'You may have to suffer a bit': a new solution for prescription drug abuse – taking painkillers away from the poor ...'
The way we take pills has changed (Photo: PA)
Imagine a British politician saying: we're so worried by the abuse of prescription drugs that we're going to reduce the supply of powerful painkillers to our hospitals. And if people in genuine pain suffer as a result, too bad.
The protests from the #WELoveTheNHS lobby would be deafening. The politician who said it would be out of office by the end of the week.
But that's exactly what Michael Bloomberg, Mayor of New York, has just announced. Here's the quote: "… supposing it is really true [that public hospitals run out of painkillers for the poor], so you didn't get enough painkillers and you did have to suffer a little bit. The other side of the coin is people are dying and there's nothing perfect."
As the Daily Mail reports: "Under the new city policy, most public hospital patients will no longer be able to get more than three days' worth of narcotic painkillers like Vicodin and Percocet. Long-acting painkillers, including OxyContin, which is often used to ease chronic backache and arthritis, as well as Fentanyl patches and methadone, will not be dispensed at all."
Bloomberg knows exactly how and why America has a prescription drug epidemic. As he explained on his radio show: "If you break a leg, you're going to be in pain, nothing wrong with getting something that reduces the pain. But if you get 20 days worth of pills and you only need them three days, there's 17 days sitting there. Invariably some of the kids are going to find them, or you're going to take them and get you addicted."
Exactly. You get to like the drugs too much, or they're stolen by kids who know how nice they are. Which takes us to the heart of the problem.
Many prescription drugs are almost as fun to take "recreationally" as illegal narcotics. They may stop short of providing you with a full-scale cocaine high or the warm and woozy euphoria of heroin – but they come damn close. As I explain in my book The Fix – published in paperback this week – opiate-based painkillers such as Oxycontin are so closely related to morphine and heroin that many junkies are happy to use them as a substitute. The effect is weaker, but if the drugs are legit then you have the great advantage of knowing what you're taking, in what dose. Likewise, attention-deficit drugs such as Ritalin and Adderall, prescribed in their millions to children and adults diagnosed with ADD, give you an amphetamine-like high. Hardly surprising, because that's what they are: slow-release speed.
Tranquillisers can be pretty moreish, too. I should know: as I confess in The Fix, I became far too fond of the damn things when I was in the last phase of my heavy drinking. I made the happy discovery (or so it seemed at the time) that zopiclone, Britain's most widely prescribed sleeping pill/tranquilliser ensures a smooth comedown from a jittery, knife-edge hangover.
These days, zopiclone and related drugs serve a slightly different purpose. Here's an extract from The Fix, based on my conversation with this newspaper's brilliant medical columnist, Dr Max Pemberton:
Dr Pemberton’s work as a psychiatrist in the Accident and Emergency department of a London hospital involves asking young patients about their drug and alcohol history. “As soon as they know I’m not going to rat on them, most of them admit to doing something – coke, MDMA, mephedrone, ketamine – in the previous few days,” he says.Another way of looking at the situation is to say that pills have subtly changed their status in society: just as hard liquor lost its medicinal label in (roughly) the 16th century and became a took for relaxation, so tablet, though still overwhelmingly associated with medicine, are viewed as mood-fixers.
“What the older generation doesn’t understand is that combining drugs and alcohol is normal for young clubbers. They might do a bit of coke before they go out, or ‘pre-loading’ with a few drinks, then go to a bar and get drunk, do a line of coke in the loos and stop drinking. If they go on to a club they’ll drop a pill – or maybe pure MDMA, because no one trusts Ecstasy these days. They don’t know what’s in it. The last thing they want to do then is drink and many of the clubs won’t even serve alcohol anyway. Then they go back to someone’s house and want to come down, so they use Zopiclone, Zolpidem or Valium.”
Is this typical behaviour for young people? “Well, let’s say the ones who aren’t risk averse. They know they’re doing something a bit naughty. But now that anyone can buy pills off the internet, the sense of danger is gone. And a lot of these drugs are really, really cheap when they first appear. If it costs literally pennies to get off your face, why spend forty quid or more doing it on booze?
“I used to see long lines of kids queuing outside Fabric [a London nightclub geared towards party-hard middle-class trendies] in the early hours of the morning. It was freezing and they were only wearing T-shirts and I thought: if the police lined them up for a drugs test every single one of them would test positive. But, as I say, that sort of behaviour is normal now. It’s part of taking control of your own psychopharmacology. It’s about wanting everything. And it’s not going away.”
And, crucially, the distinction between relieving your pain or tension and lifting your mood is beginning to disappear in the public mind.
The British government is worried. As my colleague Alice Phillipson reports:
Doctors have been told they should only issue prescriptions of sleeping pills and tranquillisers in exceptional circumstances after they acknowledged the drugs can be highly addictive.I've highlighted the word "subjected to regular reviews", because it suggests that the Departments of Health's legitimate fear of growing addiction to tranquillisers and painkillers, to say nothing of the cost to the taxpayer of prescribing them, could eventually lead us to the dilemma outlined by Mayor Bloomberg.
In a statement led by health professionals including the Royal College of General Practitioners (RCGP), doctors were warned to limit prescriptions of benzodiazepines such as Valium and were told a course of treatment on the drugs should be subject to regular reviews.
Patients coming off the medication are at risk of prolonged withdrawal symptoms, experts said, as they called for greater support for those who discontinue medication.
Almost 18 million prescriptions are written every year for benzodiazepines and for a group of tranquillisers known as z-drugs, which are thought to have similar effects over a number of years.
The debate in New York focuses on "the poor", because those are the people who use public hospitals, whereas the NHS treats a much broader demographic.
Even so, a serious crackdown on what you might call feelgood prescription drugs will disproportionately hit Britain's low-income earners. Why? There's no diplomatic way of saying this. On sink housing estates, "pills" are scoffed as readily as smarties not just by youths who can't afford a more concentrated high from a dealer, but also – in many cases – by their parents.
It's easy to condemn "shirkers" who live off incapacity benefits thanks to a non-existent or long-healed back ailment. But – and I have personal experience of this from my years in addiction – it's difficult to do anything but "shirk" if your dealer, otherwise known as your GP, hastily refills your prescription without asking too many questions. A patient who spends 45 seconds in the consulting room and leaves with a smile on their face – perfect!
Psychotropic and analgesic drugs, be they Valium or Nurofen Plus (amazingly, sold over the counter in the UK, to the delight of visiting American junkies) are as insidiously addictive as sugar, another drug-like substance whose addictive properties I discuss in the Fix. Any attempt to cut off their supply to the people who like or need them most will cause far, far more trouble than the Government anticipates. "You may have to suffer a bit." Can you think of a Westminster politician from any party who has the nerve to produce that soundbite?
Me neither.
Click here to buy the new paperback edition of Damian Thompson's The Fix.
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