Crisis of the prescription drug addicts
Acceptable drugs aimed at easing modern stress have spawned a new breed of 'respectable' addicts.
A hidden cohort of "respectable" drug addicts has emerged in Ireland in recent years, with growing numbers of men and women seeking treatment for addictions to over-the-counter and prescription drugs designed to treat the stresses of modern life.
Experts say that ordinary people with no history of illegal drug use are becoming addicted to sedatives, tranquillisers and over-the-counter codeine-containing painkillers.
Benzodiazepine - a class of drugs commonly prescribed for insomnia and anxiety - was cited as the main "problem" drug for 719 people who sought treatment in 2013, compared with 547 in 2012 and just 75 in 2005.
Addiction to codeine - an opiate commonly found in over-the-counter painkillers - is also a growing problem.
Dr Colin O'Gara, a psychiatrist and head of St John of God's addiction services, said one-quarter of its clients are addicted to either prescription medicines or codeine-containing tablets.
"There is no one stereotype, no one social demographic. They are young, middle-aged and elderly. The vast majority are not people who use illegal drugs but are people seeking relief from pressures and anxiety," he said.
"Typically we are talking about people who have jobs, who have very stressful lives and they have never touched an illegal drug in their lives....It starts with stress, being unable to sleep, feeling bad all day long, a feeling of general anxiety." Codeine addiction appears to be prevalent amongst women.
"The pressure on women is huge. The pressure on everyone is huge, but the pressure on women, doing jobs, looking after children, suffering headaches, stress, anxiety....and they take these tablets as a relief," he said.
The experience of one busy mother of four children who regularly suffered from stress and headaches cited by Dr O'Gara is typical of the cases he treats.
The woman initially took a codeine-containing over-the-counter pain relief tablet to cope with her headaches but found she had to take increasing doses of the drug to maintain the effect.
At the time the woman presented she had been taking 24 tablets first thing in the morning, another 24 in the afternoon and the final 24 at 8pm in the evening.
"Her husband had noticed her slurring on the phone during the day and that this had become progressively worse," according to Dr O'Gara, who added that the woman has now recovered from addiction after treatment at St John of Gods. "These are text book cases. The job changes or the age changes but the experience is the same," he said.
"The thing is, for a lot of people it is not seen as a serious drug addiction. No one sets out to be an addict, certainly not anyone who innocently takes a prescribed drug or over-the-counter medicine."
James McShane, who represents the addiction support group LifeRing, refers to the addicts' perception that the ingestion of large quantities of these sedatives is "acceptable".
"It is a hidden addiction. You do not know they are addicted, not unless you are looking for it," he said.
"The tell-tale signs are "slurring", the "blankness and the numbness, the person is not exhibiting any feeling, and suppressing feeling is often why they are on medication in the first place".
Ordinary people taking tablets every day can get hooked within six months. "It becomes habit, you become reliant on it and the tablets can create a nice buzz."
The LifeRing group holds meetings in communities and in hospitals with detox programmes, such as John of God's. Of the 20 recovering clients that typically turn up at their meetings, most will have issues with alcohol but in recent years, he says, there are always six or seven who will have problems with prescription drugs of one type or another.
Getting off addictive prescription and over-the-counter drugs is not easy. Codeine is like heroin, according to Dr O'Gara.
At the addiction treatment centre in St John of God's, clients are offered a managed withdrawal, with the help of supervised sedatives, others go cold turkey. Those who can't are put on methadone, the heroin substitute which is only available through the public health service.
Many people will be inpatients. "We are looking at people who are unable to detox in the community because they have continued access to these drugs," said Dr O'Gara.
Codeine-containing tablets are readily available over the counter, prescription medicines such as those for insomnia or anxiety are harder to obtain - once the prescription has run out.
Addiction knows no boundaries. Celebrity cook Jeanne Rankin has spoken movingly about her battle with prescription drugs, which began when she suffered a devastating back injury in a fall from a horse and was prescribed morphine to cope with post- operative pain. She successfully tackled her addiction after undergoing rehabilitation at the Priory Clinic in London some years ago.
Actress Drew Barrymore became addicted to illegal and prescription drugs while still a teenager and actress and singer Brittany Murphy died as a result of an accidental overdose of over-the-counter medicines. The Los Angeles County coroner stated, in 2010, that the primary cause of Ms Murphy's death was pneumonia, with secondary factors of iron-deficiency anaemia and multiple drug intoxication.
According to Dr O'Gara, serious abusers go "doctor shopping" - visiting a succession of different GPs and presenting as a fresh user of the medicine each time.
The internet is also a big source for controlled drugs. Sedatives are among the popular drugs ordered on-line, along with drugs for weight-loss, erectile dysfunction and anabolic steroids used by body builders.
Last year, Irish customs officers made 122 seizures of 89,320 "Benzo" class drugs worth around €195,970, smuggled into the country via the postal or courier system.
The online drugs trade is so huge that Interpol organises an international crackdown, with agencies in several countries coordinating raids and seizures over a week.
Raids in Ireland in 2014 yielded 104,000 units of sedatives, in a joint operation with Customs, the Health Product Regulatory Authority (HPRA) and An Garda Siochana. Ten people are being prosecuted in the District Courts.
The HPRA said: "We are aware that these products continue to be offered for sale by many illegal online sources. Much of the online sales is now conducted through social media as well as on the web. This is an area of ongoing focus for the HPRA. We strongly advise people to never use the internet or social media to source prescription medicines."
The question remains as to how widespread is the problem of what James McShane calls the hidden addiction to "acceptable" drugs by people who wouldn't otherwise have a drug problem.
The National Documentation Centre on Drugs, part of the Health Research Board, produced a fact sheet on tranquillisers and sedatives last summer. It cited the last national drug use survey, conducted in 2011.
That found that 14pc of the population had used sedatives and tranquillisers at least once. Also interesting was that women were more likely to report taking them than men. The biggest users were those between the ages of 35 to 64, and most first started taking sedatives at the age of 30.
But the numbers of people reporting for treatment for sedatives, and the numbers in whose deaths sedatives are implicated are increasing, according to the figures.
New figures released by the National Drug-Related Deaths Index (NDRDI) a database of cases of death by drug and alcohol poisoning last month show that "benzos" were implicated in 160 deaths in 2013, compared with 123 in 2012.
The figures also suggest that people use sedatives with other drugs - known as poly drug use. Of the 719 people in 2013 who cited "benzos" as the main problem drug, 76pc of them used other drugs too, according to the National Documentation Centre on Drug Use. In a paper, the Health Research Board described the "problem use of prescription drugs" as "a chronic, recurring health condition that requires repeated episodes of treatment over time".
As for codeine, the sale of codeine-containing products was restricted in 2010 but it can be sold over the counter under the supervision of a pharmacist; but is prohibited for use in children under 12 and it's not recommended for teenagers.
"Codeine-containing products tend to be the top-selling products in pharmacies," according to Dr O'Gara. "It has been said it should go completely on prescription. It would certainly help."
But it would also help to have accurate information on the extent of the problem.
More about LifeRing's meetings can be found on its website, www.dublinlifering.com