Jacko's Death Highlights abuse of prescription drugs

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.

It's not the doctor's fault that recession breeds depression

The powers that be, or in this case the powers that want to be; the Lib Dems, have reported that we docs are prescribing too many antidepressants. Their new report claims an increase of 2.1 million scripts for the drugs in 2008. Apparently we need to tackle this issue and reduce our prescribing. But are they really all completely unnecessary prescriptions, or are there simply more depressed people around? Or is there an absence of other treatment options easily available for doctors to access?

It’s considered very bad management to have a patient commit suicide on you, especially if he has been in the week before to make clear his unhappy mind, and so doctors naturally feel some sort of positive intervention must be made quickly.

A 10 minute appointment is really only long enough to write out a prescription.I have found myself asking why we are even setting targets to reduce the growth in prescribing of anti-depressants. Why are they seen as a bad thing? They are an evidence-based treatment that is appropriate to the particular malady and they allow patients who previously would have been disabled by their mental health condition to return to a normal life and give them the confidence to tackle their once insurmountable problems.

We should really be asking why there are so many depressed people around.The truth is that the recession (and I know this has now become the excuse for everything) is doubtlessly affecting the mental health of the nation. GPs are offering drug treatments because most do not have many other options. Access to therapists, psychiatrists and counsellors is limited and waiting lists are long. Mrs Creak with her achy hip can safely wait a few months to see an orthopaedic surgeon, Mr Gloom with his black mood and suicidal ideation cannot. Antidepressants may not remove the cause of the problem it is true. Popping pills wont resolve a failing business or an impending redundancy, but they at least help the patient to better ride out the storm.

Norman Lamb, the Liberal Democrats' health spokesman says "The increase in the number of people being prescribed antidepressants is deeply disturbing.” Yes Mr Lamb, it is. It implies the nation is not coping, not that GPs are overzealously handing out happy pills. We do need more alternative therapies to help counter the increasing reliance on antidepressants, but they are just not available. The government has already committed millions to plug gaps in mental health provision and has promised to train thousands more therapists and hundreds more specialist nurses. But that is for the future.

They are not here now. I think an effective solution would be to recommend good financial and debt management advisors to those caving in under the economic uncertainties. They would be able to come up with far more useful advice, and they will have longer than 10 minutes to do it in.

Men’s Health Week

Men’s Health Week has just come and gone. I know it’s confusing given we already have prostate week, erectile dysfunction week, testicular cancer week, male menopause week, testosterone week and many others. What bits could be left to cover?

Looking at the statistics of GP attendances in the UK for last year and also at the top 10 causes of death that’s easy to answer: men actually taking any notice of their general health whatsoever would be a good start. Can I just point out here that grunting away on a pec dec at it’s heaviest setting once a week and occasionally slapping on some high-tech-packaged moisturiser doesn’t count as health care. It’s vanitiy.

It may well help us to find a mate which could in time allow us to pass on our genes, arguably our primary role in life, but it’s not ging to do much to make us healthy. Men are notoriously bad at going to their GPs when they are ill, and alarmingly good at ignoring problems. In fact research shows that women are 100% more likely than men to seek preventative health care. It’s a male pride thing you see, a machismo deeply ingrained by evolution. Illness is weakness, and it would never do to admit to being weak.

It’s also to do with background access to healthcare in general. Women realise from a young age that it’s ok to talk about their bodies; their periods start and they talk about that. Then come family planning issues, with an ensuing visit to the GP’s in many cases, then babies, smear tests, mammograms, more babies and finally menopause and HRT. She is often at the GP or having some sort of medical consultation.

For man it’s a different story with most presenting to their GP’s for the first time when they hit 50 because the prostate is starting to play up. And having to talk to another bloke about his undercarriage is a mortifying new experience for which life so far has left him totally unprepared. It’s unfortunate for men that so often the bits that seem to go wrong first are the really embarrassing ones: testicles and lumps thereon, prostates with their sexual and urinary sequelae, erection probs, man boobs. Our smugness at not having to go through the hell of ‘women’s problems’ is now making us look foolish as we now die at higher rates than women from the top 10 causes of death.

We also die six years earlier than women on average. In the current economic climate men are experiencing high levels of stress, longer working hours and for many a less secure home life. This will inevitably lead to increased anxiety, depression, hypertension and heart disease. They are all treatable, as are many cases of male cancers, but only if we catch them early enough. To do that men need to start taking an interest in their long-term health, recognise and respond to health warnings and seek help when they need it.

They need to get more in touch with their feminine side when it comes to their health and take as much pride in going for a check up at their GP’s as they do in their grooming and appearance.