Prescription Medication and Substance Addiction by Alex McGuigan

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Prescription medicine addiction is affecting an increasing number of Irish families, and like all addictions, no section or strata of society, is immune from it’s insidious grip. Whether it is the housewife, with a repeat prescription for Diazepam; the young Mother hooked on Codeine since it was first prescribed as a post-childbirth analgesic, or the affluent worker, relying on over the counter (OTC) painkillers, to pass the day, all are part of a nationwide trend. Surveys of drug trends repeatedly indicate that health-care professionals in Ireland, are currently facing a growing number of patients presenting with prescription medicine addiction problems.

The prevalence of technically legal and prescription drugs use in Ireland is reportedly rising at a similar rate to street narcotics use. To a certain extent, prescription drug abuse has been a constant here, but it has been only relatively recently that it has been recognised as a problem per se and given the serious attention it deserves. So-called ‘Legal Highs’ are now also extremely popular with young people, often as young as school age, who can just about afford to score these readily available substances, presumably with pocket money, using part-time job wages or in many cases in stealing money or items from the home.

In the past, especially during the period known as The Troubles, Doctors were often happy enough to prescribe Benzodiazepine based Anxiolytics and Hypnotics as well as Tricyclic Anti-Depressants for problems, whose root cause it was well beyond their ability to treat. This should also be viewed in context of the universal prescribing practices of the 1970’s, when ‘Benzos‘ were far from being the pharmaceutical pariahs that they are fast becoming today. We have all seen the old advertisements by Pharmaceutical giants Roche (the original developer and license holder of Diazepam whose brand name was Valium) as“Mother’s little helper” which declared that their product enabled one to ‘do the housework with a smile!’

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Nowadays, Benzos and Opioid Analgesics are on most Doctors’ de facto blacklist, but the same GP’s will usually hand out prescriptions for Selective Serotonin Re-uptake Inhibitors (SSRIs) quite freely. The likes of Prozac (Fluoxetine) or the slightly different Effexor XL which effect both Serotonin and Dopamine are regularly prescribed in Ireland.  There have been  worrying findings from research conducted in the USA, not to mention the dangers of Serotonin Toxidrome when other CNS-effecting medicines are being used. Further proof that we should never underestimate the power of the giant pharmaceutical industry in a physician’s prescribing practice.

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The Oxycontin Phenomena and Ireland

There have been the beginnings of a demonstrative street level demand in Ireland for the likes of Oxycontin (Oxycodone), which has the street-name, Hillbilly Heroin, in the USA. Several years ago there was a seizure of £75,000 of generic Oxycodone allegedly sourced from the Asian subcontinent. Oxycontin contains Oxycodone, in a sustained release form of the active substance and comes in 10 mg, 20 mg, 40 mg, 80 mg and even a 120 mg strength. Users crush or chew the tablets to negate the sustained release coating and will experience a ‘rush’ similar to IV use. Oxycontin users often crush tablets, then ‘cook up’ the pills for IV use, in a similar fashion to IV Heroin users. There has been an Oxycontin addiction explosion in the USA, where black-market dealers can charge roughly a dollar per milligramme, when selling the tablets.

However, until recently, there would have been a niche market in Ireland for these more potent Opioid Analgesics in pill form but they would be fairly widely available on the black-market at present.  Another symptom of the reluctance by GP’s to prescribe Diazepam and other Benzodiazepines due to NICE (National Institute for Clinical Excellence) and other guidelines, has been an escalating increase in the black market for that product.  Most originate in the Asian Sub-Continent and their quality ranges from fair to poor quality to downright dangerous concoctions!

The reality, especially in the North of Ireland’s largest urban areaBelfast, is that there is a thriving black-market for prescription medication. This is due largely to addiction and the fact that many GP’s are doing their uppermost to discontinue, or closely reduce, longstanding patient repeat prescriptions, for the likes of Benzo drugs such as Diazepam, Temazepam or mid-level Opioid analgesics like Dihydrocodeine.

Codeine, Dihydrocodeine and Benzodiazepines

Prescription-only 30/500 Co-Codamol (brands: Kapake, Tylex, Solpadeine etc) or the synthetic Opioid, Tramadol, are also changing hands at street level. In working-class areas of Belfast, the likes of Diazepam, Temazepam, DFF118’s (Dihydrocodeine instant release 30 mgs tablets) and even the non-Benzo sleeping tablets, Zopiclone (Zimovane) or Stilnoct are regularly changing hands at the going rate of £1.00 per tablet. There have been anecdotal reports that the potency of the various Tramadol generics varies widely, to the extent that placebos are often suspected, though this is highly unlikely. Users also orally crush the sustained/time release tablet form of Dihydrocodeine (which is usually prescribed as DHC Continus, in 60mgs, 90mgs and 120mgs dosages) for an instant release effect similar to the method used to negate the timed-release feature of Oxycontin. However, the timed-release version of Dihydrocodeine aka DHC, due to it’s pharmacological profile/make-up, would be highly unsuitable for ‘cooking-up’ for IV use, with abusers potentially facing instantly lethal consequences such as pulmonary edema.

Viagra

Viagra (Sildenafil) is reportedly retailing for £5 a tablet, from similar sources. Illegal dealers situated in the Far East and Eastern Europe have been shown to be the source for much of the counterfeit Viagra tablets, currently being sold by street level dealers, linked mostly but not exclusively to Loyalist paramilitary groups. Several deaths have been recorded due to the unregulated and therefore, often adulterated nature of their products.

 

Over The Counter Medicine (OTC)

Over the counter (OTC), non-prescription medicine is also a popular source for those seeking legal highs. Low dose Codeine preparations are popular with abusers, although with 500mgs of Paracetamol being a legal requirement to be included in these preparations, abusers run the risk of serious liver damage or even death, in exceeding the recommended dose. No doubt some customers strain the harmfully toxic Paracetamol via Cold Water Opioid Extraction from these low-dose Codeine products as means of harm reduction.

A local Dentist, who became hooked on the non-prescription painkiller, Paramol, which contains the legal OTC low dose of Dihydrocodeine (7.5 mgs), reported that he had been consuming 64 tablets per day! This would have amounted to a whopping 32 grams of Paracetamol to be passed through the liver! It has been argued that the high doses of Paracetamol, which according to government regulation must be included in OTC Codeine products, supposedly to prevent abuse, are clearly harming users.

Cough suppressants are also routinely abused. Pharmacies can sell non-prescription Codeine Linctus preparations, provided they are under a certain mg/ml ratio, although most pharmacies prefer not to carry it in OTC form, opting for the less potent Pholcodeine Linctus preparations. The brand Gees Linctus is also popular with Opiate users, due to it containing tiny amounts of Tincture of Opium,though only a few Pharmacies stock it nowadays. The various Anhydrous Morphine/Kaolin stomach upset medicines are often purchased by OTC abusers.

Other cough medicines that contain Dextromethorphan Hydrobromide (DXM) such as Covonia Bronchial Balsam, are popular with younger ‘tweakers’ because of DXMs psychoactive potential. Users report experiencing dissociative Hallucinogenic trips. Antihistamine based OTC Hypnotics such as, Nytol, Sominex and even Piriton, are popular with patients who cannot persuade their Doctors to prescribe more orthodox sleeping aids or sedatives, although some users often substitute them as a non-Benzodiazepine anxiolytic.

Legal Highs

The demand for so called Legal Highs are a steadily growing prooblem and widely available  in the North of Ireland, especially among young people. A booth in a local shopping centre was openly and quite legally, selling Herbal Ecstacy, Spice (a Cannabis substitute) and Kratom leaves, which are a mild, herbal Cannabis substitute. Also readily available are Herbal Speed and a plethora of so-called other Legal-highs, including various strains of hallucinogenic mushrooms. Many of these products were found to contain various forms of the substance Ephedrine, a stimulant that is popular with slimmers and bodybuilders, because of its energizing effects, combined with appetite retardant properties.

Recently some young people in North Belfast had come across an outlet selling near industrial amounts of the local anaesthetic, Lidocaine, which was being sold, semi-legally, as ‘Legal Cocaine!’Several shops in Belfast city centre alone carry these so-called ‘Legal-high’ products, many of them in shops popular with teenagers such as Emo/Indie music stores and clothes shops.

The once “Legal-High” substance, known as Mephedrone, is still extremely popular in Ireland and the UK, for it’s Cocaine like effects. Retailers of this product got round the legalities by selling it as bath salts, or even plant food, which were not overtly for human consumption. Some years back, a shopkeeper in Derry who sold so-called Legal-Highs was badly wounded in a gun attack by anti-drugs vigilantes linked to RAAD (Republicanism Action Against Drugs).  The reality remains that the ready availability of ‘legal highs’, stimulants, counterfeit Benzos, Opiates and other substances are a worrying constant in today’s society and with the growth of social media it is quite possible to have a drug of choice delivered straight to one’s door.  The impact on families and family members having problems with these substances has been devastating.  Many have had to deal with the tragedy of suicide by the user and the ‘ripple effect’ that the permanent solution to a temporary problem invariably causes.

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It is worth noting that those who are prescribed Anti-Depressants by their GP’s and who then then go on to take depressants, such as alcohol, Benzos or other ‘downers’ completely negate any therapeutic effects from the prescribed Anti-Depressants.  Class A drugs that were dealt at pain of death during the height of the Troubles, now appear to be readily available in working class areas of the north of Ireland.  This problem is compounded by the severe lack of both Detox and Addiction Treatment Centres in the six counties

The other variable to be taken into consideration, with frequently abused medicines, is that they all have genuine medical uses and in the supposedly enlightened 21st Century, no-one should be in pain or mental distress on the basis that they, just might, be getting an illicit buzz off their meds. Furthermore, the levels of prescription medication abuse in Ireland are still dwarfed, by the high levels of Alcohol abuse, which still remains the ever present ‘elephant’ in many Irish living rooms. It is worth noting that ‘prohibition’ as a concept and measure to prevent abuse of any ‘drug’, whether it was alcohol in the USA in the early 20th century or narcotics in contemporary times have been an abject failure. Increasingly, regulation and harm-reduction are appearing most successful options in, what is after all, an imperfect world.  Regulation in some European countries, with a view to reduction/abstention have proven successful, not least that they have have negated the role of criminals.

Two organisations that have had considerable success in treating addiction using the ‘disease model’ have been highly successful, these are Narcotics Anonymous and Alcoholics Anonymous.  The contact details for Narcotics Anonymous and Alcoholics Anonymous are contained in the highlighted links, perhaps they may help someone.  There are also links further up the page that may be helpful. Unfortunately, as we all know the addict must be willing to accept help and this can be heartbreakingly frustrating, especially where a family member is concerned.  However, as a precognizant measure, it can do no harm to let someone affected by addiction know that help is there for them when or if they choose to seek help.

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Alex McGuigan

 

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