Louis Theroux’s ‘Dark States – Heroin Town’ documentary offered an insight into how prescription drug addiction can swiftly spiral out of control, with an alarming number residents from Huntington, West Virginia, eventually turning to heroin.
While the UK might seem far removed from this, the reality is that prescription drug addiction is becoming an increasing issue this side of the pond. UK Addiction and Treatment Centres (UKAT) tells HuffPost UK that in the past two years alone it has witnessed a 17% increase in admissions of people reliant on over-the-counter painkillers and benzodiazepines (prescribed to treat anxiety attacks).
Figures from NHS Digital released earlier this year found prescriptions for opioid painkillers, such as codeine, had doubled from 12 million to 24 million in the past decade. The findings prompted leading doctors to air concerns that the addictive drugs were being handed out too readily.
Revealing the gravity of the situation, UKAT says it’s not unusual for addicts to take a staggering 100 co-codamol tablets a day – that’s 50 grams of paracetamol, of which the safe daily amount is 4 grams.
At current rates, UKAT estimates treatment for prescription drug addiction will soon overtake admissions for alcohol and ‘harder’ drugs.
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The dangers of prescription drug addiction
Prescription drug abuse is very dangerous for the body, particularly the liver which has to constantly overwork to break down whichever drug is being abused. It can also cause problems for the digestive system and kidneys.
Bowel problems and constipation are common, particularly with addiction to opioids. In severe cases, this can cause blockage and need surgical intervention, explains Dr Paul McLaren, leading addiction psychiatrist at Priory’s new Wellbeing Centre in Harley Street and medical director of the Priory’s Hospital in Kent.
Sleep apnoea, sexual dysfunction, infertility and fractures caused by falling as a result of dizziness and sedation are also issues related to this type of addiction.
Ultimately, the biggest concern is that if a person slowly becomes immune to the levels of prescription drugs they take each day, there is a high risk of fatal overdose.
How do people become addicted?
According to UKAT, the prescription medications that are often abused in the UK include opioid painkillers, sleeping pills, weight loss pills, anti-depressants, anti-anxiety meds and ADHD medication.
Dr McLaren says the types which people are most commonly addicted to are sedatives or sleeping tablets, and opioid painkillers.
These drugs create dependence in roughly the same way: by causing long-lasting changes to the brain’s ‘reward system’.
“The common factor is that they produce an alteration in your mental state shortly after you take one, that is usually a positive feeling or the relief of distress,” Dr McLaren tells HuffPost UK.
“There are many pathways to addiction with prescription drugs. For some people, they will have been prescribed the drugs appropriately but then their use switches from managing pain, in the case of opioids, to managing other distressing emotions.
“Repeated use can lead to tolerance, needing to use more to get the same effect, and then withdrawal symptoms – feeling ill because you don’t have the drug.”
There’s a very real worry that people who have become addicted to these drugs will seek out ‘black market’ alternatives like heroin if their GP cuts their prescription short.
What’s perhaps even more concerning is that drugs such as heroin are being mixed with other substances, like fentanyl (a synthetic opioid that’s 50 times stronger than heroin), which are very deadly. The substance has been linked to 60 deaths in Britain this year alone.
Signs of addiction
It is important for friends and relatives to be vigilant about recognising potential symptoms in a loved one they are concerned about, as it can be difficult for professionals to recognise when prescription drugs are being abused, Dr McLaren explains.
“This is not clear cut,” he says. “There is often not a clear demarcation between appropriate long term use and addiction.”
According to UKAT, if a person runs out of painkillers, they might display erratic behaviour or their mood might change dramatically. They may also sweat profusely and struggle to sleep.
A change in a person’s emotional state, “with a flattening of emotions and withdrawal from interests or activities which were previously important to them”, is also a sign to be vigilant of.
Other symptoms include: frequent visits to the GP, a tendency to shop online for prescription drugs, regular complaints about medical conditions that justify drug use, a gradual change in school or work performance, disinterest in personal appearance and becoming defensive when talking about prescription medications.
Speaking specifically about abuse of benzodiazepines, which are prescribed for anxiety and panic attacks, UKAT’s spokesperson advises to look out for symptoms including: confusion, drowsiness, weakness, slurred speech, lack of coordination, psychomotor impairment (an increase in falling over and having accidents) and dizziness.
Another symptom to be mindful of is that when someone is hooked on prescription medication and can’t maintain their addiction, they will go into withdrawal, experiencing similar effects to someone withdrawing from a substance like heroin.
How to get help
Seeking help, or encouraging a loved one to seek help, can be extremely difficult – but it can be done.
“The key step [to recovery] is recognition that you have lost control of the drug use and that it has come to control you,” Dr McLaren explains. “Help is at hand, and the two main stages in treatment are getting clean from the drug and then staying off it.
“If the patient is still suffering from pain then an important part of the treatment is to agree an alternative plan for managing the pain without opioids.”
The first stage of treatment, known as detox, is where a patient gradually takes fewer drugs over an agreed timeframe, or they might be given a substitute drug which they will then take in smaller amounts and gradually withdraw from.
UKAT explains that with benzodiazepines specifically, there’s a high risk of seizure during detoxification so this stage should always be undertaken in a medical environment. The detox stage can last for 28 days.
With painkiller addiction, on the other hand, detoxification can take anywhere between 14 and 32 days.
It’s important to remember that the length of time to detox and the method of treatment will depend on the amount of drugs a person is taking, as well as their physical state.
The second stage of treatment involves attending relapse prevention programmes, such as Narcotics Anonymous.
“Managing the second stage can be more difficult,” explains Dr McLaren. “People addicted to opioids can struggle to see themselves as ‘addicts’ and may not want to be associated with people who have been addicted to drugs such as heroin, although the challenges they face are very similar.
“If a person has an underlying mental illness, or personality dysfunction, then that should be treated once they have detoxed and stabilised, to reduce the risk of relapse.”
Treating prescription drug addiction can be likened to treating heroin addiction, however Dr McLaren explains that it has more to do with the person than the substance.
“The physical withdrawal is very similar and managed in similar ways,” he says.
“A key factor predicting treatment outcome is how motivated they are to address the problem.”
If you’re worried about a loved one, Action on Addiction advises that you should give them “honest, straightforward feedback in a caring way”. It’s also important to offer that person help, or tell them how to get help, and provide ongoing support. The support group adds that it’s important for loved ones of people with drug addiction to recognise that they cannot make someone change.
The future of prescription drug addiction
Eytan Alexander, founder of UKAT, believes that until people’s mindset about prescription and over-the-counter drugs changes, the number of those struggling with this form of addiction will continue to rise.
“People believe that if they’re prescribed a drug or if they can buy it in their local corner shop, then they’re not an addict,” he tells HuffPost UK.
“We still admit people into our treatment centres who remain completely unaware that they have an addiction problem to codeine or benzo drugs, because they get them from their doctor, making it completely legal.
“The fact of the matter is that in most cases, the recommended dosage and length of time of consumption is exceeded, meaning that person is now a drug abuser, regardless of the ‘legality’ of the drug in question.”
He says a lot of addicts are forced to continue taking prescription drugs to avoid the “horrific side effects of going cold turkey”. Then, when these people ask for more prescriptions, they aren’t challenged or asked more about the problem by doctors “as their pain is subjective”, he adds.
“That ‘addict’ now continues to fly underneath the radar,” he explains. “It’s a hugely vicious cycle, but one that we can break with better education, advice and support.”
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