When you hear the word addict, what do you envisage? For many of us, this word coerces an image of an individual injecting heroin or snorting cocaine. This assumption is out of ignorance more so than malice but has resulted in society separating itself from the issue and pushing it behind closed doors. That could never happen to me – right?
Ireland has been introduced to a new epidemic involving prescription medication and it is rampaging through our communities leading people down a dangerous spiral. There appears to be a blissful naivety that if drugs come from a prescription pad, then they aren’t dangerous. Unfortunately, many people start off being legally prescribed to these drugs and a dependency develops. When a persons tolerance for the drug increases, the same dosage is no longer effective and people start taking more and more to get the same results that they had in the beginning. They may no longer be able to get a prescription from their doctor without raising red flags or their doctor may refuse to refill the prescription leaving the individual in withdrawals and quite often people then turn to other sources in order to buy illicit or illegally manufactured versions.
It’s not heard to believe that there is a prescription addiction problem in Ireland, the statistics and facts are there to not only suggest it, they support it.In the last 10 years alone there has been a staggering escalation in the prescribing of opioids and other addictive medications, in fact, it’s estimated to be a 1000% increase. This often leads to dependency issues, difficulties in functionality and a blunting of cognitive abilities. The use of the opioid Oxycontin is largely responsible for an addiction epidemic in America, which claims 174 lives a day. Prescriptions for Oxycontin in Ireland increased from 47,262 in 2006 to 122,611 in 2016, an increase of 159 percent. Prescriptions of the drug fentanyl, an opioid stronger than heroin, doubled, along with the increased use of sleeping tablets.
Why is this happening?
The increase in prescribing of this medication is a symptom of the failure of the health system. Waiting lists time to see doctors and to get treatment has grown dramatically and this is at the cornerstone of the problem. These factors are driving down the amount of time doctors can spend with patients. In a society where anxiety disorders are more prevalent than ever, but access to mental health services remains difficult and limited, GP’s are really restricted for many reasons including; they have insufficient time and resources available to them. Another compounding factor is that as a society, we want a quick fix to our problems; it’s much easier and convenient to take a tablet or medication for a problem than making lifestyle and behavioural changes. This is not only applicable to mental health, but we see it in relation to chronic pain and other health epidemics; such as cardiovascular disease, obesity, diabetes etc.
As a result, of the overprescribing of benzodiazepines and opioids, practitioners are now confronted with the difficulties of managing opioid medications, opioid use disorders and benzo dependency. Unfortunately, practitioners may not have been taught the skills necessary to integrate risk reduction, addiction assessment, and treatment into routine clinical practice. Further, there is an inadequate number of providers with the expertise and knowledge to treat substance use disorders to meet the current need for treatment. It appears that there are many compounding factors that have lead to this epidemic, namely, lack of education for both the prescriber and the patient.
Many of us have limited health literacy which is a marker for vulnerability and a contributing risk factor to poor outcomes. Although ethical principles support informed decision making, evidence suggests that these ideals are not always adhered to. According to studies they found that approximately 20% of interactions met the criteria for an informed decision.
These findings suggest that improvements are needed to ensure informed decision making is occurring in clinical practice. Blind faith is not for our healthcare, perhaps there is a less aggressive alternative in prescribing.
