Lyndsey Telford investigates the rise in deaths from prescription drug abuse and asks why, in Northern Ireland, these drugs kill more than heroin.
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In Northern Ireland, prescription drugs account for
the majority of drug-related deaths.
The biggest killer in Great Britain is heroin.
The biggest killer in Northern Ireland is tramadol.
Tonight on Spotlight,
we ask why our deadliest drugs come in blister packs
and over the counter, and witness the impact of their misuse.
"Please don't tell me my child is dead."
Begging the ambulance men, "Please, try. Help, please."
Spotlight has exclusively analysed
more than 20 million prescription records across Northern Ireland.
Deaths don't come as a surprise to me.
It's surprising we probably don't have more deaths.
We reveal how the number of prescriptions of a drug
commonly used here has risen by nearly 50% in the last four years.
It's a very addictive drug, very open to abuse.
We investigate the different sources of these drugs and ask,
is your GP your first dealer?
I can't, you know, say that we wouldn't fall into that category.
We certainly write the prescriptions for many of these drugs.
And we obtain a secret dossier that claims to lay bare
the extent of street dealing.
You hear the word drug dealer and you think cocaine, heroin.
It's stark to think that there's prescription drugs in their hands.
You can never have the happiness back in your life again, can you, like?
There they go.
And there's his white coffin as well.
A white coffin, he had.
Everything was purple, purple, purple.
Everybody wore purple.
It is so sad, isn't it, to think you have to bury your child?
Breaks my heart, so it does.
Patricia Browne lost her 26-year-old son, Christopher,
to prescription drugs.
-This is a cute wee one, this wee one of him when he was small.
-Christopher was a Man United supporter.
You know, as well as the boxing - he loved the boxing.
Patricia believes his problems started
when his young girlfriend killed herself.
Problems for Christopher just developed after that.
You know, mental health issues.
So when did he start taking prescription drugs?
I would say maybe at the age of 19-20.
But when he wanted more than his GP would give him,
he turned to dealers online.
It was very easy to access the diazepam on the internet.
One day you ordered them, the next day you put the money
in their bank account, and they would deliver it the next day.
You know, I think it was something like 1,000 of them for £250.
As well as diazepam, Christopher's mum says
he was prescribed by his GP Lyrica, a common brand of pregabalin.
It was when he started abusing Lyrica
that Patricia saw a sharp decline.
He didn't even know who he was, with the head down,
dribbling his food - couldn't eat his food at the table,
dribbling down his mouth.
When he wasn't on drugs, he was a good kid.
You know, he was a real lovable kid. He would give you his last.
Mother's Day, birthdays,
-Christmas - he just loved Christmas, so he did.
He was the first one always out doing his shopping.
Christopher's was one of five drug deaths
in Belfast that weekend in April.
As they await the results of postmortem examinations,
at this stage the police don't think any single drug
was responsible for the deaths.
By the end of September, the city's drug death toll had reached 37.
While it's still unknown how many of those deaths
involved prescription drugs,
latest trends indicate they will form the majority.
What is for sure is that, of those 37 Belfast deaths,
more than half took place in the north of the city.
DUP councillor Guy Spence represents North Belfast.
We first met him at a community meeting, where many people were
angry, saying the authorities were failing to tackle the drugs crisis.
That meeting in North Belfast was called
by the Policing and Community Safety Partnership
on the information that drugs,
particularly prescription drugs,
was an increasing issue within our district, North Belfast.
It was an opportunity for the public and members of the community,
community leaders, to come together and to find out more.
Feeling abandoned, the community appealed for more resources.
I don't think there's enough outcry.
I'm getting phone calls every day from parents begging for help.
Drugs are very accessible.
People can log on to the internet as if they're doing their shopping
and get drugs delivered to your house in the post.
We agree not to film the meeting
as a member of the Public Prosecution Service
wished to talk candidly off-camera.
Afterwards, we spoke to Billy Burns, who was at the same meeting.
A lot of people, a lot of angry people, in that room tonight.
Basically, all we heard was
how this is going to happen
and this is going to happen.
But the kids are down on the streets now. It needs to happen now.
Billy, who lost his son to drugs,
asked the police at the meeting about a group active on social media
called Communities Against Death Dealers, or CADD.
The group had compiled a dossier of allegations
against drug dealers, submitted, it says,
anonymously by those among its 17,000 Facebook followers.
You raised the issue of a Facebook group
-called Communities Against Death Dealers.
They have compiled a dossier of allegations
naming suspected, alleged drug dealers.
It's got to the point, Lyndsey, where the community now
have had that much anger in the community
that they have resulted in Facebook pages coming up
showing drug dealers,
telling them that they are death dealers.
CADD may have just appeared on social media,
but Billy believes it represents the desperation
of a community pushed to its limit by dealers.
It's the people crying out for some help.
They're not getting it from the PSNI or the other agencies,
so they're hitting out themselves.
As the CADD dossier is said to contain more than 250 allegations
against dealers selling across the internet
and up and down the streets of Northern Ireland,
we want to see it for ourselves.
At the meeting, it emerged the drug death toll of 37
may have risen by two.
The revelation came from coroner Joe McCrisken.
You have ordered two investigations in the last week.
The deaths have occurred as a result of what we think
are prescription drug use,
but we'll need to wait on the forensic analysis
to be carried out to be sure.
The deadliest of prescription drugs in Northern Ireland is tramadol,
which kills more than Class A drugs like heroin and cocaine.
The tramadol death rate in Great Britain has been decreasing
over the last three years.
In Northern Ireland, it has been increasing.
The biggest killer in Great Britain is heroin.
The biggest killer per drug in Northern Ireland is tramadol.
The dangers of tramadol misuse are well known.
But there now worry about another prescription drug, pregabalin,
marketed as Lyrica, according to Dr Yasir Abbasi.
Today, the Home Office launched
a formal consultation on its classification.
The Government recently suggested that pregabalin should be
classed as a Class C substance,
which was on the recommendation of the British Medical Association.
I think Northern Ireland needs to be more quick
in responding to these recommendations.
Christopher was prescribed pregabalin in the brand form Lyrica,
which he misused.
Dr Abbasi was one of the first to raise concerns about pregabalin.
If pregabalin is prescribed appropriately,
and monitored regularly,
then there is nothing to say that it's a dangerous drug.
The issue that you might have with pregabalin over-prescription
is that people, or individuals who are using it,
being dependant or addicted to it.
Alex Bunting from Addiction NI is equally concerned.
We are quite clearly seeing now that it's a very addictive drug,
very open to abuse,
and it is being abused right across communities.
With growing criticism around pregabalin,
Spotlight commissioned a special piece of research.
We have obtained a huge database of 20 million prescription records
written by GPs across Northern Ireland over the last four years.
We've had them analysed and can exclusively reveal a 46% rise
in prescriptions of the drug
that's implicated in more and more overdose deaths -
pregabalin, or as we know, most commonly referred to as Lyrica.
A 46% increase in pregabalin prescription
over the past four years is quite dramatic.
There's definitely overprescribing there.
I guess it very much raises the question
of the addictive potential of pregabalin,
and the fact that this needs some urgent attention
by the medical community.
On the morning we interviewed Alex Bunting,
US President Donald Trump made this announcement...
The federal government is aggressively fighting
the opioid epidemic on all fronts.
Alex blames America's crisis, and our increasing problems
with prescription drugs, on overprescribing.
If you look at Middle America, they have a significant problem
with heroin and injecting drug populations
that's all been developed from the overuse
and overprescribing of very potent, powerful pain medication.
If we are slightly behind that curve,
then we are walking into the same problem.
The SDLP's Nichola Mallon hears first hand the effects
of addiction to prescription drugs from sufferers,
some of whom started taking them legitimately.
What we see coming into my office
is people of all ages who are addicted to prescription drugs.
Some are addicted because they are waiting on operations
and they're living in severe pain.
She believes Northern Ireland's problem with prescription drugs
stems from a pill-sharing past in the Troubles.
During the conflict, and as a consequence of it,
we in Northern Ireland have an unhealthy relationship
with prescription drugs. Throughout the Troubles,
it wasn't unusual for neighbours to share prescription drugs.
It is referred to locally as nerve tablets to try to deal with anxiety.
-What happened just then?
-That explosion there, just behind College Street.
Does this sort of thing happen often?
Very often. It does, indeed.
And how do you feel when you hear and see
-these explosions all around you?
-It frightens you.
Benzodiazepines, under the brand name Valium,
first came to Northern Ireland 50 years ago.
-The doctors I met in Belfast gave me the impression
of standing watch over a psychiatric volcano.
and the demand for what is now known as diazepam has stabilised.
But our research suggests it's just being substituted
with something else.
This new drug that came in, by the name of pregabalin,
was considered to be a safer option.
And they started prescribing this more, in effect,
and so they were replacing one chemical with the other.
And Dr Abbasi believes more research is needed to see
if pregabalin has the same potential for addiction that diazepam has.
I do not question its safety profile,
I do question as to its potential for addiction.
We are seeing a drug which is marketed as a very safe drug -
and, again, I do not question the safety there -
but what is very important is we have not established
its links to addiction.
And I think, in my clinical practice,
that there are links there.
Other front-line professionals are increasingly sharing this view.
One of Dr Michael McKenna's patients is among the 37 dead.
And while it's still unknown if Lyrica was involved in that case,
he's very worried about its impact.
I am becoming increasingly sceptical about its use in pain,
and I'm trying not to prescribe it.
This was heralded as a very safe drug,
and not addictive in any way.
And yet, as time goes on,
we see the increasing problems that it's causing.
We also see a drug which,
when used inappropriately and abused,
is...is extremely dangerous.
You know, we have seen a lot of drug-related deaths now, recently,
where Lyrica is showing up in the toxicology screening.
The day after the North Belfast meeting,
the Falls Community Council gives us an idea of just how many drugs,
including illegally-obtained prescriptions, are on the streets.
This is a drugs bin.
So what people do is, they can come in,
dispose of drugs in here in a safe way.
The PSNI then come, and they empty the bin.
With waiting times for addiction treatment of 6-9 months,
this place offers practical support to addicts and their families.
The PSNI weren't due to come out
for about another two weeks.
We had to phone them to come out and empty it
because it was actually full.
We literally couldn't get anything more into it.
So that is the amount of drugs
that this is helping to take off the streets.
But funding for the service ended last month.
We are in actual real danger of having to close the service here.
We are still waiting on word
to see whether we will get the funding renewed for this service.
And so, are you literally waiting to find out if you are getting
-this much-needed money?
-Yes, that is actually the point that we're at.
Gerry believes places like his can be the difference
between life and death for addicts,
and fears the drug death toll will only rise if they shut.
The number of recorded deaths through drugs
will be higher this year, so we actually do have a crisis.
With some patients becoming addicted
after being legally prescribed drugs as medication,
your GP is effectively your first dealer.
We put this to Dr McKenna.
I can't, you know, say that we wouldn't fall into that category.
We certainly write the prescriptions
for many of these drugs.
But with that comes a responsibility.
One, to be aware of what we are prescribing.
Two, to make our patients aware of the potential for addiction.
And then, three, to monitor it to ensure that
we can get them off the medications at an appropriate time.
Dr McKenna admits this approach doesn't always work.
He says that, on some occasions,
the drugs he prescribes make it to the street.
We know that Belfast is awash with prescription drugs.
With those illegally-bought prescription drugs,
where are they coming from?
There are two sources.
One, the internet is a big source.
And then, we have the prescriptions
that I prescribe and my colleagues prescribe,
which are sold on by our patients.
And there is an element of that that happens.
So you suspect that you have patients who come in here
and you are prescribing them drugs,
they are going out onto the street and selling them?
They are not using them themselves, they are selling them on?
In some instance, yes, that is happening.
Or they will take half for themselves
and sell the other half on.
It's a form of income for them.
And how many patients have you seen where you suspect them
to be not really using the drugs, and selling on?
I've certainly had one person removed from the list
for fraudulent misuse of medication.
And when did you first notice this as a phenomenon?
It's really only something that's been happening
in the last four or five years.
Christopher's mum, Patricia, says it's common for people
to stage symptoms to obtain and sell on their prescriptions.
It was a whole craze here as well that kids had to Google the six symptoms
what they needed to get Lyrica, and they got them,
and then they were selling them.
-They got them so easy off them.
-Just checking off this list?
Checking online what they needed,
and then they would have sold the tablets.
Some addicts deal to fund their habit,
but there are also dealers selling prescription drugs
alongside hard drugs on a bigger scale.
It's anger with what is seen as a failure to tackle dealers
that CADD uses to justify its dossier.
What it appears to show is the sheer scale of dealing taking place.
Revealed within its pages are names,
addresses, pictures and text exchanges
that can be traced to all corners of Northern Ireland.
It also shows that there are
over 30 alleged dealers seemingly pushing Lyrica.
But it is when it is taken with
a cocktail of drugs that it can be particularly dangerous.
Michael Hall was prescribed Lyrica
and began misusing it in his early 20s.
His parents felt helpless watching him fall deeper into his addiction.
His father, Robert, is haunted by one exchange.
And I says, "Look at the state of you - you're black."
And he was, like, all waxy.
He was just like a dead body in a coffin.
He says, "Daddy, I'll not do it no more, that's it finished."
But it wasn't.
His dependence got so bad,
his mother, Josephine, even drove him to his dealers.
Because, without the drugs, Michael was worse.
You would have taken him to get drugs because,
when he was on the drugs, the drugs helped him?
-When he came off them, he would have been in a bad way?
He would have been in a very, very bad way, shaking,
and, like, foaming at the mouth.
And what would he have been taking?
What, you took him out to get stuff like that?
I thought you told me it was only blue you were getting him.
I didn't know what he was getting.
But in April, aged 25,
Michael took a cocktail of drugs including Lyrica and diazepam.
He just kept on collapsing,
and he collapsed three times.
But I got him into bed, got his clothes off,
left his T-shirt and his boxers on, and put him into bed.
Michael had a seven-year-old son
and planned to see him the following day.
But he never woke up from his latest drug binge.
Michael was still warm when I found him.
He had fallen out of the bed
and looked as if he was trying to crawl to the door.
That's the shape he was in on the ground.
-As though he had been on all fours, almost?
-On all fours,
and his mouth was sort of stuck to the ground.
When you come out and you look up, do you...?
-Think of Michael?
-You think of him?
How have you been getting on?
I've never felt as lonely in my life.
I can't stick it.
When families lose a loved one in Northern Ireland,
many can end up here.
You work very closely with families who have been bereaved.
You sit at this table with them.
I met a family just last Friday - in fact, in this room -
who had lost their son as a result of Diazepam toxicity.
They were talking about how they had picked their son's cot for him
and his first buggy and his first bike,
and how then they had to go along and pick his coffin.
He also thinks more people need to be aware of the dangers of taking
a cocktail of prescription drugs.
Ten years ago, we would have seen one drug on a death certificate,
perhaps heroin, cocaine, ecstasy.
Now, we see regularly three, four, five, six -
mostly prescription drugs.
We have people who are taking what they consider to be
small levels of prescription medications,
but all those drugs are all building up to do one thing,
which is cause unconsciousness and then death.
He warns that when a person overdoses on prescription drugs,
they don't look like they're dying.
What we hear sometimes during an inquest is that
a person was snoring.
They are kind of displaying signs of being intoxicated.
People think, well, someone is intoxicated with alcohol,
put them to bed and they will sleep it off.
You don't sleep off, normally, drug toxicity.
You die, if you don't receive treatment.
The effects of prescription drug misuse are not just
a threat to addicts,
but frequently a source of real danger
to those who stand between them and their habit.
Over a career, I have been held up 11 times.
Terry Maguire, the pharmacist of two of the 37 who died
from drugs overdoses, is on that front line.
I had the point of a knife inserted into my nostril.
There was a gun produced.
And it was the first time
that I really felt my life threatened, in a sense.
Christopher, Michael and three others died on the same weekend.
Also at that time, two of Terry's nearby colleagues were attacked
with knives, for prescription drugs.
-The two staff who were stabbed,
were both pharmacists in the shop.
That reflects the degree of violence which we are increasingly seeing
from people who are robbing pharmacies.
Terry may be shocked by the escalating violence
around prescription drugs, but not by the deaths
of two of his patients.
Was death something that you genuinely anticipated?
Were you surprised?
I very much appreciate the dangers of misusing drugs
and therefore deaths don't come as a surprise to me,
they are tragic, but they aren't a surprise.
It is surprising we probably don't have more deaths.
Despite the violence and the deaths,
Detective Superintendent Bobby Singleton describes CADD's dossier
Their actions are entirely unhelpful.
They are, in many instances, I believe,
potentially frustrating either ongoing police investigations
or future police action
because they are alerting people to the fact
that there may be an awareness of their activities.
He says naming suspects endangers them.
The PSNI has a responsibility to anyone who they believe
is subject to a threat, to take action
in order, obviously, to protect them from any perceived threat.
So, what that does, in my view, is tie up police resources.
I'll, first of all, formally welcome
everyone here this morning.
Last month, Sinn Fein MLA Alex Maskey launched
an unofficial inquiry into the drugs epidemic in West Belfast.
We had what has been described as a "spike"
in the number of people who were losing their lives
to the scourge of drugs.
Whether that was the opioids,
as they call it, or the misuse of prescription drugs.
One of the many issues it hopes to address is repeated calls
from the community to see dealers jailed, not bailed.
There has been criticism against the PSNI,
and there has been criticisms against what people call
the revolving doors in the Magistrates' Courts and so on,
where people are walking away with lenient sentences and so on.
All of that is in the mix.
When at least 37 have died in just nine months, in Belfast alone,
some believe a key message support workers must teach
is simply how to take drugs safely.
Because what we are talking about is people taking drugs...
And, as you know, we live in the real world,
people are taking drugs.
So this is where we talk about making it safer.
This training at the Falls Community Council gives practical help to mums
from a community on the edge.
See, if you are going to use, this is what you need to know.
The reality is, this is what could happen.
We're back to hear if Sharon's boss got the funding for the centre.
The last time we were here, Gerry McConville
was sitting waiting by the phone.
-Has that call come through?
-No, that call hasn't come through.
The frustrating thing for the community
is that the little help there is on the ground is at risk.
I know that some of the families that we've worked with,
it has saved someone's life.
Most people say to us, "I didn't know that this place existed."
And the reason, probably, for some of that is because people...
We see a lot of people when they're in crisis.
This was exactly the situation
that Josephine and Robert were in with Michael.
In crisis, but unable to find help.
No matter who I phoned for help, um, I never got help.
People give you these numbers to phone
and you phone and the phone rings off or they'll get back to you -
they never do.
Lyndsey, this is Michael's room.
And this is...down here...
I found Michael...
But it's what the dealers who sold her son prescription drugs
did to him to ensure payment that also haunts Josephine today.
The beatings Michael took, the scarring on his body,
was out of this world.
And he was at Divis flats and they got a boiling kettle
and poured it over him.
And it was that coat that saved him.
It was... His stomach was burnt and his arm was burnt.
But he told me it was this hot water bottle and that hot water bottle...
There's fur over that, so how could he have got burnt?
Like Michael, for Christopher, dealers were his downfall.
Can you take me back to the Sunday night...when you last saw him?
Me and him sat talking.
He told me that day he was going to try to go off prescription drugs.
I know he left. He went to the Dublin Road.
He met his death there.
Patricia believes her son's final drug deal was done
in the centre of Belfast.
He went behind a wall, where he met his death, really.
And the deal was done in five minutes.
I'll never forget my sister-in-law coming here to get me
and I remember just squealing at her,
"Please, don't tell me my child is dead!"
And she kept saying, "They're working on him,
"they're working on him."
Begging the ambulance men, "Please, try... Help, please."
And they were saying, no, he was dead.
You hear the word "drug dealer" and you think - cocaine, heroin.
It's stark to think that there's prescription drugs in their hands.
Guy Spence is appalled by how many dealers now
peddle prescription drugs, but he is also shocked
by our figures that highlight the growing prescribing
of pregabalin, or Lyrica...
It's my generation
who is going to be affected by the use of these drugs,
..and, as a result, is calling for serious change.
I do think that the parameters for prescribing drugs
within the whole of the UK needs to be reassessed and reconsidered,
taking into account the effects of Lyrica.
Pfizer, which devised Lyrica,
told us the drug was found to be...
..for neuropathic pain, epilepsy and anxiety.
It said it had updated its labelling for Lyrica in 2014,
following a European review, and products carry warnings
about the risk of dependence, misuse or abuse in patients
with a history of substance abuse.
It said it would take part in the Home Office consultation
over plans to classify pregabalin as a Class C drug.
It is absolutely essential that, within Northern Ireland,
this review takes place because there is a quite dramatic increase
in the prescription of those medications.
In a statement, The Health and Social Care Board said it,
"recognises we have an issue that..."
It said, "There is an onus on GPs to prescribe drugs in accordance
"with symptoms reported by the patient.
"And while that relationship could be exploited,
"GPs are aware of the risks and exercise diligence."
It said it, "regularly monitors prescribing" and it has made calls
"for consideration to be given to more stringent controls
"over supply of the drug and its classification."
Deirdre Lennon lost her 19-year-old son
to a cocktail of prescription drugs two years ago.
Coamhan's death prompted the then coroner to say
he was increasingly concerned about toxic combinations
of prescription drugs.
-Can you actually see Coamhan's grave from here?
Every morning, Deirdre is confronted by Coamhan's memory.
See, one, two, three
-four, five, six down?
It's the middle grave, with the Bible on it and Our Lady.
As soon as I open my eyes in the morning...
Now, her only surviving son is fighting
his own addiction to drugs like Lyrica.
When we meet her,
she says she believes that he has not used for two weeks.
He's just...he's just existing.
I mean, um...
Rarely goes out. Never leaves the room.
It's just in my mind that I'm going to find him the same way,
if he doesn't stop the tablets.
And do you ever worry that...?
Yeah, every day.
Every day and every night. You just...
Cos you don't know the minute.
Just hoping and praying.
And I pray every day
that it doesn't happen again.