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Don't keep taking the tablets

Independent on Sunday
April 8, 2001
by Gavanndra Hodge

In the US, the modern junkie is more likely to be getting drugs
from their GP than on the street. Could it happen here?

Painkillers, antidepressants, sleeping tablets – all these drugs are regularly prescribed by GPs or can be bought over the counter And yet many of the mundane, everyday pills that fall into these categories can be as addictive harmful and more difficult to kick than heroin or cocaine, the traditional villains of the chemical world. It is a problem that is quickly starting to eclipse that of illegal narcotics. Twelve out of the 20 most abused drugs are prescribed.

Nor is this just housewives on Valium needing to keep calm – addicts are increasingly taking prescription drugs for recreational purposes, a phenomenon propelled into the media spotlight following the rehab confessions of such stars as Melanie Griffith, Courtney Love and Matthew Perry. The latest reports from LA show a disturbing shift in the drug culture, in which cocaine and Ecstasy are being replaced as the partygoers' drug of choice by Vicodin, a potent combination of paracetamol and dihydrocodeine, which is now the most prescribed painkiller in the US. Controversial rapper Eminem proudly features a crushed Vicodin pill on an album sleeve, while a report in the March issue of Details magazine claimed that there is a new trend in Hollywood for "Vicodin Sunday" parties. At such events, bowls of "Vike", as it is commonly known, are laid out on coffee tables as if the drug were a cocktail snack, prompting comedian David Spade to quip at January's Golden Globe awards, "I found 10 Vicodin in my gift basket!"

The drug is relatively easy to get hold of, whether from a willing doctor, via a trip across the border to Tijuana or from dealers on the street, it is socially acceptable and users can continue to work and play apparently unhindered by any adverse effects. It is these three factors that have made it so popular.

In America, the level of misuse of prescription drugs is reaching epidemic proportions. In fact, it has become such a high-profile social issue there that a recent tongue-in-cheek "behind the scenes" episode of The Simpsons showed Homer admitting that he, too, was once addicted to painkillers. According to one government estimate, more than six million Americans have, at some point, used the drugs prescribed by their doctors in an unhealthy way. It has also been reported that more than 50 per cent of emergency room visits for drug-related problems are connected to prescription drug misuse or accidental overdose.

There has been a startling rise in the problem over the past few years. Results of a recent US Department of Health and Human Services survey showed that 1.5 million Americans started taking prescription painkillers for non-medical reasons in 1998, which is almost three times the number who started taking them in 1990.

As with most American trends, this is a problem that is making its way across the Atlantic. Vicodin cannot be obtained legally in this country but is available to buy over the internet, while its closest equivalent, codydramol, is already on most UK doctors' prescribing rosters. Furthermore, there are many other alternatives that are all too easy to obtain.

"Prescription drugs can be bought on the internet," confirms Dr Robert Lefever, director of the Promis recovery centre in Kent, which has treated more than 2,500 patients with addictive disorders over the past 15 years. "But, to be honest, there is no shortage of doctors who will prescribe them." And likewise there is no shortage of British people who will abuse them. Between 1994 and 1999, there was an increase of 13 per cent in the number of prescriptions dispensed, and there are now approximately 530 million items prescribed yearly. It is estimated that more than a third of the UK adult population is on prescribed tranquillisers, antidepressants or sleeping pills.

Dr Graham Lucas, consultant psychiatrist at The Priory Hospital in Roehampton, has noted a particular rise in the abuse of minor analgesics.

"Instead of using exercise and massage to alleviate muscular-skeletal pain, I see many people popping pills," he says. "It is all too easy for people to become psychologically dependent on painkillers."

Dr Lucas attributes this to an increasingly stressful and unstable working climate. "People are working harder, and there are fewer contracts being given out," he says. "Painkillers are easy to take and have very little stigma attached."

Dr Lefever agrees. "No one could sit at their desk shooting up heroin, whereas it is perfectly acceptable to take a pill prescribed by a doctor. What's more, you can expect sympathy and understanding from your friends and colleagues."

Alex, 46, works in sales and lives in central London. Five years ago, a serious toothache led her to discover the powerful analgesic effect of Nurofen Plus taken with Scotch whisky. Alex was a compulsive gambler and began taking the combination on a daily basis so as to avoid facing up to her problem. "I was taking up to 20 Nurofen a day for three years," she says. "I didn't think I had a 'drug' problem – I was buying the tablets at the chemist. It didn't affect my work. I would feel a bit tired in the mornings, but nothing more. The fact that I had a problem only came to a head when I took an overdose of about 40 tablets and I found myself in hospital. I spent 12 weeks in the Promis clinic conquering my addiction."

Alex was lucky – three years of painkiller abuse seem to have done her no long-term physical harm. Prolonged abuse of these kinds of medications can cause serious liver and kidney damage. Furthermore, the two main groups of problematic prescription drugs – codeine derived painkillers, such as Vicodin, and benzodiazepines, which are used to control anxiety and include the likes of Ativan, Valium and Xanax – are incredibly hard to give up.

"Prescription drug dependency is one of the three most difficult addictions to treat, along with nicotine addiction and anorexia," says Dr Lefever. "Addicts have the best excuse of all not to give up: 'My doctor gave it to me."'

Paula, a counsellor from Pinner in her early forties, was addicted to Ativan for seven years. She was prescribed the drug after she had given birth at 38 weeks to a stillborn baby boy. "Because it was given to me by a doctor, I didn't question it," she says. "But very quickly I became physically and psychologically dependent."

At first, the medication just served to numb Paula's emotions, but soon she found it was becoming an integral part of her everyday life. "Ativan gave me more confidence. I found the pills liberating; I would take them before I went out, and would always make sure I had some in my bag at parties, just in case." After three years on Ativan, Paula started increasing her doses from the prescribed three a day to as many as 10. "If I finished a prescription early, I would just say that I had been having a particularly bad month."

After seven years, Paula found that the side effects of her Ativan use were becoming unbearable. She was perpetually agitated, started having palpitations, would sweat profusely, suffered hallucinations and felt weak at the knees. "But when I considered giving them up," she recalls, "friends and relatives would say: 'Don't you think you should discuss that with your doctor? These pills are helping you."' Eventually Paula went to Narcotics Anonymous, where she faced up to the fact that she was an addict.

Coming off the drug took 12 weeks, during which time she suffered the traditional "cold-turkey" symptoms of nausea, insomnia and hypersensitivity. "I had to realise that this was a drug, and not a medicine," she says. "It was difficult for me to identify myself with someone who went out to score heroin, but that was, in essence, what I was." She now feels as though she has wasted seven years of her life.

Following considerable media exposure and medical investigation of the dangers of benzodiazepines, doctors in the UK and US have become careful about prescribing them. Nevertheless, official figures show that 17 million prescriptions for benzodiazepines were made out last year. Paul Entwistle, administrator and scientific adviser for the Council for Involuntary Tranquilliser Addiction (CITA), has noticed a rise in the number of people coming to him for help with addiction to this group of prescription drugs, although he concedes that this is partly due to increased awareness of the problem. "In the past," he says, "some of these people may not even have realised they were addicted to the medication that they were being prescribed by their doctor."

These prescription drugs are necessary and in many cases perform a life-saving function for those who take them, but the problem of prescription drug-abuse over here could easily rival that in America if left unchecked. And the only people who can step in to improve the situation are medical professionals. "Doctors prescribe by nature," says Dr Lefever. "I had a patient who told me that her doctor had warned her that if she came off her medication she might die. I just saw another patient who was on 70 tablets a day. There are doctors out there who are absolutely committed to prescribing, and if the patient doesn't get better, they just up the dose."

For more information, call the Promis 24-hour crisis line, freephone 0800 374318, or the CITA helpline 0151 9490102 (lines open Monday to Friday, 10am-1 pm).

Benzodiazepines: How they Work & How to Withdraw
Professor C Heather Ashton DM, FRCP.

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