Another death and so another issue becomes ‘hot’ this week. This time it’s misuse or abuse of prescription drugs following the death of Michael Jackson. I’m not sure the issues are quite the same in the UK. Patients here don’t have doctors at their beck and call in quite the same way as they do in, say, the US. There, the very nature of the way doctors are paid means that they have a greater need to keep their patients happy and coming back to them, which dare, I say it, means providing them more readily with the prescriptions they ask for (I now ready myself for indignant letters from American medics...) It is now claimed that the abuse and trafficking of prescription drugs, including painkillers and stimulants, has overtaken the use of nearly all illegal drugs.
If you think about it from the addicts point of view this shouldn’t really be that surprising: medications containing narcotic drugs or psychotropic substances can provide a high comparable to practically every illicitly manufactured drug when taken in appropriate (or perhaps that should be inappropriate) quantities, but without the risk of them being ‘cut’ with various noxious substances by the dealer. Fentanyl, a painkilling drug is thought to be around 80 times more potent than heroin and is pure. Why would you ever go back to heroin?
The two most commonly abused drug groups are opioids and benzodiazepines. They are usually prescribed for short-term use but they may also be prescribed for chronic pain or generalized anxiety and this is where the problem starts.
The body becomes tolerant to their effects and so larger doses of the drugs are needed to achieve the same effect. Doses get gradually higher until patients are taking huge quantities and become completely dependent.
Addiction is different. Addicts tend to be reliant on the regular use of a drug to satisfy physical, emotional, and psychological needs so that the drug begins to take over their lives and becomes more important than anything else. There are many housewives who are unidentified addicts. Started on antidepressants during a bad patch a year or so ago they become convinced that they now cannot function without their tablets. They depend on them emotionally and getting them off them will be a Herculean task.The elderly are particularly at risk. It’s estimated that as many as 17% of adults 60 and over abuse prescription drugs.
This is because there is less likelihood that an elderly person will comply with directions. We docs give advice like ‘always take with food’, ‘don’t drink alcohol with these pills’, ‘finish the course’, or even, in the case of addictive drugs, ‘only take for a short time and don’t sell your pills to dodgy looking blokes down the pub’, but this advice is rarely stuck to. Doctors are also much more likely to prescribe addictive medications to elderly patients than to younger ones.
But possibly a more acute problem in the UK is the effect that the pressures of looking good seem to be having on our fitness fanatics. A survey of male and female gym users last year found that 10 % used diuretics, 10% had used thyroxine, 14% insulin, 22% tamoxifen, 24% growth hormone and 44% had used ephedrine to boost their fitness.
And the issue of body dysmorphia is increasing in young men so that steroids remain the most abused drug, and even 7% of women admit to taking them. This is still abuse of medications, even if it’s not the addictive ones. I’m not sure that as a nation we are all hooked on painkillers, but we clearly have plenty of demons to fight.
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