:00:10. > :00:20.On Panorama tonight, the NHS clinic offering the detox for people on
:00:21. > :00:25.prescription drugs. The first time we follow patients trying to quit
:00:26. > :00:31.the medication their doctors gave them. I just feel slightly clammy,
:00:32. > :00:35.and it is uncomfortable, and I feel slightly sick. GPs are prescribing
:00:36. > :00:42.record doses of potentially addictive painkillers. There has
:00:43. > :00:48.been a doubling in the number of prescriptions. Double? A doubling.
:00:49. > :00:54.Around 4 million people in the UK are now taking drugs from the same
:00:55. > :00:58.family as heroin. That is the highest dose I'd ever seen. And we
:00:59. > :01:03.find out what happens when prescription turns into addiction. I
:01:04. > :01:07.had gone into rehab and they said, you do realise you are a heroin
:01:08. > :01:10.addict? I said, hello, I've got a really nice boots on, I can't
:01:11. > :01:29.possibly be. Watergate Bay, Cornwall. The weather
:01:30. > :01:37.is beautiful and I am in one of the most scenic parts of the country.
:01:38. > :01:44.It's a perfect day, if you are able to get out and enjoy it. Helen
:01:45. > :01:51.Derici lives just a few miles from the sea, but it might as well be
:01:52. > :01:56.another world. Used to spend all of our summer holidays on the beach.
:01:57. > :02:05.Like nearly 8 million other people in the UK, Helen suffers from
:02:06. > :02:08.chronic pain, a complex spinal problem, osteoarthritis and
:02:09. > :02:13.fibromyalgia have changed her life completely. I was a primary school
:02:14. > :02:17.teacher. I had to leave that job because I couldn't walk any longer,
:02:18. > :02:22.I could not sit and I can't stand for a period of time. What is the
:02:23. > :02:31.pain like? Throughout my entire body, my fingers, my wrists, my
:02:32. > :02:35.elbows, my knees, my ankles, my toes. Helen now rarely leaves the
:02:36. > :02:42.house. A good day is when she can get out of bed. When I turned 50
:02:43. > :02:45.last year, I realised I had spent most of my 40s lying down on a bed,
:02:46. > :02:58.yeah. Each day begins with a large number
:02:59. > :03:10.of different drugs. First, it is co-codamol, and then the next is
:03:11. > :03:21.Valium. Tramadol, a drug called Gabapentin. The next one is slow
:03:22. > :03:26.release morphine. I do have liquid morphine for breakthrough pain. I
:03:27. > :03:33.imagine I would take that two or three times a day, depending on my
:03:34. > :03:37.pain levels. Morphine and tramadol are opioids, derived from an opium
:03:38. > :03:42.poppy, or man-made, with similar effects. There are many different
:03:43. > :03:46.opioids, all closely related to heroin. Once they were reserved
:03:47. > :03:52.mainly for cancer patients and for people recovering from operations.
:03:53. > :04:03.There has been a doubling in the number of prescriptions. It is a
:04:04. > :04:16.very significant increase. The doubling has occurred since 2006.
:04:17. > :04:19.Roger Knaggs has analysed the records of 5 million patients to
:04:20. > :04:23.find out where the increases coming from. The purple boars to let bars
:04:24. > :04:28.show cancer patients receiving descriptions of strong opioids. They
:04:29. > :04:31.increased gradually, but non-cancer patients getting prescriptions
:04:32. > :04:37.increased sixfold in ten years. It is so dramatic.
:04:38. > :04:44.This represents ape culture shift in prescribing. It's a big change in
:04:45. > :04:51.the way these medicines are being used. The research suggests that
:04:52. > :04:58.about a third of patients who take opioids will be on them for years.
:04:59. > :05:05.And long-term use can, for some, lead to the nightmare of addiction.
:05:06. > :05:09.I behaved like a complete monster with my GP. I would lie to him. I
:05:10. > :05:14.would shout. I would scream. People in the waiting room would have heard
:05:15. > :05:19.me screaming that I was not a drug addict, I was not an addict and I
:05:20. > :05:24.wanted that prescription because I was in excruciating pain. Cathryn
:05:25. > :05:29.Kemp has written about her experience of becoming addicted to
:05:30. > :05:35.prescription pain killer after being diagnosed with pancreatitis. She was
:05:36. > :05:39.prescribed an opioid drug called Fentanyl. She was supposed to take
:05:40. > :05:43.eight lozenges a day. Her problem start whenned he exceeded -- when rb
:05:44. > :05:48.-- started when she exceeded the dose. Within the first month I was
:05:49. > :05:55.up to 11 lozenges a day. I needed that 11 lozenges and needing 12 a
:05:56. > :06:04.day, needing 15 a day. Less than two years later, I was on 60 lozenges a
:06:05. > :06:07.day on prescription from the GP. Cathryn's life descended into chaos.
:06:08. > :06:12.She thought her addiction would kill her. By the end, the last couple of
:06:13. > :06:15.months, I was writing a note and putting it under my pillow every
:06:16. > :06:19.night saying to my family and friends basically, I'm really sorry.
:06:20. > :06:23.I don't know what to do. I don't know how to come off these drugs. I
:06:24. > :06:25.was leaving it in case I died overnight because I was taking a
:06:26. > :06:41.fatal dose every day. Southmead Hospital in Bristol - home
:06:42. > :06:45.to an NHS pain clinic and renowned specialist Dr Cathy Stannard. Hi.
:06:46. > :06:54.Nice to meet you. Welcome to the pain clinic. She often sees patients
:06:55. > :06:59.on hype doses of opioids. -- high. I gave you that amount of oral
:07:00. > :07:03.morphine as a single dose now that would almost certainly kill you.
:07:04. > :07:09.This amount of oral morphine would kill me?. If you drank it now. 200
:07:10. > :07:14.milligrams can be fatal. But patients build up a tolerance, often
:07:15. > :07:21.they end up on pills, patches and liquids. We frequently see patients
:07:22. > :07:25.who are on 5,000 milligrams of morphine equivalent a day. So this
:07:26. > :07:36.amount of morphine? Yeah. That's how much somebody might be having. In a
:07:37. > :07:40.day? In a day. The team oversees the care of thousands of chronic pain
:07:41. > :07:49.patients, often with complicated health histories. Dr Stannard has
:07:50. > :07:52.strong views about opioids. She thinks they're unsuitable for many
:07:53. > :07:56.patients with chronic pain in the long-term. The scientific studies
:07:57. > :07:59.suggest that opioids have very little use. There is very little
:08:00. > :08:07.evidence that these drugs work in the long-term. A few patients do
:08:08. > :08:11.derive benefit taking these drugs over long periods, but only if the
:08:12. > :08:22.doses are low and probably only if the drug is taken intermittently.
:08:23. > :08:26.This way. OK, thanks. Today Helen is arriving for a two-week stay at the
:08:27. > :08:31.clinic. Thank you. The team at Southmead are planning to take away
:08:32. > :08:36.the cocktail of opioid pain killers she's been relying on for years. I
:08:37. > :08:47.will take that medication and lock it into the treatment room OK. OK?
:08:48. > :08:53.Yeah. I feel that I've relinquished control of what is a big part of my
:08:54. > :09:01.life because my life has been ruled by drugs for the last seven or eight
:09:02. > :09:07.years. Coming off opioids can be traumatic. To help Helen cope with
:09:08. > :09:12.her withdrawal, she'll be given methadone, a drug normally used to
:09:13. > :09:16.wean addicts off heroin. We've calculated a dose of 15 milligrams.
:09:17. > :09:23.It's a starting point. It may need to be adjusted depending on how her
:09:24. > :09:28.experience of the drug goes. The idea is she asks for a dose if she's
:09:29. > :09:38.in pain or possibly if she's feeling she's going into withdrawal. A few
:09:39. > :09:49.days later, Helen's body is craving the prescription opioids she's used
:09:50. > :09:57.to. The morphine withdrawal I can feel it. It's kind of like a wave of
:09:58. > :10:01.heat that comes from my feet and all the way through my body. I feel
:10:02. > :10:10.slightly clammy. It's uncomfortable and I feel slightly sick. Hi. Can I
:10:11. > :10:16.have my drugs, please? I'll check when you're next due them on your
:10:17. > :10:20.chart. OK. We've got Helen's medication chart here. We can see
:10:21. > :10:25.what she's been given and when and how long she's going and also how
:10:26. > :10:31.we've been recording her withdrawal. She's actually doing really well.
:10:32. > :10:42.Today is the worst. She's got sweating and hot and cold flushes.
:10:43. > :10:49.At the moment, I'm just waiting to be given my next dose of methadone
:10:50. > :10:57.and it's now been increased to see if that is more effectful...
:10:58. > :11:08.Effectful? Effectful? Yes? What is it? Effectful. Effective. I told
:11:09. > :11:11.you, my brain has turned to mush. No-one should stop taking
:11:12. > :11:19.medications like this without medical help. Go and have some
:11:20. > :11:23.supper now. Uh-huh. Helen's withdrawal symptoms are relatively
:11:24. > :11:31.mild. Without methadone, it can be far worse. Muscle cramps all over my
:11:32. > :11:35.body, sweating, shaking, tremors, hallucinations. At one stage, I
:11:36. > :11:39.remember telling my counsellor in rehab that I could hear an orchestra
:11:40. > :11:44.coming from the plug point in my room. I really thought I was going
:11:45. > :11:53.insane. For me, it took a long time actually. It took about three months
:11:54. > :11:59.before I felt in any way that the withdrawals had kind of passed. When
:12:00. > :12:03.it comes to opioids, the dangers of physical dependency are well known.
:12:04. > :12:10.So why are doctors now handing out more than 22 million prescriptions a
:12:11. > :12:15.year? We have an ageing population. We have a society that wants to keep
:12:16. > :12:21.active. Sometimes pain killers allow you to do that. We also have a basic
:12:22. > :12:28.need to relieve pain as well. Doctors therefore prescribe things
:12:29. > :12:40.that help to relieve that. Doctors haven't always used opioids for
:12:41. > :12:49.chronic pain. The change in medical thinking began in America. It was
:12:50. > :12:53.here in the late 80s research first suggested that opioids could be more
:12:54. > :12:59.widely used without a significant risk of addiction. It was a
:13:00. > :13:02.radically different way of thinking and for the pharmaceutical
:13:03. > :13:10.companies, it opened up a market worth billions. New opioids were
:13:11. > :13:14.developed for chronic pain, like OxyContin. Some patients may be
:13:15. > :13:19.afraid of taking opioids because they're perceived as too strong. Or
:13:20. > :13:30.addictive. But that is far from actual fact. It turned out the new
:13:31. > :13:35.drugs were far more addictive than the marketing had suggested.
:13:36. > :13:42.Prescription rates quadrupled and pills flooded the plaque market. --
:13:43. > :13:47.black market. Armed robbers are pulling out guns and saying, "Give
:13:48. > :13:51.me all your OxyContin." People crushed, snorted and injected the
:13:52. > :13:58.drugs. Kentucky was one of the worst-hit states. Sean Riley, the
:13:59. > :14:03.deputy Attorney-General, says the state was devastated by the opioid
:14:04. > :14:07.epidemic. This is unlike anything that Kentucky has grappled with
:14:08. > :14:12.before. This is a highly addictive, highly dangerous substance. You
:14:13. > :14:18.would see grandmas who had a hip replacement who had become addicted.
:14:19. > :14:30.You'd see stereotypical soccer moms who had a knee injury would be given
:14:31. > :14:36.OxyContin. They'd become addicted. Rural Kentucky, these are the very
:14:37. > :14:42.hills which first spawned the term hillbilly. The drugs were so widely
:14:43. > :14:53.used around here, they became known as hillbilly heroin. I'm driving
:14:54. > :14:58.into the heart of the Appalachian mountains in eastern Kentucky. This
:14:59. > :15:04.place has been described as Ground Zero for the epidemic of
:15:05. > :15:07.prescription opioid abuse. Many of these small, rural coal-mining
:15:08. > :15:14.communities have been completely ravaged by these drugs.
:15:15. > :15:26.Coal once was king in these parts. But there is a different growth
:15:27. > :15:30.industry now. Rehab. The first time I ever experienced the feeling of
:15:31. > :15:35.overdoing the medication was when my back was hurting me really bad one
:15:36. > :15:39.night and so I took an extra one. About an hour after I took them, I
:15:40. > :15:47.have this warm feeling coming all over me. It made me feel like
:15:48. > :15:51.Superman. I was prescribed four per day, and as I got used to them, I
:15:52. > :15:55.would take eight each day. It wouldn't do anything for me, I'd
:15:56. > :15:59.still feel the pain so I kept taking them. Justin and Mark ended up
:16:00. > :16:05.turning to the black market to feed their habit. They lost their jobs
:16:06. > :16:10.and stole to get the money. I got in trouble with the law. My wife, she's
:16:11. > :16:15.never experienced any kind of addiction. She is working, going to
:16:16. > :16:23.college, raising my two boys right now, while I am here. This area now
:16:24. > :16:32.has a massive prescription drug problem. The police say that crime
:16:33. > :16:36.has soared with it. I started, years ago, a gas station robbery, a
:16:37. > :16:41.service station robbery, something like that was unheard of. Now it
:16:42. > :16:47.became commonplace, once a week, a couple of times a week. Just like
:16:48. > :16:50.last week, we had two. Sergeant Peppi says that prescription
:16:51. > :16:56.painkillers have transformed the place where he grew up. It is all
:16:57. > :16:59.classes of society. This addiction does not recognise any class, it
:17:00. > :17:06.doesn't matter how much money you've got, how poor you are, it affects
:17:07. > :17:13.all. It has no boundary. Dr Bill Fannin knows that only too well. He
:17:14. > :17:16.began describing opioids to his patients after being assured by
:17:17. > :17:19.drugs representatives that there were no significant risks of
:17:20. > :17:25.addiction. But he soon realised something was wrong. Patients were
:17:26. > :17:29.lying to me. They were manipulating and they were trying to get
:17:30. > :17:35.prescriptions filled before they were due. It just started growing
:17:36. > :17:42.and growing. Individual tablets were changing hands on the streets for up
:17:43. > :17:47.to $50 each. Bill Fannin's son, Sean, started using them when he was
:17:48. > :17:52.just a teenager. Over time, he became addicted to the very drugs
:17:53. > :17:56.his father had been prescribing to his patients. One night, Sean bought
:17:57. > :18:02.opioids and took them, and another drug, in his bedroom. We were
:18:03. > :18:08.sitting there, watching something on TV. My wife looked around at me and
:18:09. > :18:12.she said, there's something wrong. She got up and went upstairs to
:18:13. > :18:22.check on Sean. And I heard her screaming. Sean was dead from an
:18:23. > :18:26.overdose. His father now believes that some of the drugs he prescribed
:18:27. > :18:35.may well have found their way onto the black market and ended up in his
:18:36. > :18:39.son's hands. Some of them were deserted, I know they were. Whether
:18:40. > :18:47.he ended up with them or not, it is the same big pool of dealers. Could
:18:48. > :18:52.have been mine, could have been somebody else's, but it's the same
:18:53. > :18:56.story. It must have been an extremely difficult thing to come to
:18:57. > :18:59.terms with, that you come as a doctor, were disseminating these
:19:00. > :19:10.drugs, and yet this drug led to your son's death? Yes. Yes, sir. Purdue
:19:11. > :19:13.Pharma, the makers of OxyContin, say they have accepted responsibility
:19:14. > :19:18.for the actions of some staff in the 90s and are now combating
:19:19. > :19:22.prescription drug abuse, including making pills with abuse deterrent
:19:23. > :19:26.properties. They say courts across America have dismissed numerous
:19:27. > :19:32.cases against them because the evidence did not establish their
:19:33. > :19:36.marketing caused the alleged harm. The UK also has a problem. 1.8
:19:37. > :19:41.million people have admitted misusing prescription painkillers.
:19:42. > :19:47.So, code what happened in America happen here? I think we have to be
:19:48. > :19:51.very aware of the situation in the States. I think the health care
:19:52. > :19:56.system is, however, in the UK, totally different. AGP acts as a
:19:57. > :20:02.wonderful gatekeeper. I think the GP situation is completely different
:20:03. > :20:09.and would stop the escalation that we had in the states. Patients with
:20:10. > :20:13.chronic pain are hard to deal with. But, surprisingly, it is left to
:20:14. > :20:19.individual doctors to decide which opioids, and in what doses, they
:20:20. > :20:25.should describe their patients. If you take diabetes and asthma, GPs
:20:26. > :20:29.have excellent guidelines. They know how to monitor those patients. But
:20:30. > :20:35.opioids are not like that. Are you saying that it is completely up to
:20:36. > :20:47.the GP to work out, by themselves, how much opioids somebody needs
:20:48. > :20:53.question? Yes, at the moment. That's astonishing, isn't it? It is. The
:20:54. > :20:58.government is now considering new guidance.
:20:59. > :21:07.This is Simon England. He suffers from a painful condition called
:21:08. > :21:15.colitis. He has been taking massive doses of prescription painkillers
:21:16. > :21:21.for years. You could look at it like I'm dependent on it or addicted to
:21:22. > :21:26.it. I don't like the word addiction. But, to all intents and purposes, if
:21:27. > :21:32.you need to take a... I have to take it. You could be said to be addicted
:21:33. > :21:38.to it? Yes. Well, dependent is just another way of saying addiction. How
:21:39. > :21:42.do you feel about that, thinking of yourself as being addicted to it? Is
:21:43. > :21:48.it something you could have foreseen yourself being? No, never. Simon
:21:49. > :21:50.Noble longer trusts himself with the drugs. So his family controls them
:21:51. > :22:05.for him. Job done. That's it, simple as that.
:22:06. > :22:11.I'm disgusted with myself. I really don't like myself. But I'm in a
:22:12. > :22:14.corner. There's nothing I can do about it. It's not something I
:22:15. > :22:36.chose. Simon is now desperate to come off
:22:37. > :22:44.the prescription opioid drugs. How old are you now? 50. In pain terms,
:22:45. > :22:51.where is your main pain? Today, he and his wife, Sarah, have come to
:22:52. > :22:59.the pain clinic. On a bad day, you are taking 7200 mg. That is the
:23:00. > :23:04.highest dose I have ever seen. Simon is taking the morphine equivalent of
:23:05. > :23:10.9000 non-prescription co-codamol tablets a day. You are going to be
:23:11. > :23:15.able to help me? I think our best bet for years to do what we usually
:23:16. > :23:23.do, convert you, temporarily, to a drug called methadone. Have you
:23:24. > :23:25.heard of that? Places after -- at the clinic are in such demand that
:23:26. > :23:31.it could be months before Simon is admitted to detox. But at least
:23:32. > :23:38.today, for the first time in a long time, there is hope. There is a
:23:39. > :23:44.light at the end of the tunnel? There is a glimmer at the end of the
:23:45. > :23:54.tunnel. We can get out. We can. We can.
:23:55. > :24:02.Helen is coming to the end of her stay. Thanks a lot. Staff here have
:24:03. > :24:06.been working on different ways of addressing her pain, from
:24:07. > :24:10.physiotherapy to counselling and even simply getting her a good
:24:11. > :24:18.night's sleep. We have identified that your sleep and wake cycle could
:24:19. > :24:23.easily be modified. She has said after a good night's sleep, she is
:24:24. > :24:26.not in as much pain. Then you look at her sleep, and her sleep has been
:24:27. > :24:33.completely disrupted for the past nine years. Helen will be on
:24:34. > :24:39.methadone plus time. But already she feels like a new person. -- on
:24:40. > :24:44.methadone for some time. I can't stress enough how much better I
:24:45. > :24:54.feel. I wanted to get some normality back into my life. I want to get
:24:55. > :24:59.back into the water. Surfing, body boarding? Body boarding, I think I'm
:25:00. > :25:04.going to try. I don't think I'll be able to surf. Maybe just getting
:25:05. > :25:08.into the water. OK, I'll make you a deal, I will come and visit you in a
:25:09. > :25:13.few weeks and I'll go bodyboarding with you. How does that sound? That
:25:14. > :25:20.would be quite good, actually, it would be quite funny. Living without
:25:21. > :25:24.opioid drugs is not always easy. Coming off them should only happen
:25:25. > :25:30.under medical supervision. For Cathryn Kemp, it was a terrifying
:25:31. > :25:35.step. But it is one she feels she had to take. Living with pain is
:25:36. > :25:38.really difficult and there isn't necessarily a fairy tale ending.
:25:39. > :25:41.Anyone out there who is going through it and who is terrified of
:25:42. > :25:46.coming off their drugs, I really urge them to think about it. You
:25:47. > :25:52.know, there is the possibility you can live with your pain. How is it
:25:53. > :25:57.now, compared to how it was then? I can honestly say, actually, I think
:25:58. > :26:03.the pain is currently almost exactly the same as when I was taking all of
:26:04. > :26:08.those painkillers. I don't feel there is much difference. But life
:26:09. > :26:12.is better? Well, I am actually living now. Even though I am in
:26:13. > :26:20.pain, every day is 1 million times better than being on all of those
:26:21. > :26:26.opiate drugs. NHS England says that high prescribing GPs are monitored,
:26:27. > :26:31.but that pain needs to be treated and that opioids should be available
:26:32. > :26:35.for patients they will benefit. Opioids may be excellent short-term
:26:36. > :26:41.painkillers. But the question now is, are we using them too much for
:26:42. > :26:46.chronic pain? One of the things we have to be aware of is when to say
:26:47. > :26:51.no and when to try to bring in other resources. Do you believe that we
:26:52. > :26:57.are not saying no enough? I agree. We are not saying no enough at the
:26:58. > :27:00.moment, because GPs like to help their patients. I think if you are
:27:01. > :27:04.treating somebody with opioids and they are not working and the patient
:27:05. > :27:08.still has pain, even if there is nothing else to offer that patient,
:27:09. > :27:25.it is better coming off their drugs. Back in Cornwall, I've got a promise
:27:26. > :27:31.to keep. Helen, how are you? Not too bad. Can you believe we are going
:27:32. > :27:37.body boarding? Not really, no. Do you feel different? Yes, hugely
:27:38. > :27:41.different. I feel so much better. My thought processes are clear and my
:27:42. > :27:51.speech isn't slurred any more. I can think clearly.
:27:52. > :28:01.Helen is still on methadone. But the plan is that it will also be taken
:28:02. > :28:07.away gradually. I seem to have more motivation than I had before. I'm
:28:08. > :28:14.able to think about what I'm going to do tomorrow, and the day after,
:28:15. > :28:19.which before I wasn't doing. Helen's future will still involve
:28:20. > :28:25.pain. But she hopes to manage it without a cocktail of opioid
:28:26. > :28:26.painkillers. And for Helen, at least, taking the plunge has made
:28:27. > :28:30.all the difference.