Archive for February, 2013

Breaking news – GPs to carry tasers

Thursday, February 14th, 2013

The official bodies representing GPs and psychiatrists have released a joint statement raising concerns about addiction to prescription drugs. I don’t really know who they are raising the issue with as it’s them who are prescribing the bloody things – it’s a bit like punching a child then telling it off for having a bruise.

Bodies representing pharmacists, social workers and drug workers have also jumped on board. The difference is – they mean it. While the GPs and psychiatrists spend 5 minutes every 3-6 months with these patients, it is the pharmacists who have to double-check dates and signatures on prescriptions every week to make sure they are dispensing legally and are not operating outside the law because they have been duped by some pitiful neurotic; it is the social worker who will be trying to monitor parenting skills through a legal, medical haze; it is the drug worker who faces abuse when the patient uses their medication illogically and unmathematically and comes begging for an early script. And the housing workers. And the Jobcentre staff. And Probation. And counselling services. And Women’s Aid. Basically any service that attempts to address the route cause of the ailment instead of smothering it with something sedative.

In exactly the same way that heroin dependence ruins people’s lives, addiction to prescribed medication can be, in many cases, as debilitating. And whilst it is more sociably acceptable, amongst the middle classes at least addiction is still embarrassing, and the lies resorted to in hiding it can be crippling and destructive.

In terms of the physical dependence, benzodiazepines (such as Valium, temazepam and nitrazepam, generally prescribed for anxiety, muscle spasms and insomnia) in particular are horrendous. Along with alcohol, they are one of the few groups of substances that can lead to death from withdrawal. They are so addictive that in heavy abusers, tolerance can eventually overtake capacity – meaning that the amount of the drug you need to stop your body going into withdrawal can be higher than the amount needed to induce overdose. That’s a pretty fine line to walk.

The withdrawals also create a desperation that supersedes even opiate addiction. Whereas a heroin user that has ‘dropped’ (read ‘sold’) his methadone dose will start to panic when he realises he is soon to start squitting out of both ends as the dreaded withdrawals set in, benzodiazepine users will go that extra mile in an attempt to procure what they need. We’re talking threats to kill, smashing stuff up, full-on tantrums and shameless sobbing. Now any but the most integrous GP will swat a script at that to get it out of their consulting room.

There are a fair few people now in drug treatment that have become opiate-dependent due to prescribed painkillers too. Generally prescribed in the first place for toothache or back pain, these clients are chilling reminders that this could happen to anyone. These people never thought they would end up in a drug clinic being treated in exactly the same way as a heroin user.

And the problem with both benzodiazepines and opiates is – they are amazing emotional blockers and make you feel great. Emotional pain – gone. Traumatic memories – vanished. Feelings of guilt – disappeared. And stopping taking them results in sky-high adrenaline production, so that these buried feelings are not only exposed, but anxieties around them go through the roof. So if you couple that with quickly-built tolerance, and the fact that these are being given to you, nay insisted on, by a revered specialist – and are free – it would take a strong person to resist. And the people going to their GP in pain or with depression or anxiety do not meet this criteria.

And while I’m levelling my criticisms at GPs, I want to uncategorically state that psychiatrists are a hundred times worse. In my experience, it is extremely rare to find a psychiatrist that doesn’t just dish out sedating meds. This is despite an ever-increasing evidence base for psychological therapies and social interventions to improve people’s quality of life. You only need to visit to psychiatric ward to see the scrap heap that people with enduring mental health problems get thrown on. There is no inkling that these people might get better, or any real effort made to increase their level of function – they are dosed up and kept quiet until they say little enough to be discharged. Then they are expected to be able to cope in the outside world, on reduced medication (as high levels are only safe to dispense in a controlled environment), and within a matter of time they are back in hospital and whacked up again. No wonder people become institutionalised. To anyone who likes to think that One Flew Over The Cuckoo’s nest is a thing of the past, I challenge you to visit a psychiatric ward and tell me how treatment has improved over the last fifty years.

And in my usual cynical manner, I can’t help but think – you’ve been dishing out tablets for years because it is the cheapest way to keep ‘problem patients’ quiet, so what’s changed? This has got to be laying the groundwork for some political announcement about austerity and impending cuts to prescription budgets, because many GPs and psychiatrists didn’t give a shit about the highly-strung benzo-dependent housewives and the antipsychotic-shuffling oddballs before, and I struggle to see why suddenly they would do now. I reckon it’s another one of those Tories’ ‘we’re doing it for your own good’ measures. Like benefit cuts. And paying bankers’ bonuses. And Care In The Community.

One thing’s for sure – it won’t be the whiskey-drinking doctors or the pill-popping politicians that have their doses reduced and their scripts stopped. And, to be honest, unless GPs start wearing stab vests as standard, I doubt anybody else’s will be either.

Postscript – catslondonmarathon you are a wonderful GP and human being and I do not refer to you or your practice here. There are many more like you – but we both know you are in a minority.

Also, here’s a link to (wait for it) The Daily Mail *gasp* – a scare-mongering set of photos relating to crystal meth, clearly an advert for private rehab programmes, but freakishly interesting all the same. Make you count your blessings it never really took off over here. We’ve got enough on our paste with Cocodamol and Mogadon.

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Frank – it’s Cockney rhyming slang

Thursday, February 7th, 2013

It’s ten whole years since the Government launched their new weapon against the war on drugs – Frank. I’m guessing the name was intended to be a pun bulging with bathos.

At the time the campaign went public, there was a real need for something practical and useful for young people. Drug use was at an all-time high, and ecstacy had become cheaper than alcohol. Schools didn’t have a clue how to deal with drug use, with responses ranging from ignoring it to calling the Police, parents knew they were out of their depth, and the links for young people between vulnerability and drug use grew fiercely stronger.

The problem with Frank was – it was absolutely shit. Fancy branding and expensive adverts could not hide the fact that on the end of the phone was not Frank, knowledgable big brother with his hand on your shoulder and a quirky sense of humour, but instead Bernard, a middle-aged divorcee with charisma issues who works in a call centre and hasn’t yet quite mastered the software providing him with his stilted answers. It was like having a conversation about sex with a nun on an iPhone. I could have got better drugs advice off my grandma. Thinking about it, Frank could easily have been the most common name amongst its employees.

Ten years on, there are claims that this service is somehow linked to the reduction in drug use nationally. Then there is the opposition that the service has not stopped anyone taking drugs. These positions both seem to miss the central purpose of the service, as I understand it – Frank was never intended to stop people taking drugs. It was developed during the heyday of harm reduction, and was created to provide information so people made more informed decisions about their drug use.

These misconceptions are either accidental and come from the assumption that ‘drugs are bad, kids’, or are purposefully missing the point to support whichever political argument you might favour. However they may also be symptomatic of what Drink and Drug News have called ‘stigma created by an abstinence-focused recovery wave’. Which side-lines drug users. Which means people don’t get the information or support they need. Which leads to health and social problems. Which is why the harm reduction movement started. (Can anyone else see a pattern emerging..?)

I have to agree with the critics – that this is an attempt by the Government to plug a hole that should be filled by comprehensive drugs education in schools (possibly why it has escaped budget cuts so far). But as long as the drug stats are falling, despite this not being the raison d’ĂȘtre for the service, the politicians can sit back and say they are ‘addressing’ the drugs problem.

However, considering that they had nearly four million contacts with young people last year, Frank certainly seem to be doing something right.

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