Addictive prescription drugs: understand the risks
Get the facts on opiate and benzodiazepine misuse, and how to seek help.
It starts innocuously enough. You have your wisdom teeth out and are given an opioid like oxycodone for pain relief. You complain of insomnia and your doctor prescribes you Xanax, Valium or another benzodiazepine. You feel the onset of a migraine and head to the pharmacy for codeine. For most of us it's just a way to manage pain in the short term. But for some people, it's a pathway to addiction, or worse.
Nearly four Australians die every day by misusing prescription and over-the-counter drugs, according to the Penington Institute's Australia’s Annual Overdose Report 2016. The report states 71% of drug-related deaths are from legal drugs compared to 29% from illicit drugs. Some of these come from simple dosage errors: a weekly pill taken daily with lethal effect. But most are connected to a pattern of prescription drug overuse and addiction.
In most cases, the first step is a perfectly valid prescription for real pain. Then the pain lingers and another doctor writes another script. And when you stop taking the pills, the pain returns and you suffer withdrawal symptoms – like nausea, cramping and agitation – so you seek out another script.
The main culprits here are oxycodone and benzodiazepines, and the main victims are middle aged and older Australians. The UN's 2014 World Drug Report listed Australia as second only to the US in prescription drug addiction, with 3-4% of the population affected.
How does prescription misuse start?
The problem is twofold: we trust our GPs when they say a drug will help, so we take what's prescribed without asking about side effects, and prescriptions are often offered when alternative treatments exist.
“It’s easier to give a prescription than address the condition,” says Dr Richard Kidd, GP and chair of AMA Queensland’s Council of General Practice. “There’s a lack of awareness about how addictive medicines are and a lot of prescriptions could be prevented by seeking alternative treatments. If you have a patient with chronic back pain, for example, a better long-term solution is to seek non-pharmaceutical solutions like Pilates rather than prescribing painkillers.”
While chronic pain sufferers need help to manage ongoing conditions, strong medications are also prescribed for comparatively minor procedures, like dental surgery. Australia is also one of the few Western countries where codeine (an opiate) is still available over the counter, though this will end in February 2018. Accessing strong drugs that can lead to addiction, or even overdose in the short term, is alarmingly easy.
It doesn't help that emergency departments usually don't have access to a patient's prescription history, and even though GPs have anti-prescription shopping programs in place, they can be too time-poor to use them.
A prescription for education
Bee Mohamed, CEO of ScriptWise, says raising awareness is just half the battle – providing avenues for treatment and education is the other. ScriptWise is a non-profit organisation dedicated to reducing prescription medication misuse and overdose fatalities in Australia.
The stigma of being a drug addict prevents medication dependents from seeking the right kind of help, she explains. “People who do end up dependent, when they seek information, tend to go to the drug and alcohol space, and they're not comfortable in that space. Ultimately, to address this issue we have to address the stigma of addiction because it doesn't matter what type of drug it is.”
ScriptWise is careful not to blame the issue on prescribers or patients, instead encouraging patients or family members to tell their stories at community forums – particularly in rural and regional areas where prescription opioid deaths have increased by 140% – and conferences for primary healthcare professionals. “It puts a human side to the issue, a mother telling how her son got addicted to opioids and it can happen to anyone,” says Mohamed.
As for broader solutions, Tasmania has implemented real-time monitoring of prescriptions, with other states committed to follow suit, says Dr Kidd. “We have a lot of the really important parts in place in terms of the GP software but the states still need to tweak legislation to make it work.”
Mohamed is in favour. “If we had a system where the doctors are able to know what medications the patient is on and how long they've been on them for, I think GPs would be in a better position to make a more informed decision when they prescribe.”
Public awareness and education will still be key, however. Mohamed says consent will be an important step. “What we’re trying to lobby for in the next two years is to ensure that GPs get informed consent from the patient before they prescribe opioids and benzodiazepines to make sure the patient is aware of the risks."
This consent will mean you're given more information, so you're equipped to decide whether you want to take a drug that carries a significant risk of addiction or overdose.
Mohamed would also like to see the extent of the problem recognised at a higher level. She says a lot of federal government money has been put into combating ice, but in many communities, ice isn't even on the radar. “While they get a lot of funding for addressing illicit drugs, the reality is they need funding for education around prescription drugs, as this is a bigger issue.”
Find out more
If you're worried about prescription drug use, the first stop is usually your GP, but this can be an awkward conversation if they’ve prescribed your medication. Lifeline has a good online resource to check if you think you or someone you know may have a problem, and their Service Finder will help you find a counsellor or other addiction support service in your area. There are multiple successful strategies that work to break addictions, from simply tapering off under supervision to behavioural therapies.
Meanwhile, the Penington Institute has produced an app for iOS and an online resource to help people recognise the signs of overdose and understand what to do. And ScriptWise is working hard with rural and regional communities to get the word out about the risks of prescription drugs and help us all become better informed.