Sharon Ní Chonchuir hears how addictive painkillers are leading to chronic problems among people who began taking them for medical reasons.
Ant McPartlin of Ant and Dec fame has recently been in the news for all the wrong reasons. The Britain’s Got Talent presenter checked into rehab for his addiction to the prescription painkiller tramadol.
McPartlin, right, isn’t the only one hooked on painkillers. Golfer Tiger Woods has confessed to being addicted to vicodin. Pop icons Prince and Michael Jackson both died from overdoses of the painkiller fentanyl.
According to pharmacist Caitriona O’Riordan, a member Irish Pharmacy Union executive, this problem isn’t confined to the rich and famous. “A drug addict is no longer a junkie with a needle,” she says.
“Ordinary people like you and me can find themselves addicted to painkillers.”
The statistics are worrying. In the US, 45 people die every day from opioid prescription painkillers. In Britain, more than 192,000 people are said to be addicted to the drugs.
Last year, the state pathologist for Northern Ireland Professor Jack Crane reported that there had been 33 deaths from tramadol alone in the North in 2015, a figure that amounted to more than the deaths caused by heroin and cocaine combined.
Here in the Republic, there were 354 deaths from overdoses in 2014. Three out of every four of those involved prescription drugs, including painkillers.
Dr Colin O’Gara, consultant psychiatrist at St John of God’s Hospital, confirms that there’s a problem. “Ten years ago in Ireland, people who had an issue with substance abuse were addicted to alcohol, heroin, cocaine or ecstasy,” he says.
“Now the prescription drug problem is much bigger. It’s set to exceed illicit drug use.”
Many people are introduced to prescription drugs in the same way as Ant McPartlin was. He was prescribed tramadol when he was recovering from an operation to his knee.
“Tramadol, codeine and morphine are opioids, which means they are the same family as heroin,” explains Dr O’Gara.
“These drugs are very effective at killing physical pain but they kill emotional and mental pain too and can bring about a feeling of euphoria.”
The science behind this is based on a chemical known as GABA. This chemical controls the release of dopamine in the brain but opioids prevent it from being released. When it is not present, dopamine floods the brain and creates the feeling of wellbeing.
“These drugs offer a physical and psychological relief from pain,” says Maebh Leahy, CEO of the Rutland Addiction Treatment Centre in Dublin.
“People can be naïve about how quickly they can build up a tolerance to the active ingredient and may not recognise that they are becoming hooked.”
Even painkillers on the lower end of the scale such as codeine can be addictive.
“Codeine may be a weak opiate but when taken in the doses that we see — up to 100 tablets a day — it’s certainly not weak,” says Dr O’Gara.
The fact they cause you to relax makes driving dangerous. In the longer term, side effects can include damage to the heart, stomach, kidneys and liver.
A study carried out in 2009 recognised the seriousness of the situation. It found that 97% of pharmacists in Ireland believed there was a misuse of over-the-counter codeine products. This led to the PSI placing restrictions on how codeine was sold.
“It can no longer be displayed in pharmacies,” says Caitriona O’Riordan, who runs a pharmacy in Enniskeane, Co Cork.
“The customer must ask for it and this means the pharmacist gets to ascertain if they really need it.”
In some instances, O’Riordan says that they don’t, in which case she recommends other treatment.
“If they do need it, I feel professionally and morally obliged to warn that these are drugs you should only take if you need to and that you should only use them for a short time, certainly not longer than three days,” she says.
If she suspects a dependency problem, she does her best to help.
“Pharmacists share information with each other in order to prevent customers from being given medication elsewhere,” she says.
“But we don’t just present a barrier. We also tell them that there is support available, whether that’s going to see their GP or approaching a specialist facility.”
Not everybody is receptive to this advice. Many don’t see themselves as drug addicts because they don’t conform to the stereotype of the junkie on the street.
“These are people who haven’t followed a traditional route into substance abuse,” says Dr O’Gara. “A doctor was initially involved in prescribing the medicine and then they got hooked to what made them better.”
Maebh Leahy has seen many patients who are in denial. “Because they don’t see themselves as the same as a homeless person on the streets, they convince themselves they don’t have a problem,” she says. “They won’t consider the idea that they might be addicted until a crisis emerges.”
There are specialist rehabilitation centres, self-help groups such as Narcotics Anonymous, local treatment centres and community addiction schemes.
“Even going to your GP is a good first step,” says Dr O’Gara. “It will inevitably lead to recovery.”
Addiction to painkillers is a real issue.
“Nobody wants to frighten people into not taking painkillers that they need to take,” says O’Riordan. “But at the same time, people need to be aware of just how addictive these drugs can be.”
“It’s a serious medical issue,” adds O’Gara. “People end up addicted without wanting to and they need and deserve help.”
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