“A quick smack never did me any harm.” So said my gran.
This week, the bottoms of Australia’s doctors got a collective smack. We had been asked nicely but we wouldn’t stop; we were threatened with the naughty corner, but still we carried on.
For years we’d been told we’re prescribing too many opiates, people are dying, be more careful. Did we listen?
If we did, we didn’t change what we were doing. In 2016-17 (the latest year for which figures are available), 15.42 million scripts for opiates were dispensed, a rise of 11% (on a per-capita basis) compared with 2012-13.
For many years Australia has had a prescription medication crisis. Between 2010 and 2016, 8421 people died due to prescription opioids. When you realise that in the same period 1721 people died from heroin overdose, it’s clear our prescription medications are doing a lot of harm.
Also in the same period 8769 people died on Australian roads. And just as with road deaths there are dozens — not counted — injured and traumatised, so it is with prescription medication misuse.
‘The drugs stole my soul’
Drug addiction, whether licit or illicit, is a full-time occupation for many sufferers; it dominates their lives. “The drugs stole my soul,” was how one recovered user put it to me.
So we got the smack we deserved. From Monday June 1, standard pack sizes for most opiate medications were reduced. If we want to prescribe larger quantities, or the stronger opiates, the hoops we have to jump through are higher and tighter. If we want the fortius, we now have to go altius — which will be tardius, not citius. Smack.
Doctors often blame patients, and it’s easy to see why. Once hooked, many become desperate and resort to subterfuge and, at times, threats. The drugs become like oxygen — without them, they can’t breathe. If your head is held under water you’ll scratch, claw and do anything to get free to take that breath. So it is with addiction.
But just as the longest journey starts with a single step, the road to prescription medication addiction starts with one script. One that a doctor has issued. Followed all too often by a second, and a third…
We write the scripts, and we have to accept responsibility for knowing when not to write them. So far we have failed.
Reducing access generally reduces use. Make cigarettes more expensive, fewer people smoke. When codeine went prescription-only last year, its use dropped by 50% — as did the rate of codeine overdoses.
Since we doctors were doing nothing to stop people’s access to opiates, it’s been done for us. I suspect this is one time my gran was right: this smack won’t do us any harm, and it could just do others a lot of good.
Meanwhile people like myself who’ve spent years being treated like junkies & malingerers because opiates have proven to be the only means of relieving our chronic pain, find ourselves facing a future of jumping through the hoops all over again, justifying ourselves to yet another parade of specialists who’ve already decided we’re addicts. I was left with horrific nerve pain after botched surgery (thanks, QLD Health!), and forced to go through the whole process of finding something that worked.
Pregabalin – psychosis & memory loss.
Gabapentin – passed out & woke up in my car with my head on the horn.
Tramadol – confusion, violent nausea, memory loss.
Tapentadol – brilliant for the neuropathic pain initially, although no effect whatsoever on any pain, but it stopped working completely after 4 weeks.
Then there was the foul Topiramate! “The only side effects are some weight gain & a little confusion!” I was assured by THREE pain clinics! I took ONE tablet, and was rescued several hours later by my housemate (who was, thankfully, an RN) screaming in terror & trying to hide under my lounge suite. After getting me to bed & calmed, at around 5am the terrors returned. It was more than a week before I was game to leave my house, and even then I couldn’t walk a straight line. My memory (which I was renowned for) was in tatters. I couldn’t recognise faces, but the scariest event was almost a month after that damned pill. I ventured out to get some groceries, got in my car, & couldn’t remember how to drive OR where I lived! It took a lovely old man who saw my distress & took the time to calm me down before it slowly came back to me. It was more than a year before I felt “normal”, but even now it’s left me with anomic aphasia, yet they’re STILL pushing this disgusting drug in Australia as some kind of miracle pain reliever. I was accused by the new head of my pain clinic (whom I’d never met, or even spoken to) of being a “high seeker”, and it’s only the fact that his own staff & my wonderful GP know my history that stopped me from dropping him on his arse when I read that. After all this, it turned out that SR morphine blocks my nerve pain. I don’t get a buzz, I don’t get relief from inflammatory or other pain, weirdly, but it’s been a literal lifesaver for me. I take issue with Greg Hunt & Co laying the blame for physical harm solely at the feet of codeine, while blithely glossing over the horror of paracetamol overdose & irreparable liver damage, and ignoring the harm of ibuprofen in excess doses. We have a problem with chronic pain, and it’s not as simple as “tEh OpIaTeS iZ bAd”. Before you blame people for seeking pain relief, climb down from that breezy, ivory tower & find out WHY they need relief in the first place. We don’t all share identical metabolisms.
Forgive the typos. The Tapentadol line should read “any other pain”. You get the idea.
There’s always the solution offered by that great philanthropist & humanitarian Lang Hancock – “Put a 44gallon drum of drugs on every street corner – the problem will be over in a week.”
Ah, yes. The great….thing….that wanted to dump Depo Provera into the water supply to sterilise those pesky aborigines who were standing in the way of him pillaging everything he wanted to pillage. How dare they think they’re people! Imagine how much better off we’d be right now if Death Duties had been in place to prevent Jabba Swinehart from owning the current government.
There is a f*cktonne of people living with chronic pain. People with acute and chronic pain mostly become poor. I’d like a quid for every smartarse “pain specialist” I’ve met who smugly plugged some doubtful, or already discredited, therapeutic regime not available on Medicare and who wagged their finger at folks who asked for the admittedly marginal relief of opioids. This current witch hunt directed at people with pain is a massive, hand-washing-victim-blaming exercise that will do nothing for people suffering pain but will deliver a massive boost to the bottom line of the black market suppliers.
1. Many, many people have life-destroying unbearable chronic pain.
2. Removing their access to medications which go some small way to enabling them to live will only cause more pain, and reduce their tiny margins of liveability.
3. Therapies that relieve the cause of the pain also relieve the need for the meds.
What therapies are YOU offering Nick Carr?
But where are the alternatives on offer? Exit strategies for taking away long term and effective treatments for victims of chronic pain and refractive pain syndromes?
Will this mean that these people will now have their pain properly investigated? CT & MRI scans? Neurologists? Other specialists? At what cost? At whose cost?
Yes I believe my pain has not been properly investigated, that I was farmed out to a pain specialist before any proper investigations were done. My pain is 15 years old. I was ignored for 10 years and have only been “treated” for the last 5.
I have tried to get tested. Scanned. Poked and prodded. Anything I could think of. Usually I was ignored though.
I would love not to need tramadol to function in society and keep working. But now after 3 years of 6 monthly scripts they are reduced to month by month with no guarantee they will ever be renewed.
Where to then? Illicit drugs Unemployment? Self harm? Alcohol abuse?
Tell me doctor, out of the paths that are in my control which should I take?