Most of the people Dr Alun George treats at Bradford’s Unity Centre are seeking recovery-based treatment for class A drug use – but he also sees people who are dependent on prescription drugs.
Dr George is Clinical Lead at Unity, part of Bradford drug treatment charity Bridge. Unity provides recovery-based treatment for drug users committed to reducing their substitute medication.
He says prescription drug dependency has risen in recent years, largely because the internet has increased accessibility. The internet also passes knowledge around – people familiar with drugs know how to mix substances, and share information.
When it comes to obtaining medication from a GP, which the patient intends to sell or pass on, they lie about symptoms or a condition. “They’ll say they need more pain relief, or something for anxiety or to help them sleep. Addicts are manipulative, they know how to lie to up their medication,” said Karen, a former prescription drug addict, in recovery at Bridge, who spoke to the Telegraph & Argus.
As a prison doctor, Dr George has seen newsletters sharing information on how to “fool” a GP into prescribing medications. He says that while GPs can spot signs of this, when it comes to prescribing medicine they are under pressure from increased demands on time.
“They have a difficult job, they’re under pressure to reach a mutual agreement with their patient. This is particularly hard with a patient with a substance misuse,” he said. “If you have a dependency you have an irrational drive that transcends everything else. Whatever is prescribed is seen as a potential high. People with a history of substance misuse are incredibly resourceful. And often patients are being coerced by manipulative partners into getting them medication.
“GPs don’t have time to step back and make the assessments we make. At Unity, if we can sense something is wrong we step back and ask ‘why?’ GPs have 10 minutes. When it comes to repeat prescriptions, some people slip under the radar.
“There is concern among GPs about the abuse of prescription drugs, and we talk to them about drugs like pregabalin and say ‘these are the risks’. Pregabalin, which we’re very concerned about, is being pushed as a drug for anxiety and nerve pain. We haven't seen a shift away from this yet, but we're collecting reports on deaths associated with its use, and we’re hoping the warnings will soon be louder.
“While we talk to GPs about prescription drug problems some react immediately, some are slower. And drug companies constantly try to get us to prescribe their drug.
“Younger GPs tend to be more on the ball because their training covers substance misuse.”
Dr George says prescription drugs are generally taken as an enhancement to Class A and B drugs, rather than a substitute. Among the most commonly used, and dangerous, are diazepam, which users can quickly become dependent on; tramadol, which raises serotonin levels, benzodiazepine, known as ‘benzos’, used for treating conditions such as anxiety, insomnia, agitation and seizures, and highly addictive, and over-the-counter antihistamines such as Nytol and Piriton.
“Some tricyclic anti-depressant drugs are also being sold on the streets, and anti-sickness drugs,” said Dr George. “A lot of patients with drug problems take anti-depressants as they think these will help their mood. They won’t – only stopping drugs will help their mood. The anti-depressant just adds to their chances of getting serotonin syndrome (overheating) if they take other unknown drugs – and that can kill.”
He adds: “Alcohol often goes hand-in-hand with drugs. Usually when alcohol is added to the mix, it results in death.”
Dr George said prescription drugs taken illegally are often not prescribed in this country. “They’re prescribed in other countries which can have looser controls on things such as etizolam, similar to alprazolam. We don’t prescribe it in the UK but we come across it a lot in packages from clients who have bought it from dealers or ordered on the net,” he says. “Also, dealers will often cut heroin with prescription drugs, so people don't know they’re taking it.
“While we do what we can to counteract these things – and all we can do is educate the public and other health professionals – it’s very difficult to control these drugs. If people want them. They’re easy to get hold of.”
While some medication is obtained illegally, for £2 or £3 on the streets, some can be bought over the counter at chemists. Some painkillers and sleep aids can become addictive.
“It’s a pseudo-addiction,” said Dr George. “When you stop taking codeine the pain comes back, so you continue taking it. When it starts to take priority over other areas of life, such as family or work, it becomes a dependency problem.”
Those in recovery at Unity are given prescriptions as part of a withdrawal process to reduce and eventually cease taking medication. Some service users take medication such as methadone at chemists, under supervision, but are not allowed to take it if intoxicated.
Although it’s taken under supervision, some addicts manage to get their medication out onto the streets. “We know of people regurgitating methadone for others, or holding pills in the mouth and passing them on before they dissolve,” said Dr George. “People will find ways of cheating the system.”
Some users are prescribed a week’s worth of medication, to take daily at home. The doctor makes a judgement taking into account circumstances such as where they live, whether there are children living there, and where medication is kept at home.
“If they’re sleeping rough it’s not safe to take a week’s dose. We also look at mental health issues and suicide risk,” said Dr George. “We carry out random tests and can tell by behaviour if someone is “topping up” with other medication. When it comes to taking medication home, we tell them if it’s taken all at once they won’t get anymore, and they could die. There’s trust involved, but most people do take it properly.”
He adds: “There’s no reason why someone ends up a drug addict. It’s more prevalent in deprived areas, and it can run in families, but it’s non discriminatory. I see people from all races, sexualities, jobs, walks of life, intellects. Triggers, good and bad, can set off drug use.
“We say to people ‘it’s not your fault, but you’re in treatment now and it is your responsibility’.”
Treatment emphasis is on support
At the Unity Recovery Centre Dr George’s role as a prescriber is “fairly minimal”, something he makes clear to service users.
When reducing medication, people may experience anxiety, pain issues or mental health problems, tackled with psycho-social intervention. Unity offers groups and activities designed to help people achieve and maintain a drug-free lifestyle. Specialist support helps them acquire skills to reduce medication and deal with underlying issues, and there is an emphasis on recovery programmes such as support groups led by former addicts.
“Recovery services have changed shift over recent years. Heroin use is very much on the decrease, and contributing to this is the recovery-oriented approach to treatment. We want to spread this approach to all drugs,” said Dr George. “People who use drugs become very isolated, and there’s a ritual with drug-taking that is hard to break away from. We encourage mutual aid – there is good evidence that it works.
“At Unity we sometimes see people specifically for prescription drug dependence, and we take the same approach – changing their way of thinking and how they use the drugs. The focus needs to be treatment in a non-judgemental way. When people come to us, we won’t judge them on what they’re taking or where they got it from. It’s what they want to do next.
“The focus is also on harm reduction; letting people know the risks they are taking and letting them know there is good help, non-judgmental help out there.”
He adds: “When it works well here it's because of the team work. Everyone involved in a patient’s care all talk to each other with the patient's best interests at heart.
“There is good support in Bradford, including residential help and Narcotics Anonymous groups around the district.”
- For more about the Bridge project call (01274) 723863 or visit bridge-bradford.org.uk