Hidden dangers of opiates

The Flock

During the pandemic, there’s been a 40 per cent spike of prescription opiate use. But at what cost?

There was a frightening moment this summer when I realised I was more than just dependent on prescribed opiates. I was in the garden enjoying the sunshine, and the usual pain in my hip and abdomen was throbbing.

Instead of wanting relief from the pain, I longed for the warm, tingly feeling my codeine brought when it hit my blood stream and the desire for a high terrified me.

That night, I began a long, lonely and loathsome journey to taper myself off the high-dose codeine tablets I had on repeat prescription for my chronic pain.

Even though I’d kept to my prescribed dose, my dependency was tipping into addiction.

As I began stretching out the hours between doses, I suffered withdrawal. Effects vary, but for me it included diarrhoea, fatigue, nausea, insomnia, anxiety and ‘feelings of doom’ - a psychological term for feeling like something horrific is about to happen, or you’re about to die.

Over 20 years, I’ve been prescribed opiates on repeat to manage the pain of my severe endometriosis (I’ve had six operations and lost an ovary) multiple times. A hip injury during pregnancy led to two ops, steroid injections and prolonged physical therapy, all adding to my daily pain.

There is no cure for endometriosis, and my hip, whilst better, remains inflamed and sore. Both ] limit my energy, mobility, bring me pain and impact my mental health.

Despite that, I’ve worked through gritted teeth and sometimes, tears and despair. I have also parented my precious daughter who turned five last week. Without the codeine prescriptions my doctors were right to give me in their management of my incurable pain, I would have long ago given up work and drowned in self-pity and sorrow.

When there is no cure for your pain, or if you’re one of the 5.6 million people in the U.K. currently awaiting a delayed surgery due to the pandemic, what choice do doctors have but to prescribe medications including opiates in an attempt to ease or manage your pain? It would be inhumane not to, but also a double-edged sword.

The pandemic has brought the UK a 40 per cent spike in opiate prescriptions. I’m one of those people who, previous to the pandemic, has been coping either without opiates, or with far less.

But as the lockdowns and months of restrictions wore on, and my support network of physiotherapists, chiropractors, childcare, friends and family were stripped away, I called on my doctor.

The GP gave me anti-inflammatories, and referred me for counselling. There was a six-month waiting list, but I joined it. The meds didn’t work, and over a matter of months, my codeine was doubled from 15mg to 30mg, and went from once a day, to three.

This is a typical pattern for patients on opiates where higher amounts are needed in order to provide the same pain relief. This partly why opiates can be dangerous - that reduction in efficacy over time.

It’s why opiates can be a ‘gateway drug.’ When strong prescription meds like morphine no longer work, desperate people sometimes turn to illegal drugs like heroin - a very potent opiate.

Not everyone becomes addicted to prescription meds, or moves on to illegal substances, but the risk is real and documented. Every year, the number dying from opiates is trending upwards, according to the Office of National Statistics.

This summer, NICE issued new guidance to the NHS in the prescribing of opiates to patients with chronic primary pain that essentially says: don’t prescribe them, NSAIDs or offer manual therapy, and instead give antidepressants and advise therapy.

I don’t personally agree, because most of us are anxious or low because of pain, but I can understand the need for change. Many patients do become dependent on their opiate prescription and their cells get used to functioning on them. Others become addicted and crave the high.

What many don’t realise is how hard it is to get off opiates. You can’t just stop, and experts warn against going ‘cold turkey.’ Even a controlled and tapered withdrawal – where you gradually and slowly reduce the medicine – brings a host of physical and mental symptoms that are incredibly hard to tolerate and occur not for a day or two, but months.

I am now on the tail end of my latest withdrawal, which I’ve managed alone. It’s been a hideous few months, physically. I’ve also felt my mood dip despite therapy, and there are days where I cannot get out of bed. Of course, the physical pain of my conditions remain, too.

I can’t afford private rehab, and in my experience, GPs simply don’t know how to help patients like me. They don’t really know what to suggest and in the past, I’ve encountered many who didn’t even accept that withdrawal was happening or was a big deal.

I’m glad to see the latest NICE guidelines for managing chronic pain state GPs need to be mindful of withdrawal occurring and help patients taper off, because I’ve lived with the consequences many times of GPs not knowing enough.

The first four times I went through withdrawal, I didn’t realise that’s what was happening. It was only from Googling my symptoms and finding forums with opiate addicts in full withdrawal that it dawned on me. It was alarming and soul-destroying.

I was a young, successful journalist, holding down life, a job, a home, a relationship. I’d never taken any illegal substances, and had dumped friends overnight who did. And, there I was in full-blown drug withdrawal. How could it have happened to me I wondered, feeling an abundance of shame. I kept it a secret from everyone.

I found out it takes just 72 hours to become dependent or addicted to opiates. In 2013, I’d been on them for MONTHS with no warning from the GP. That has now thankfully changed with clear warnings on every packet of opiates, digital screens in GP surgeries and posters.

But even in the last six months, my GP has had nothing of note to offer me in managing my withdrawal except telling me taper off. Previously, I was told to do it over the course of two weeks. Looking back now, I see how ridiculous and unhelpful that advice was. It’s taken me the best part of six months to do it this time, slowly increasing the minutes and hours between doses over a course of many weeks.

Each step down has brought me the renewed ferocity of withdrawal.

Everything I’ve learned about how to come off my medication and survive, I’ve learned by talking to other professionals in withdrawal, in exchanges with press contacts at addiction clinics, and GP friends who are actually switched on.

One told me to manage the symptoms, rather than expect there to be none which was helpful and eye-opening. Another told me to expect my brain to be in chemical withdrawal for up to a year after physical symptoms fade, helping me understand why depression or anxiety hits out of nowhere.

Whilst the dangerous reality of the UK’s opiate epidemic has now filtered down into the NHS and GP clinics, the advice on how to deal with it hasn’t really moved on. I’ve only succeeded because of an iron-clad level of willpower, my desire not to fall into the category of addict, and learning what works for me along the way.

I’ve acknowledged what a big deal withdrawal is, the magnitude of the battle I’m waging, and not to hide that from my close friends and relatives. I’ve sought support and comfort from the people I love. I tell them I’m in withdrawal, that I’m having a really awful day, that I need a break from social contact, or simply that I feel shit and need a hug.

I’ve taken time off from work just for coping with withdrawal. I’m having therapy and working really hard on myself, and also learning to accept and cope with my physical pain. I take over the counter medication for diarrhoea and paracetamol to ease my throat.

I’ve even researched why orgasms bring relief from withdrawal. For anyone that’s interested, post-orgasm chemicals like serotonin bind with the same receptors as the ones for opiates.

Now, I worry for the millions of people who will need help in the months and years ahead to come off prescribed painkillers and won’t know where to start. I worry for the 50 per cent who will relapse because at the end of it, it’s down to you, and you alone, to get off them.

ENDS