19 April 2016

Addictive prescription drug use in Canberra

| Steven Bailey
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Every day, general practitioners in Canberra are confronted with patients asking, often pleading, for drugs of addiction.

The two most sought-after drugs of addiction are those belonging to the opioid family and those belonging to the group of medications called benzodiazepines. Both drugs have a high potential for abuse and are highly addictive, and abrupt cessation of either drug can be catastrophic for the user.

Opioids are generally used for pain, and the most commonly prescribed opioid in Australia is oxycodone. Endone is the short-acting form of the drug which is used for acute pain, and Oxycontin is the longer-acting form used for chronic pain and cancer pain.

Benzodiazepines can be used for numerous medical conditions but are most commonly used for the short-term treatment of insomnia and anxiety. There are many different types of benzodiazepines, with a plethora of brand names: diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax or Kalma). Recently, alprazolam became a restricted schedule 8 substance as it has been associated with many drug-related deaths and crimes where the perpetrator claims that they have no memory of the incident.

It is difficult to ascertain exactly how many deaths are caused by prescription drugs in Australia as tragic deaths are often caused by a combination of contributing factors. But according to the Australian Bureau of Statistics, drug overdose deaths totalled 1,427 in 2012, which outnumbers road deaths by 89 in the same year. And according to Australian National University researcher David McDonald, 70 per cent of Australian opioid deaths can be attributed to legal medications – the other 30 per cent being attributed to heroin.

Prescription drug abuse is a medical problem just as much as it is a political one. In many cases opioids and benzodiazepines are very effective medications but medical practitioners are often reluctant to prescribe them in the fear that their patients may be ‘doctor shopping’ in order to feed their habit.

For instance, Canberra’s Phillip Medical Centre displays a sign on the front counter informing patients that the practice will not prescribe any drugs of addiction.

This type of attitude can result in negative health outcomes.

Canberra’s Cincotta Discount Chemist in Phillip has expressed concern to RiotACT regarding such a blanket policy after being confronted by a young patient’s mother whose son had recently been in a car accident. The child presented to a doctor with pernicious vomiting (uncontrolled vomiting). The doctor prescribed a medication to stop the vomiting but it was the pharmacist’s opinion that the child was suffering from shock and should have been prescribed a short course of Valium to control the vomiting and calm the child. After explaining this to the mother, she later returned with a prescription for Valium from another doctor.

Many ACT medical professionals have been calling out for a real-time database that can be accessed by prescribers and dispensers in order to ascertain whether a patient has been ‘doctor shopping’ or not.

It is an unfortunate reality for many Canberrans that they may not be prescribed the appropriate medications because of the legitimate apprehensions of a medical practitioner.

The central political concern is that the privacy of a patient must be considered if a real-time database was to ever be established in the ACT. It is also a political concern that if a prescriber denies a patient a certain medication, the patient may seek a more dangerous medication illegally.

As a politician who is deeply concerned with this issue, it is my view that the actions of a minority should not tarnish the majority from receiving the good health care that we all deserve.

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wildturkeycanoe8:54 am 03 Apr 15

lynehamovaluser said :

In an aside in response to Narcobear and HenryBaits:- whilst Opiates are not the ‘best’ or only option they are a part of the arsenal. What works for some does not work for all. I don’t recommend Oxycodone to anyone, but I do explain to people how I started taking it, why, the risk of addiction, the inevitability of dependence and how FOR ME I have a better quality of life when taking this drug.

Well said. I agree that “alternative therapies” and “sucking it up” may be fine for a majority or perhaps a minority, but there are some who inevitably end up needing the last resort. I’ve been to a “pain psychologist” and after two appointments and a one hour video presentation they conceded that there was nothing they could do to help me. Over the counter drugs might as well have been candies. There are certain types of pain that respond to mind over matter and then there are those that even the strongest prescription drugs do not fix, but do give some relief.
For the advocates of making blanket bans on opiates and other addictive drugs I say this “Don’t knock it till you try it.”, meaning that until you’ve experienced a debilitating illness that completely changes your life you have no idea what you are asking of the community.

lynehamovaluser8:32 pm 02 Apr 15

As a long term user who has spent time educating myself I understand the difference between addiction and dependence. I know the value of non medical treatments and avail myself of those that work for me and that I can afford. These factors vary depending on the nature and primary placement of the pain and my available funds.
To advocate a blanket response is useless. There are those who abuse drugs, those who drugs damage physically and others who suffer psychologically.
GP’s are often under educated, under resourced, over monitored, lied to, cried at, screamed at and expected to have magic wand fixes.

Perhaps a voluntary system for patients who don’t want to run into those awful moments when they have miscalculated and a long weekend or doctor’s holiday has caused a gap in continuity of medication. That database wouldn’t offend because it’s voluntary. AND IF it meant that a person with legitimate need for a legitimate prescription was treated less like a criminal (it happens) then this could only be a step in the right direction.

In an aside in response to Narcobear and HenryBaits:- whilst Opiates are not the ‘best’ or only option they are a part of the arsenal. What works for some does not work for all. I don’t recommend Oxycodone to anyone, but I do explain to people how I started taking it, why, the risk of addiction, the inevitability of dependence and how FOR ME I have a better quality of life when taking this drug.

Doctors love to prescribe these drugs because they alleviate symptoms and guarantee return customers. They are a poor choice for most people.

Benzo’s are a throwback to the 60’s – no good for treating anxiety (except in extreme and acute situations) and only indicated in a limited way for muscular spasm and insomnia. Alcohol withdrawal however, does respond to benzodiazepines.

Opioids are a mistake for any chronic pain syndrome (HenryBaits gives a perfect example of how poor prescription control leads to dependance within a short period) A factoid for you… >80% of the world’s legal opioids are consumed in only a handful of countries (including Australia, USA and UK) – pain management and palliative care in most of the world (take Indonesia for example) is more a case of ‘suck it up princesses’.

Our medical culture dictates that pain should be medicated away, its what doctors are taught. And after decades of this treatment, Australians have come to love their drugs – prescription or otherwise. Its culturally engrained, from alcohol to zolpidem we will use or abuse anything we can get our hands on. We have been thorough sold on the message from the medical world, pharmaceutical companies and the alcohol industry that antidepressants/antipsychotics/alcohol and the like are good for us – perhaps even necessary – while the blacklisted substances are the harbingers of death and desolation. Its only a fine line that separates a legal use of a substance from illicit abuse – and as history has shown, times change and worldwide medical opinion has shifted on many of these substances.

The only way to address the problem is with open discussion and real world education that addresses the benefits and drawbacks, but also recognises the human desire to be somewhere other than here/feel something more than the mundane prison of reality we find ourselves in.

Harm minimisation and respect for personal liberty should guide us in this debate, not outdated moral proscriptions. When politicians and law makers gain the nous to appreciate this we will see progress. Otherwise its onwards with the war on drugs, which just like the war on Iraq/Afghanistan has proven to be aimless and impuissant.

wildturkeycanoe8:25 pm 31 Mar 15

HenryBaits said :

I started taking oxycontin after I had a back injury. I started at 10mg and then ended up on 80 mg a day. But when I tried to get off of it, it was hell. My Pharmacist told me that what I was going through was worse than someone coming off heroin. My back pain was worse than ever. I could not eat, had stomach cramps, diarrhoea, could not sleep and was extremely anxious and really depressed. It went on for over a 2 weeks. It was the most awful experience of my life. They’re really dangerous drugs. Dont take them. Try and find another way but just don’t take them ever.

On what medical basis are you making this recommendation? Just because you had a bad reaction, does not mean everybody else will also have one. It sounds to me like you tried going cold turkey, which is just as dangerous an idea as taking an overdose.
Not taking them at all is not an option for a lot of people. Those with chronic illnesses who cannot find any drug to combat the disabling pain apart from opioids would give anything to have the comfort and relief provided by such prescription medications. Under medical guidance, they can be very effective and give a person some quality of life. I myself have taken them recently and also gave them up after some months due to unwanted side effects and the fact I’d built up a tolerance to them. Rather than upping the dose, I went back to nothing, slowly and cautiously so as not to get withdrawals. Recently the pain has come back to the point I have resumed taking them, but I am being cautious not to let the pain determine how much I need. There are versions of the drug that also cannot be abused as easily, with added ingredients to make them useless for injecting or smoking, etc.
I have gone through the hurdles involved with “shopping around”, as I wasn’t aware that you can’t just see any doctor for a refill. It makes it difficult when the walk in clinics don’t have the same doctor available every day and you can’t make an appointment. Now it means getting in days before the stash runs out and waiting for over two and a half hours once every fortnight just to get a prescription, due to the fact you can’t get repeats or more than two week’s worth in one go. Frustrating when just sitting in the waiting room involves unbearable pain and going for a stretch means losing the seat you had.
I understand and agree with the laws involved with prescribing addictive drugs, but I don’t agree with the policy of these clinics not making them available. In a way, they are actually forcing the patient to go and shop around for someone who will prescribe it, meaning they also have to go through their whole medical history all over again and get all the medical records transferred. It isn’t easy I’d imagine, if they are suffering some form of severe pain.

I started taking oxycontin after I had a back injury. I started at 10mg and then ended up on 80 mg a day. But when I tried to get off of it, it was hell. My Pharmacist told me that what I was going through was worse than someone coming off heroin. My back pain was worse than ever. I could not eat, had stomach cramps, diarrhoea, could not sleep and was extremely anxious and really depressed. It went on for over a 2 weeks. It was the most awful experience of my life. They’re really dangerous drugs. Dont take them. Try and find another way but just don’t take them ever.

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