Your Painkillers Could Kill You
Prescription drug addiction is a growing problem worldwide and the fastest-growing drug problem in the USA. South Africa is not immune, with almost 1 in 5 adults suffering from chronic pain and up to 7% of rehab admissions being for addiction to prescription drugs.
Painkillers, sleeping tablets, tranquilisers – doctors prescribe them and pharmacists dispense them every day, but many suffering from pain, insomnia or anxiety are at risk from a “hidden pandemic” of addiction to prescription and over-the-counter (OTC) drugs.
In Drug Awareness Week, 20-26 June, pain management expert and South African Society of Psychiatrists (SASOP) member, Dr. Shaquir Salduker highlighted that addiction and substance abuse problems are not only linked to illicit drugs such as heroin and cocaine, but also to prescription and over-the-counter drugs trusted and seen as “harmless” by patients.
These include opiate-based pain medications containing oxycodone, fentanyl, morphine, or codeine, and many codeine-based OTC cough mixtures and cold and flu medications; benzodiazepines and “Z-drugs” used for anxiety and insomnia; and stimulants such as methylphenidate which should be reserved for the treatment of attention deficit-hyperactivity disorder (ADHD).
Opioid and benzodiazepine “highs”, feelings of euphoria, relaxation, tranquillity, and pleasure, and the similar effects of stimulants along with high energy levels, can be highly addictive, and just as addictive as “street drugs”, from prescription to addiction your painkiller could kill you. This is the most addictive substance known to humankind.
Just because these drugs are prescribed by physicians or stocked in pharmacies does not make the risk of addiction any less, nor are they any less likely than illicit drugs to cause long-term permanent damage to the individual’s brain function, overall mental and physical health, and ability to be a productive member of society.
Widely available over-the-counter for pain, coughs, colds, and flu, codeine is the most commonly abused opiate in South Africa and is just as addictive as low-dose morphine, he said. Codeine when swallowed metabolises into morphine, and morphine is a close chemical relative of both opium and heroin. When an individual consumes large amounts of codeine, they are effectively consuming large amounts of morphine, with the same effect as consuming heroin.
Overuse of prescription drugs can have similar long-term effects to “hard” drugs on brain function, moods, concentration, and thinking abilities, as well as impacting on mental and physical health, with potential long-term organ damage and the risk of premature death by overdose.
Addiction to prescription medications – when an individual consumes the drug for non-medical reasons to the point of physical and psychological dependence – affects the ability to function at work, socially and in relationships, is frequently misdiagnosed as a mental illness, and may need admission to hospital or a substance abuse treatment facility.
Tolerance develops with continued use, leading the individual to take increasingly higher doses in order to achieve the same effect, and only realise they may be addicted when they try to stop taking the drug and find themselves unable to function and experiencing withdrawal symptoms.
It is not unusual for patients to be self-medicating with OTC or low-schedule codeine-containing drugs such as combination painkillers or cough mixtures, and to have developed an incredible level of tolerance. They could be taking between 20 and 100 tablets a day and still be able to function without being noticed.
While some may not be aware that their self-medication has reached the level of addiction, others border on the illegal by badgering doctors to issue prescriptions with no diagnosis, persuading pharmacists to dispense without a prescription, go “doctor-shopping and pharmacy-hopping”, or even steal doctors’ prescription pads and forge the doctor’s signature.
Warning signs of addiction
A key indicator of dependency and possible addiction is needing to take more of the drug to achieve the same effects, taking the medication for uses other than why they were prescribed, and intense cravings when stopping the medication or being unable to obtain more. Behaviour such as watching the clock to see when the next dose can be taken, being worried about whether one has enough supply, and being defensive or secretive about taking the medication, are also critical warning signs.
South Africa is one of few countries in the world where codeine-containing medications are available over-the-counter, with a “triple jeopardy” of being easily available, widely used and tolerance being quickly developed, leading to a high demand for more doses to achieve the same effect.
For those suspecting they may be addicted to prescription medications, he advised seeking help and support. Medically-assisted detox and withdrawal might be needed; supported by counselling and psychotherapy to help manage withdrawal symptoms, understand the roots of a person’s vulnerability to addiction, and help them get their lives back on track with improved life skills to manage pain and stress.