Hooked on Painkillers Panorama

On Panorama tonight, the NHS clinic offering the detox for people on

prescription drugs. The first time we follow patients trying to quit

the medication their doctors gave them. I just feel slightly clammy,

and it is uncomfortable, and I feel slightly sick. GPs are prescribing

record doses of potentially addictive painkillers. There has

been a doubling in the number of prescriptions. Double? A doubling.

Around 4 million people in the UK are now taking drugs from the same

family as heroin. That is the highest dose I'd ever seen. And we

find out what happens when prescription turns into addiction. I

had gone into rehab and they said, you do realise you are a heroin

addict? I said, hello, I've got a really nice boots on, I can't

possibly be. Watergate Bay, Cornwall. The weather

is beautiful and I am in one of the most scenic parts of the country.

It's a perfect day, if you are able to get out and enjoy it. Helen

Derici lives just a few miles from the sea, but it might as well be

another world. Used to spend all of our summer holidays on the beach.

Like nearly 8 million other people in the UK, Helen suffers from

chronic pain, a complex spinal problem, osteoarthritis and

fibromyalgia have changed her life completely. I was a primary school

teacher. I had to leave that job because I couldn't walk any longer,

I could not sit and I can't stand for a period of time. What is the

pain like? Throughout my entire body, my fingers, my wrists, my

elbows, my knees, my ankles, my toes. Helen now rarely leaves the

house. A good day is when she can get out of bed. When I turned 50

last year, I realised I had spent most of my 40s lying down on a bed,

yeah. Each day begins with a large number

of different drugs. First, it is co-codamol, and then the next is

Valium. Tramadol, a drug called Gabapentin. The next one is slow

release morphine. I do have liquid morphine for breakthrough pain. I

imagine I would take that two or three times a day, depending on my

pain levels. Morphine and tramadol are opioids, derived from an opium

poppy, or man-made, with similar effects. There are many different

opioids, all closely related to heroin. Once they were reserved

mainly for cancer patients and for people recovering from operations.

There has been a doubling in the number of prescriptions. It is a

very significant increase. The doubling has occurred since 2006.

Roger Knaggs has analysed the records of 5 million patients to

find out where the increases coming from. The purple boars to let bars

show cancer patients receiving descriptions of strong opioids. They

increased gradually, but non-cancer patients getting prescriptions

increased sixfold in ten years. It is so dramatic.

This represents ape culture shift in prescribing. It's a big change in

the way these medicines are being used. The research suggests that

about a third of patients who take opioids will be on them for years.

And long-term use can, for some, lead to the nightmare of addiction.

I behaved like a complete monster with my GP. I would lie to him. I

would shout. I would scream. People in the waiting room would have heard

me screaming that I was not a drug addict, I was not an addict and I

wanted that prescription because I was in excruciating pain. Cathryn

Kemp has written about her experience of becoming addicted to

prescription pain killer after being diagnosed with pancreatitis. She was

prescribed an opioid drug called Fentanyl. She was supposed to take

eight lozenges a day. Her problem start whenned he exceeded -- when rb

-- started when she exceeded the dose. Within the first month I was

up to 11 lozenges a day. I needed that 11 lozenges and needing 12 a

day, needing 15 a day. Less than two years later, I was on 60 lozenges a

day on prescription from the GP. Cathryn's life descended into chaos.

She thought her addiction would kill her. By the end, the last couple of

months, I was writing a note and putting it under my pillow every

night saying to my family and friends basically, I'm really sorry.

I don't know what to do. I don't know how to come off these drugs. I

was leaving it in case I died overnight because I was taking a

fatal dose every day. Southmead Hospital in Bristol - home

to an NHS pain clinic and renowned specialist Dr Cathy Stannard. Hi.

Nice to meet you. Welcome to the pain clinic. She often sees patients

on hype doses of opioids. -- high. I gave you that amount of oral

morphine as a single dose now that would almost certainly kill you.

This amount of oral morphine would kill me?. If you drank it now. 200

milligrams can be fatal. But patients build up a tolerance, often

they end up on pills, patches and liquids. We frequently see patients

who are on 5,000 milligrams of morphine equivalent a day. So this

amount of morphine? Yeah. That's how much somebody might be having. In a

day? In a day. The team oversees the care of thousands of chronic pain

patients, often with complicated health histories. Dr Stannard has

strong views about opioids. She thinks they're unsuitable for many

patients with chronic pain in the long-term. The scientific studies

suggest that opioids have very little use. There is very little

evidence that these drugs work in the long-term. A few patients do

derive benefit taking these drugs over long periods, but only if the

doses are low and probably only if the drug is taken intermittently.

This way. OK, thanks. Today Helen is arriving for a two-week stay at the

clinic. Thank you. The team at Southmead are planning to take away

the cocktail of opioid pain killers she's been relying on for years. I

will take that medication and lock it into the treatment room OK. OK?

Yeah. I feel that I've relinquished control of what is a big part of my

life because my life has been ruled by drugs for the last seven or eight

years. Coming off opioids can be traumatic. To help Helen cope with

her withdrawal, she'll be given methadone, a drug normally used to

wean addicts off heroin. We've calculated a dose of 15 milligrams.

It's a starting point. It may need to be adjusted depending on how her

experience of the drug goes. The idea is she asks for a dose if she's

in pain or possibly if she's feeling she's going into withdrawal. A few

days later, Helen's body is craving the prescription opioids she's used

to. The morphine withdrawal I can feel it. It's kind of like a wave of

heat that comes from my feet and all the way through my body. I feel

slightly clammy. It's uncomfortable and I feel slightly sick. Hi. Can I

have my drugs, please? I'll check when you're next due them on your

chart. OK. We've got Helen's medication chart here. We can see

what she's been given and when and how long she's going and also how

we've been recording her withdrawal. She's actually doing really well.

Today is the worst. She's got sweating and hot and cold flushes.

At the moment, I'm just waiting to be given my next dose of methadone

and it's now been increased to see if that is more effectful...

Effectful? Effectful? Yes? What is it? Effectful. Effective. I told

you, my brain has turned to mush. No-one should stop taking

medications like this without medical help. Go and have some

supper now. Uh-huh. Helen's withdrawal symptoms are relatively

mild. Without methadone, it can be far worse. Muscle cramps all over my

body, sweating, shaking, tremors, hallucinations. At one stage, I

remember telling my counsellor in rehab that I could hear an orchestra

coming from the plug point in my room. I really thought I was going

insane. For me, it took a long time actually. It took about three months

before I felt in any way that the withdrawals had kind of passed. When

it comes to opioids, the dangers of physical dependency are well known.

So why are doctors now handing out more than 22 million prescriptions a

year? We have an ageing population. We have a society that wants to keep

active. Sometimes pain killers allow you to do that. We also have a basic

need to relieve pain as well. Doctors therefore prescribe things

that help to relieve that. Doctors haven't always used opioids for

chronic pain. The change in medical thinking began in America. It was

here in the late 80s research first suggested that opioids could be more

widely used without a significant risk of addiction. It was a

radically different way of thinking and for the pharmaceutical

companies, it opened up a market worth billions. New opioids were

developed for chronic pain, like OxyContin. Some patients may be

afraid of taking opioids because they're perceived as too strong. Or

addictive. But that is far from actual fact. It turned out the new

drugs were far more addictive than the marketing had suggested.

Prescription rates quadrupled and pills flooded the plaque market. --

black market. Armed robbers are pulling out guns and saying, "Give

me all your OxyContin." People crushed, snorted and injected the

drugs. Kentucky was one of the worst-hit states. Sean Riley, the

deputy Attorney-General, says the state was devastated by the opioid

epidemic. This is unlike anything that Kentucky has grappled with

before. This is a highly addictive, highly dangerous substance. You

would see grandmas who had a hip replacement who had become addicted.

You'd see stereotypical soccer moms who had a knee injury would be given

OxyContin. They'd become addicted. Rural Kentucky, these are the very

hills which first spawned the term hillbilly. The drugs were so widely

used around here, they became known as hillbilly heroin. I'm driving

into the heart of the Appalachian mountains in eastern Kentucky. This

place has been described as Ground Zero for the epidemic of

prescription opioid abuse. Many of these small, rural coal-mining

communities have been completely ravaged by these drugs.

Coal once was king in these parts. But there is a different growth

industry now. Rehab. The first time I ever experienced the feeling of

overdoing the medication was when my back was hurting me really bad one

night and so I took an extra one. About an hour after I took them, I

have this warm feeling coming all over me. It made me feel like

Superman. I was prescribed four per day, and as I got used to them, I

would take eight each day. It wouldn't do anything for me, I'd

still feel the pain so I kept taking them. Justin and Mark ended up

turning to the black market to feed their habit. They lost their jobs

and stole to get the money. I got in trouble with the law. My wife, she's

never experienced any kind of addiction. She is working, going to

college, raising my two boys right now, while I am here. This area now

has a massive prescription drug problem. The police say that crime

has soared with it. I started, years ago, a gas station robbery, a

service station robbery, something like that was unheard of. Now it

became commonplace, once a week, a couple of times a week. Just like

last week, we had two. Sergeant Peppi says that prescription

painkillers have transformed the place where he grew up. It is all

classes of society. This addiction does not recognise any class, it

doesn't matter how much money you've got, how poor you are, it affects

all. It has no boundary. Dr Bill Fannin knows that only too well. He

began describing opioids to his patients after being assured by

drugs representatives that there were no significant risks of

addiction. But he soon realised something was wrong. Patients were

lying to me. They were manipulating and they were trying to get

prescriptions filled before they were due. It just started growing

and growing. Individual tablets were changing hands on the streets for up

to $50 each. Bill Fannin's son, Sean, started using them when he was

just a teenager. Over time, he became addicted to the very drugs

his father had been prescribing to his patients. One night, Sean bought

opioids and took them, and another drug, in his bedroom. We were

sitting there, watching something on TV. My wife looked around at me and

she said, there's something wrong. She got up and went upstairs to

check on Sean. And I heard her screaming. Sean was dead from an

overdose. His father now believes that some of the drugs he prescribed

may well have found their way onto the black market and ended up in his

son's hands. Some of them were deserted, I know they were. Whether

he ended up with them or not, it is the same big pool of dealers. Could

have been mine, could have been somebody else's, but it's the same

story. It must have been an extremely difficult thing to come to

terms with, that you come as a doctor, were disseminating these

drugs, and yet this drug led to your son's death? Yes. Yes, sir. Purdue

Pharma, the makers of OxyContin, say they have accepted responsibility

for the actions of some staff in the 90s and are now combating

prescription drug abuse, including making pills with abuse deterrent

properties. They say courts across America have dismissed numerous

cases against them because the evidence did not establish their

marketing caused the alleged harm. The UK also has a problem. 1.8

million people have admitted misusing prescription painkillers.

So, code what happened in America happen here? I think we have to be

very aware of the situation in the States. I think the health care

system is, however, in the UK, totally different. AGP acts as a

wonderful gatekeeper. I think the GP situation is completely different

and would stop the escalation that we had in the states. Patients with

chronic pain are hard to deal with. But, surprisingly, it is left to

individual doctors to decide which opioids, and in what doses, they

should describe their patients. If you take diabetes and asthma, GPs

have excellent guidelines. They know how to monitor those patients. But

opioids are not like that. Are you saying that it is completely up to

the GP to work out, by themselves, how much opioids somebody needs

question? Yes, at the moment. That's astonishing, isn't it? It is. The

government is now considering new guidance.

This is Simon England. He suffers from a painful condition called

colitis. He has been taking massive doses of prescription painkillers

for years. You could look at it like I'm dependent on it or addicted to

it. I don't like the word addiction. But, to all intents and purposes, if

you need to take a... I have to take it. You could be said to be addicted

to it? Yes. Well, dependent is just another way of saying addiction. How

do you feel about that, thinking of yourself as being addicted to it? Is

it something you could have foreseen yourself being? No, never. Simon

Noble longer trusts himself with the drugs. So his family controls them

for him. Job done. That's it, simple as that.

I'm disgusted with myself. I really don't like myself. But I'm in a

corner. There's nothing I can do about it. It's not something I

chose. Simon is now desperate to come off

the prescription opioid drugs. How old are you now? 50. In pain terms,

where is your main pain? Today, he and his wife, Sarah, have come to

the pain clinic. On a bad day, you are taking 7200 mg. That is the

highest dose I have ever seen. Simon is taking the morphine equivalent of

9000 non-prescription co-codamol tablets a day. You are going to be

able to help me? I think our best bet for years to do what we usually

do, convert you, temporarily, to a drug called methadone. Have you

heard of that? Places after -- at the clinic are in such demand that

it could be months before Simon is admitted to detox. But at least

today, for the first time in a long time, there is hope. There is a

light at the end of the tunnel? There is a glimmer at the end of the

tunnel. We can get out. We can. We can.

Helen is coming to the end of her stay. Thanks a lot. Staff here have

been working on different ways of addressing her pain, from

physiotherapy to counselling and even simply getting her a good

night's sleep. We have identified that your sleep and wake cycle could

easily be modified. She has said after a good night's sleep, she is

not in as much pain. Then you look at her sleep, and her sleep has been

completely disrupted for the past nine years. Helen will be on

methadone plus time. But already she feels like a new person. -- on

methadone for some time. I can't stress enough how much better I

feel. I wanted to get some normality back into my life. I want to get

back into the water. Surfing, body boarding? Body boarding, I think I'm

going to try. I don't think I'll be able to surf. Maybe just getting

into the water. OK, I'll make you a deal, I will come and visit you in a

few weeks and I'll go bodyboarding with you. How does that sound? That

would be quite good, actually, it would be quite funny. Living without

opioid drugs is not always easy. Coming off them should only happen

under medical supervision. For Cathryn Kemp, it was a terrifying

step. But it is one she feels she had to take. Living with pain is

really difficult and there isn't necessarily a fairy tale ending.

Anyone out there who is going through it and who is terrified of

coming off their drugs, I really urge them to think about it. You

know, there is the possibility you can live with your pain. How is it

now, compared to how it was then? I can honestly say, actually, I think

the pain is currently almost exactly the same as when I was taking all of

those painkillers. I don't feel there is much difference. But life

is better? Well, I am actually living now. Even though I am in

pain, every day is 1 million times better than being on all of those

opiate drugs. NHS England says that high prescribing GPs are monitored,

but that pain needs to be treated and that opioids should be available

for patients they will benefit. Opioids may be excellent short-term

painkillers. But the question now is, are we using them too much for

chronic pain? One of the things we have to be aware of is when to say

no and when to try to bring in other resources. Do you believe that we

are not saying no enough? I agree. We are not saying no enough at the

moment, because GPs like to help their patients. I think if you are

treating somebody with opioids and they are not working and the patient

still has pain, even if there is nothing else to offer that patient,

it is better coming off their drugs. Back in Cornwall, I've got a promise

to keep. Helen, how are you? Not too bad. Can you believe we are going

body boarding? Not really, no. Do you feel different? Yes, hugely

different. I feel so much better. My thought processes are clear and my

speech isn't slurred any more. I can think clearly.

Helen is still on methadone. But the plan is that it will also be taken

away gradually. I seem to have more motivation than I had before. I'm

able to think about what I'm going to do tomorrow, and the day after,

which before I wasn't doing. Helen's future will still involve

pain. But she hopes to manage it without a cocktail of opioid

painkillers. And for Helen, at least, taking the plunge has made

all the difference.