Huge rise in prescriptions for strongest painkillers
'When you're in pain, you just want something to stop it," says Robert, 53.
He used to be a sales manager but has not worked since 2003, when he developed persistent and mysterious abdominal pain. Eventually, a specialist prescribed slow release morphine tablets (MST). Robert joined the growing number of patients in Britain who receive heavy duty opioids for chronic conditions.
His daily dose climbed to a colossal 3,000mg enough to kill most people. Robert, who speaks softly with a West Country accent, is intelligent and level headed, even genial. But his personality deteriorated drastically with the morphine. "It makes you sluggish," he says. "It makes you more aggressive, more abrupt." He relied on Viagra to revive where to buy pandora charms cheap his flagging sex life, and if he forgot to take his midday dose of MST, horrendous withdrawal symptoms set in. "You've seen the junkies on the television shaking, sweating, agitated. Exactly the same."
Just 10 years ago, a million prescriptions for strong opioids were filled. Now that figure is more than four million. Increasingly, the bathroom cabinets of middle England are stocked with painkillers so powerful that one of them, OxyContin (timed release oxycodone), is known as "hillbilly heroin" in America.
Opioids, from codeine to diamorphine (heroin), all act on the central nervous system, banishing anxiety, inducing a blissful feeling of security and easing pain. That makes them a favourite in Hollywood, where some in the film and television industry like to "decompress" by swallowing a couple of little teal blue OxyContin tablets instead of a dry martini.
In Britain, some doctors are worried. They welcome the fact that chronic pain, long ignored, is at last being taken seriously. But they pandora charms for sale online fear that more generous prescribing is releasing ever greater quantities of addictive drugs into the population.
And the figures are startling. And research for this article has revealed that prescriptions for the strongest compounds morphine, oxycodone, fentanyl and buprenorphine rose from one million to 4.1 million.
This month the British Pain Society is publishing new recommendations on good practice in opioid prescribing. Compared with previous guidelines, the document, edited by Dr Stannard, strikes a cautious note, balancing benefits with burdens.
What explains the fourfold rise in prescriptions? Well, for one thing, drugs such as OxyContin are relatively new. Drug companies like to devise novel delivery systems for old drugs lollipops, lozenges, transdermal patches etc, so you would expect to see an upward trend as prescribers take up new products. Another possibility is that doctors are switching to opioids from non steroidal anti inflammatory drugs, which can cause gastric bleeding and other long term problems.
The most intriguing explanation, however, is that the increase in prescriptions for this group of drugs reflects a shift in the way doctors treat chronic pain. Only a fraction of the prescriptions are for terminal cancer. Most are given for chronic conditions such as back pain and osteoarthritis. This is not how it used to be. In the last century, chronic pain was undertreated and doctors were reluctant to use strong opioids except in the most desperate cases.
In the past 20 years, pain patients have lobbied for better treatment, and drug companies poured money into educating doctors about their new formulations. Research has shown that when opioids are used to relieve real discomfort they rarely cause addiction. Addiction where a person craves an ever higher dose and finds it impossible to give up is what happens when a healthy person takes a drug for its euphoric effect. The patient who is suffering from trauma or disease will become physically dependent but, generally, not addicted. It is a key distinction.
That is the theory, anyway. But what is pain? Is it simply what the sufferer says it is? If so, how do we explain the marked variation in people's experience of it?
"The presentation of persistent pain is not a single thing,'' says Dr Stannard. ''It's complex." Cultural, social, biological and psychological factors tend to be commingled. According to research by the World Health Organisation, the prevalence of persistent pain in women in Santiago, Chile, for example, is 40.8 per cent; for men in Verona, Italy, the figure is a mere 3.9 per cent.
Certainly, our generation is not as stoical as our grandparents were. Dr Stannard points to "the medicalisation of life" and says, "There are conditions that people used to live with, but they won't now."
Dr Des Spence is a GP in Glasgow who feels so strongly about the use of opioids that he contributed a forceful opinion piece on the subject to last month's British Medical Journal. He believes the increase in prescribing cannot reflect a real increase in pain; instead, he says, doctors "are engaged in the widespread over diagnosis of pain". He thinks that strong painkillers may not be what we, the patients, need even if they are what we want. Opioid treatment can impair social functioning and create a "pain disability".
He also refers anxiously to the misuse of prescription medicines in the US. To be fair, the American experience is unlikely to be replicated in Britain. Our medical culture, with a centralised health service, is different. British doctors are not subject to the market forces that render the American consumer all powerful. Since Harold Shipman, the NHS exhaustively monitors prescriptions. Doctor shopping obtaining multiple prescriptions from different doctors is much easier in the United States. Even so, the Department of Health is currently conducting a review of all "addictive medicines."
Dr Spence believes the middle classes are especially vulnerable to this class of prescription drugs. Dr Stannard agrees: "A lot of the people I see getting into a muddle are middle class because they are the people who are vocal about their health care [and therefore more demanding of effective treatment]." Patient power could be part of the trouble. "The element of the patient always being right and being seen as a customer has led us into problems," Dr Spence adds.
Talk to many pain specialists, on the other hand, and they cite patients who have rebuilt their lives after learning how to manage their pain with powerful drugs. "We're here to create a pain free window," says Dr Christopher Jenner, a consultant at Imperial College NHS Trust in London. "Then you pandora jewelry dealers can start to rehabilitate them. I do not know of any pain clinics that just say: 'Oh, here's your tablets. Next.' "
Patients tell of the drugs' miraculous effect on debilitating pain. Miriam, 39, suffers from sciatica, herniated discs and incontinence. She has been off work since 2006. She requested OxyContin after a friend recommended it. The pain clinic was reluctant but agreed a trial.
"It was wonderful at first," Miriam says. "It was literally like somebody turning on a switch. Oh, I've finally found something that bloody works. I thought it was the best thing ever." Now she is more ambivalent. She feels "snappy and irritable" and her GP is helping her to reduce her dose. "I am glad I went on the oxycodone. Obviously I've pandora rings jewelry sale got concerns. I think I have become a bit of an addict," she says.
Man has used opium for pain relief since Neolithic times. Opioids don't remove pain; they make it bearable. Victorians self medicated with tincture of opium (laudanum) purchased over the counter. Morphine named after Morpheus, the Greek god of sleep was first extracted from the opium poppy, Papaver somniferum, in the early 1800s. Sir William Osler, known as the father of modern medicine, considered it to be "God's own medicine".
And today, morphine remains the gold standard although it's no longer the most potent remedy and patients actually prefer drugs that aren't called "morphine". "[With morphine] you open up the Pandora's box of fear about opioids," says Dr Jenner. "But even though you say to people that oxycodone is a morphine like drug, it doesn't have that social stigma because it doesn't have that name."
As for Robert, he says he felt "locked in" to taking his pills, even though he insists that: "I never got a buzz or a high on any morphine whatsoever." In the end he came off the medication in hospital. "Now I take a milder painkiller," he says. "And I suffer.
My choice is morphine or pain. The pain is a sobering thing.".
Prev: beads for pandora bracelets
Next: buy pandora jewelry