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.

9 comments on “Breaking news – GPs to carry tasers

  1. handmadebyfi says:

    Very good post, I’ve witnessed a particular service user go into a practice with what amounted to a benzo shopping list, throw a tantrum which Naomi Campbell would have been proud of, and without much conversation or review of medication she strolled out straight out with exactly what she wanted and proceeded to woof the lot with numerous bottles of lambrini and subsequently keeled over, and before you ask DWTW, no it wasn’t me πŸ˜‰

  2. jamie. says:

    Well so much said there and so much to comment on ,where to start? Well I find myself with an opportunity to rant a bit within the framework you set out…having some experienec in the field with subs and yp my first point to assert is that ………….
    Over the past decade and probably since the snake oil salesmen I have seen the supposed caring madical proffession, especially where mental health/ emotional well being is concerned make a packet out of pathologising yp, and when they done this and been highly paid to sentence a yp via diagnosis they step away because all the treatment and intervention they have are talking adult model one to one things – how many kids relate to stuff as individuals ,their identity is with groups,peers and through bbm etc and their application in the most part is practical not academic or literal. So often highly qualified,highly paid specialists present a polaroid picture via assesment and think that a solution is defining the problem…FAR FROM IT!! A solution should be to treat the yp not the label or diagnosis – an adolescent is hardly formed in most cases to pathologise .in my experience kids have a number of challenges they need help to understand and over come -(being a parent I know I’m one of these)… Quite rightly facing challenges of maturity whilst dancing on the moving carpet of adolesence may mean yp present as depressed or anxious ,I don’t believe labelling and prescribing ritalin is anything but a deflection from the issue and realistically suits the adult rather than the yp…interestingly most specialist yp mental health staff appear not to work after 5 pm,not at weekends and certainly not on the street corner where the dirt exists…it all appears a self fulfilling money racket to which yp are the victims.
    The second bit is around gp’s again yes there are good ones, mine though has left me asking the question ‘how does he get paid, what are his targets and what does my national ins contribution actually buy me’. I feel totally powerless in this situation, I get whisked in and processed like the more folk he sees the more cash he makes ..obviously he fits me in between botox clients etc but the ‘in place of fear ideal ‘ anuerin bevan.. has long gone ,the nhs is being rung dry by people who have no principles relating to its concept existing and aspire to the same ideals as te new money wannabe millionaaires on the same street.. I have long been a socialist and never thought I would say – the nhs is dead -unfortunately there are too many well paid specialists and gps who are highly qualified in all but an understanding and principle of the welfare state . I hope they enjoy good health ,wealth and a private number plate in all their cheapness..I do know there are good gps out there that understand the wealth of the position they have and recognise the last decade plus of managerialsm has taken its toll and made folk more target driven .we seem to now have people succeeding in a proffession where to care and take time is a weekness cameron you’ve succeded ,I want my NI contributions back, where’s that bupa application form..I want to go and see THE SAME DOCTOR but get a decent service and maybe some arse implants at the cost of the retired ex miner getting treated for knackered lungs! Pah sorry for the rant I can’t even spell emphicema !!!!

  3. Josophine says:

    After wasting my 20’s addicted to codine and other migraine relieving drugs and then my 30’s coming off them and healing the damage done by them …. with such horrific advice from docs and encouragement to pop pills, and never warning of side efects or recognising them, instead prescribing more pills…i could not aggree more with u on
    this post.I only started to get healthy when I said good bye to doctors. Personally I wouldn’t trust a gp as far as I could throw one….
    There is so much evidence now that proves there is,a connection between the gut and
    brain….. Toxic gut =toxic brain=psychiatric problems… most gp’s have no belief in this fact. neither do psychiatrists, both never look into a patients digestive health.. However both are happy to prescribe pills that are swallowed and disolved in the gut, understanding they will take effect on patients psychology! Crazy fools.

  4. Many thanks to you all for your comments, I’m so glad you enjoyed the post and it’s great to hear your opinions on the matter.

    Handmadebyfi and Jamie, it’s clear you both work in the field, and it sounds as if you have had similar experiences to me. I think we share the same frustrations with the system, which is wide open to manipulation by people whose drug habits depend on their survival techniques, no matter how ruthless.

    Josophine, thank you for your honesty, and for sharing your story. I suppose that, for me, your comment is especially poignant as it is not the story of a stereotypical ‘drug user’ but instead of someone GIVEN health problems by their doctor. You also point out that what doctors are doing is masking symptoms without looking at the impact on the individual holistically – I know this is especially true of mental health medication, which can have horrendous and sometimes life-threatening side-effects, and generally when no alternative interventions have been tried first.

    I think that we all agree that the current system in place to address health needs is reactive and does not look at a person but instead a set of symptoms, and prescribing can be tailored to addressing these in the short-term without any real consideration for the person as a whole long-term.

    So, what should be done about it?

  5. I love this blog entry. It’s so realistic and right! I have to say, one of my biggest challenges and heart sinks of some days are the routine ‘medication review’ appointments of patients who have been bunged on sedatives in the past (often >10-20 years earlier) who I now have the unrewarding task of trying to wean from their nightly benzo or ‘Z-drug’ that they “absolutely can’t live without”. Not that they’ve ever tried! And not that they ever will. It’s like talking to a lump of stone. I have to admit, I usually have to give up because after a 20 minute discussion (?argument) about it, I’m then running 10mins late in surgery, and have made no progress!
    My biggest brag is that I cannot remember the last time I prescribed a new prescription for sleep medication. I just say “no, you’re not having it, it’s dangerous, addictive, affects your memory and physical health”. “Get some lavender oil, have a cocoa and a hot bath and try Yoga Nidra!” It works for me! πŸ™‚

  6. Just realised that could sound a bit callous! I don’t ‘literally’ say that and chuck them out the room! It’s usually a 20 minute chat about why I’m not happy to prescribe meds for their sleep problem, and a long exploration of why they have a sleep problem and how we can change it. And after that 20min discussion, I’m running a further 10mins late! You’re starting to see what my surgeries are like! Might help some people to understand that the GPs who are always running late are not the bad GOs but the good ones! I’m spending more time than I’m allocated to do my job! My regulars know that they’ll get as long as they need, and are prepared to wait for that time. Still stresses me out though! It takes longer than 10minutes to do my job right!

    • The fact that you don’t dish out talents to get people out of your room is evidence of the integrity of your practice. It is much easier, quicker, and ultimately cheaper than working with someone to look at modifications they could make to their lifestyle to improve their sleep pattern – especially when they have come to the appointment with the fixated intent to leave with some sedatives and you only have ten minutes! My clinics also run horribly late all the time – but again I do my best give people the time they need and explore issues instead of bulldozing through them (or letting others bulldoze through me). My own GP is always at least 45 mins late for my appointments, but, as you say, I don’t feel frustrated because once I get into the room I receive a wiling ear and the best possible treatment he can offer.

      Going back to the benzodiazepine / zopiclone issue, I can honestly say that of the many occasions when a client has refused to leave the room (and voices get raised, people knock on the door, and eventually the Police get called – not an irregular occurrence), I cannot think of a single time when it hasn’t been for benzos. Actually, once, for pregablin (beware of that – they are all whacking it down in prison and then seeking it on release as it amplifies the effects of heroin), but otherwise, it’s always for benzos. As a GP, do you find a disproportionate amount of aggression related to seeking these drugs?

      But yes, without a doubt, benzodiazepine addicts are the worst to work with in the drug field (most aggressive, most manipulative, most unpredictable), and it’s not surprising this is also the case in general practice. Thank god there are doctors out there like you that advocate healthy methods!

      • Thanks for your encouragement that I’m trying to do the right thing! Thank goodness I’ve never had to get the police in to get one my 80+ year old grannies off their temazepem though πŸ˜‰ Making me smile just to think about it – the headline – “Cop and Doc battered by cold-turkey Granny”!! I’m lucky to work ‘in the sticks’ where these problems are fewer. I can’t remember the last time I actually had aggression used towards me in drug-seeking, although I have been manipulated and conned a few times in the past. New patients who move in from out of area are the biggest problem. In fact, I’ve got a challenge coming my way tomorrow morning, I think. Wish me luck……

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