A LETHAL DRUGS LOOPHOLE
Debbie, 41, took painkillers for a bad back. But when her doctor tried to wean her off, she turned to online pharmacies who sold her 3,700 codeine pills in the months before she died. How CAN that be legal?
D ebbie was the love of my life. i loved her with all my heart,’ says Mike Kellard. ‘She was the kindest — and the happiest — person you could hope to meet. i had absolutely no idea this was going to happen.’
Mike’s life unravelled one July morning in 2017, when he got a call at work to say Debbie, 41, hadn’t arrived at her office.
Nor was she answering her phone. Mike went straight home, where he found Debbie Headspeath, his cherished partner of 20 years, lying dead. ‘She had her coat on ready to leave. She had collapsed shortly after i left for work,’ he recalls.
The cause of death, her family believe, was an accidental overdose of opioid painkillers.
‘ Debbie had started taking over- thecounter codeine for back pain about ten years ago,’ says Mike, 54, a Post Office worker from ipswich.
She then developed a dependency on the drug which initially she tried to deal with on her own — Mike says the couple only ever had one conversation about it, one night about four years before she died.
‘She told me she was addicted to painkillers and needed help. She then went to the doctor and he had devised a plan to supply her with reducing amounts of codeine. As far as i was concerned, that was happening.’
in fact, unbeknown to Mike, as well as prescription painkillers from her GP, Debbie was taking codeine she had bought online — after she died, he found that in the nine months before her death she had taken some 3,700 codeine painkiller tablets bought from 21 legal internet drug suppliers. ‘i believe she just couldn’t cope with the dose being reduced,’ says Mike. ‘She went online to get it. These suppliers operate outside this country and there’s apparently nothing you can do.’
Opioid painkillers can be ‘ lifetransforming’ for short-term pain, say experts. However, there have been growing concerns about their use for chronic pain — because the drugs often don’t ultimately work for this form of pain, and carry the risk of addiction.
This has led to demands for better guidance for GPs prescribing the drugs and better support for people trying to come off them, including a 24-hour helpline — calls backed by the Mail.
Following these calls, Public Health england ( PHE) is reviewing prescription pill dependency, and campaigners hope this will lead to changes in guidelines from the National institute for Health and Care excellence (NICE) for opioids and antidepressants.
Yet as Good Health has discovered, another major problem is emerging, in the internet pharmacy free-for-all, with an uncontrolled supply of powerful, opium-based painkillers such as codeine and tramadol — highly addictive drugs that are chemically similar to the street drug heroin — readily available online.
SO WHATEVER any new nice guidelines might say about when doctors should prescribe the drugs, patients can simply turn to the internet.
‘even if doctors become restrained in their opioid prescribing, people will be able to go online to get more,’ says pain specialist Dr Cathy Stannard, widely recognised as one of britain’s leading experts.
Owen bowden-Jones, a consultant psychiatrist who leads Addiction to Online Medicine (Atom), britain’s only clinic to help those affected by the issue, explains: ‘it really got going a year and a half ago. Patients would tell us they had been started on one of these drugs by their GP, who then said they couldn’t increase the dose.
‘The patients then started finding it online and were often surprised at how easy it was to obtain without prescription or speaking to their doctor. They would find sites that would post the medication next day.
‘There are online pharmacies where there is a pretence of screening and others supplying prescription medicines without any attempt at offering healthcare. A lot of them aren’t in the UK.’
As we have previously reported, most other european countries have prevented their citizens being prescribed drugs by a remote online doctor from another country in the EU. The UK Government has not closed this loophole, however, even though the number of people admitted to hospital here after overdosing on opioids has doubled to 11,500 a year in the past decade.
Deaths from prescription opioid painkillers are bundled up with those from heroin addiction by the Office for National Statistics, but fatalities from these two sources have soared to around 2,000 a year, a rise of more than 40 per cent in a decade.
An inquest into Debbie’s death is scheduled for May. The coroner, Dr Daniel Sharpstone, has asked for witness statements from the owners of all the websites that supplied her drugs. His inquest will also consider whether the circumstances of her death breached the european Convention on Human rights, which requires the state to protect its citizens from harm.
‘if you investigate the sites, it’s apparent that if you say the right things you can get your prescription — and it’s quite easy to learn what to say,’ one of the coroner’s staff who did not want to be identified told Good Health. ‘The systems in place online for monitoring repeat prescribing seem very weak. individuals can hop from one site to another.’
it is not clear whether inquest findings have much impact. back in 2003, a 24-year- old Durham University physics graduate, Liam bracknell, became one of the first online pharmacy casualties. evidence at his inquest showed he was getting 300 tablets of various kinds of drugs delivered daily to his home.
Last October, an inquest was told that 51-year-old Jennifer Lacey had been found dead in a South London Travelodge with the remains of 210 tramadol tablets in her body — and that many had been obtained via a doctor registered in Prague who had never seen her and had no access to her medical records.
Nicki Hari, 50, a former call centre worker from borehamwood in Hertfordshire, has spent the past seven years as a UK Addiction Treatment counsellor, after emerging from 25 years as a painkiller addict. She says there has been a huge increase in the number of
victims in the past two years, which she believes is linked to the rise in the drugs’ availability online. She speaks as one who used to obtain the pills this way herself.
Her own dependency began in her early 20s, when she was prescribed co- codamol for chronic knee pain.
She has since endured 15 operations which left her taking painkillers for so long ‘ my body became quite immune to the effects’ — and dependent on them. ‘i would make appointments with different GPs. When they said they would review the medication, i just changed my doctor. i used to borrow them from my friends, then about 15 years ago i started getting them online. if you say you are in pain, you just get given painkillers.’
Dr cathy Stannard is deeply concerned about the potential risks of online opioid prescriptions. ‘People shouldn’t be able to use an online question-and-answer tool to get these powerful drugs,’ says Dr Stannard, who is chair of Opioids aware, an online resource.
‘i don’t understand why it’s being allowed. it should be possible to develop a robust system that links into healthcare records in the NHS structure. We all know it’s difficult to get GP appointments, but online prescribing is not the answer. i don’t think it would disadvantage anyone if none of these painkillers was available online.’
The royal college of GPs, the General Pharmaceutical council, which regulates pharmacies; the care Quality commission, which regulates healthcare providers, and the Medicines and Healthcare products regulatory agency (MHRA) have expressed concern.
Psychiatrist Owen Bowden-Jones adds that he doesn’t think there is a single solution ‘ but we do need to educate users about the risks of these medications, the risk of fake treatments or medicines mixed with other things’.
nicki Hari adds: ‘anyone who has been on one of these drugs for a month should worry. Unless you have multiple sclerosis or some chronic condition, these drugs are just masking the pain, which is probably going to worsen the underlying problem.
‘We need education about the dangers, and people who can’t cope on the prescriptions they are given should ask to be referred to a pain management clinic.’
Since that fateful day in 2017, Mike Kellard has felt bewildered by his loss. The couple had no children and Debbie devoted her life to Mike, her full-time work for charities including Suffolk refugee Support and Blind Veterans UK, and a prodigious output of hundreds of poems.
‘as far as i was concerned, the dose of her painkillers was being reduced,’ says Mike, who is being comforted by Debbie’s parents and siblings. ‘She was feeling really positive and talking about the future when she died.’