estimated 72,287 people died of drug overdoses in 2017 — a 10% increase on the year before. It was a new record, one the authorities there say was driven by the deadly opioid epidemic — nearly 49,000 of the deaths were caused by these.
This class of drugs includes heroin, prescription pain relievers such as oxycodone (often sold under the brand name OxyContin) and hydrocodone (usually known under its brand name Vicodin), codeine and morphine. It also includes the deadly fentanyl, a synthetic opioid that is estimated to have killed more than 29,000 Americans in 2017.
Declared a ‘national health emergency’ by President Donald Trump back in October 2017, this particular drugs crisis kicked off in the 1990s when pharmaceutical companies claimed their new and hugely effective opioid pain relievers were not addictive.
Doctors and hospitals began to prescribe them at greater rates before it became clear that they could, in fact, be highly addictive.
The figures from 2017 estimate that 1.7 million people in America were suffering from substance abuse disorders related to prescription opioid pain relievers and that almost 200 people a day were dying from overdoses.
And it has seeped into every corner of American society, including Hollywood. Actors Matthew Perry and Jamie Lee Curtis have spoken about their addictions to painkillers, as have Jack and Kelly Osbourne.
Actors Heath Ledger and Brittany Murphy, not to mention pop stars Prince and Michael Jackson, were all found to have dangerous levels of prescription drugs in their systems at the time of their deaths. In an effort to tackle these horrendous numbers, in October, President Trump signed into law several new measures, including expanding access to substance abuse treatment in Medicaid, the government health insurance programme for the poor and disabled, and cracking down on mailed shipments of illicit drugs.
Latest figures in Ireland, from 2016 data published by the HSE, show that opioid prescriptions for patients who have medical cards here rose sharply over a ten-year period.
For instance, in 2006, the number of scripts written for Oxycodone (trade name OxyContin) was 47,262; by 2016 that had risen to 122,611. In 2006, Fentanyl was prescribed 34,884 times; in 2016 that figure had almost doubled to 62,399.
However, experts in Ireland don’t believe we are on the cusp of a crisis as severe as that of the US. It would seem the medical profession here is more aware of the dangers of addiction. Opioids are also less available. ‘We haven’t seen as much of that here, a little bit, not quite as much yet,’ says Sara Cassidy, manager of the Aiséirí Addiction Treatment Centre in Cahir, Co. Tipperary. ‘I think we are on top of it a bit and there isn’t as much availability as there is in the States.’
Dr Chris Luke, recently retired as a consultant in emergency medicine at Cork University Hospital and Mercy University Hospital, agrees. ‘We kind of run the same risk as the Americans,’ he says. ‘But there’s a slightly more vigilant culture here.’
This vigilance, however, has not stopped the boom in other prescription drugs. And the profile of abusers and how they got started is very similar to what has happened in the US. As one pharmacist explained: ‘A drug addict is no longer a junkie with a needle.’
Indeed many addicts are respectable parents and professionals who have found themselves unable to wean themselves off painkillers they no longer need. Once the original problem was sorted, they were left with another, altogether more serious issue: addiction. It happened to Belfast-based celebrity chef Jeanne Rankin, who has spoken publicly before about how she became addicted to morphine and other prescription drugs for over seven years after a couple of major back operations. She eventually checked herself into rehab and recovered.
Then there is the younger generation of drug takers, interested in trying anything that’s new or that their friends are offering.
And of course, the ‘traditional’ drug addicts, people who have discovered that prescription drugs can help enhance their highs and level out their lows.
Sara Cassidy, who has worked in the addiction field for over 20 years, says she started noticing the rise in prescription pills being abused around five years ago.
‘There’s been a very large increase in the use of prescription types drugs like benzodiazepines,
whether it’s Valium or Xanax, those types of drugs,’ she says. ‘They get a relaxant type effect from them. I’ve spoken to people recently who have used them to come down off coke. For others it’s a mixed bag. Middle-aged people may have been prescribed them and then got addicted. For those who are younger, 15 to 30, it just became prevalent on the street.
‘We have an adult detox centre in Cahir and an adolescent unit in Kilkenny. Most of our detox needs are now around benzodiazepines, more so than any other drugs like heroin. It’s a very difficult withdrawal and it’s relatively dangerous because of the risk of seizures, a lot more dangerous withdrawal than one from heroin or coke.’
Sara has seen people from ‘every walk of life’ come to them for help to wean themselves off prescribed medications.
‘Some are coming in because of prescriptions, normal straightforward legal prescriptions, but the main increase is around the illicit side of things, people buying them on the street or the internet,’ she says. ‘You also have people who will get scripts off doctors and sell them on, and there are some doctors who are well known to addicts as being a little bit easier to get scripts from.’
Young addicts being treated have told how they were taking 50 tablets at a time, often first thing in the morning. ‘It’s shocking, you or I would fall over after taking one,’ says Sara. ‘But they build up a tolerance over time and whatever other drugs are being taken can make the tolerance very high.’
Dr Luke has also noticed an increase in patients presenting with addiction to drugs that are legally available with a prescription. ‘I wouldn’t say it was a surge, more of a simmering issue for a good five to ten years,’ he says.
‘With the misuse of benzodiazepines in particular,’ he says. ‘The other one that’s increasingly misused is Lyrica [otherwise known as pregabalin], a pain drug that was originally an epilepsy drug and was found to be useful for nerve pain. It’s now on the street. It amplifies the high you get from other drugs.
‘A lot of these drugs are what you might call amplifiers or co-drugs, they give you a better buzz if you take them with a main drug.
‘There’s been a normalisation of cocktail drug taking, it’s now very common to take three or four drugs at a time — in fact, it would be unusual to take just one.
‘We’ve had serious drugs in Ireland for 40 to 50 years and in that time people have learned how to calibrate their hit, if they’re short of heroin they might lob in a bit of Xanax. Or if there’s a shortage of heroin they might take sleepers. It’s like a form of self-care, they know how to regulate their own mental sensations. Drug abusers consider themselves experts in their own treatment and self medication — they know exactly what works for them, how they can blend drugs with a bit of drink and so on.
‘There’s no doubt prescription drugs have been making inroads for the last ten years and I think we are on an upwards trajectory. It’s relatively gentle but relentless.’
The Irish medical authorities have not been oblivious to the abuse of such medications
‘It’s the reason the sale of Solpadeine was curtailed,’ says Dr Luke. ‘People were becoming addicted to codeine, it’s a mild cousin of morphine, and very popular among ladies, you hear of them taking 10 to 20 a day and the odd death.
‘Housewives like clean, scientific drugs. They don’t like messy drugs, they don’t want to smoke, they don’t want to inject and they don’t want powder. They prefer drugs like the Valiums and Tramadols.’ But as we know, it’s not only middle-aged women who like uppers and downers.
Marie Metcalfe is the co-ordinator of the Community Policing Forum in Dublin’s North Inner City. Originally set up in the late 1990s to help monitor the heroin epidemic that threatened to destroy local communities, Marie has been in a perfect position to see what drug trends have hit Ireland over the last 20 years.
‘I’ve seen the patterns and changes and right now the most visible dealing around where we are is in stuff like sleepers, Benzos, Xanax — they have loads of different code names. Why, I’m not sure, legislation was brought in to deal with the issue,’ she says of the fact that in 2016 Health Minister Simon Harris added illegally held prescription drugs to the controlled substance list under the Misuse of Drugs Act.
‘Since we were set up here in 1999 the drugs scene has changed so much, from heroin and hash to cocaine and crack cocaine. We’ve gone through the whole lot and then when it came to the tablets, we were stuck because there was no legislation to deal with them. Every time a new drug comes in we have to look at it and legislate.’
Although efforts have been made to curb the sale of illegal prescription drugs, in reality, the new laws have made little difference.
‘If you’re talking about a young dealer on a corner with a couple of sleeves of tablets, there’s not much the gardaí can do about it,’ explains Marie. ‘It’s not hard drugs and they only carry small amounts on them, so when the guards come along, a couple of packets of tablets is nothing major.
‘It’s made it much much easier for them to deal.
‘The lads out there are very good at what they do, if they put their brains to something else they’d be millionaires. They sell them in cards, blister packs, that cost from €15 to €20 — it depends what patch you’re looking at.
‘But they’re still selling a mixture of everything. The drug users take the heroin or their methadone and then this prescription stuff helps bring them up or brings them down, takes the edge off.’
Is she shocked by the popularity of these latest drugs?
‘I’m not surprised by anything around here anymore,’ she says with a short laugh. ‘You just have to wait for the next thing to come at you and see how you’re going to deal with that then. Drugs are here forever, they’re never going away.
‘It’s about how we live with the dealing going on around us, not what they’re selling.’
‘There’s not much the gardaí can do about it’