Pubdate: Sun, 09 Jun 2002
Source: Scotland On Sunday (UK)
Copyright: 2002 The Scotsman Publications Ltd.
Contact:  http://www.scotlandonsunday.com/
Details: http://www.mapinc.org/media/405
Author: Orla Heron

ADDICTED TO LEGAL SUBSTANCES

THE crumpled ?10 note clutched in her shaking hand, Andrea McKay shudders 
as she feels the effect of the drugs beginning to wear off. She hands over 
the money, rips the wrapping from the packet she is given and gulps down a 
handful of the pills it contains.

McKay has driven more than a hundred miles, but not for a meeting with drug 
pusher in a dingy squat. Instead, she has travelled halfway across Scotland 
to make a purchase that is perfectly legal.

The 51-year-old business executive from Glasgow is one of a rising number 
of Scots who are addicted to over-the-counter medicines. She has just 
bought a packet of pain-killers at a high street chemist.

For most people, cough medicines and pain-killers provide welcome relief 
from a cold or a bout of the flu. For others their use is more than 
temporary and they find themselves hooked on the pills and liquids for years.

Once the addiction has taken hold, going without the medicines can lead to 
a harrowing array of withdrawal symptoms, including depression, mood 
swings, headaches, nausea and constipation. In some cases the addiction can 
even kill by causing fatal epileptic seizures.

The medical consequences of becoming hooked are also significant. While 
short-term effects are similar to those suffered during withdrawal, in 
longer term addicts these can intensify into Chronic Daily Headache 
Syndrome and chronic constipation, or even cause gastrointestinal disorders 
and ulcerative colitis.

'I'm treating someone on 32 painkillers a day. He is addicted to the 
opiates in them. The paracetamol is severely damaging his liver'

McKay, who has asked for her name to be changed, has previously only 
revealed her addiction to her husband. She has been hooked on the 
codeine-based pain-killer Cocodamol for three years.

"I can't buy the medicines where I live because my husband has begged our 
local pharmacist not to sell them to me any more," explained McKay. "I 
drive all over the country, to Ayr, Stranraer and Alloa, to get Cocodamol. 
I can't tell my GP because he plays golf with my husband and it would just 
be too embarrassing."

McKay's situation is unusual but not unique - she is just one of an 
estimated 10,000 people in Scotland who are addicted to over-the-counter 
medicines (OTCs). The problem has a low public profile compared to illegal 
and prescription drug addictions but that is because most addicts are too 
embarrassed to admit their problem. And yet the most recent survey on the 
problem shows that Scotland is one of the worst affected areas in the whole 
of the UK. Only London was found to have more addicts than Strathclyde, 
principally due to the fact that it has a much larger population.

What is unusual about this trend is that, unlike stereotypical 'junkies' 
who lose their job, family, and even home, OTC addicts are generally well 
heeled, middle class people who enjoy positions of prestige in society. 
Whilst drugs like heroin and cocaine are taken with full knowledge of the 
risks entailed, the majority of people who become dependent on painkillers 
and cough medicines do so initially to treat a genuine medical complaint. 
They end up enjoying the benefits so much they find they cannot stop.

The social mapping of OTC addicts makes for interesting reading. Two thirds 
of sufferers are women, mostly 20- or 30- something housewives whilst men 
are generally 20 years older and enjoy executive or professional positions. 
Having access to a car would also seem to be a crucial factor since most 
addicts find themselves banned from their local pharmacist and have to 
spend an average of ?1,250 a year travelling a total of 4004 miles to get 
their fix.

David Grieve from Dumfries is an ex-addict, who at his worst was downing 90 
bottles of cough mixture a week.

He set up Over-Count in 1994 to help fellow sufferers and he has his own 
theory as to why Scotland has such a problem. "Part of it could be the 
Scottish weather," he said, "which means that people are more vulnerable to 
coughs and colds. People take them to help with pain but because they also 
make them feel good they keep taking them. And because the tablets are not 
on prescription, people don't realise how dangerous they can be."

The most commonly abused substances are those which are based on codeine, 
which is an opiate. Some 10% of the medicines are converted to pure 
morphine in the brain. Taking eight tablets of certain over-the-counter 
pain-killers in one day means ingesting the same amount of morphine as a 
heroin addict would absorb from shooting up once a day.

Dr Brian Kidd, a consultant psychiatrist with the Community Alcohol and 
Drug Service in Forth Valley treats a number of OTC patients. He says this 
form of addiction is in some ways more dangerous than more common cases of 
drug abuse.

"The thing that people become addicted to is the codeine in the drugs, but 
the problem with pain-killers is that they contain paracetamol as well. I'm 
treating someone at the minute who is on 32 pain-killers a day. He is 
addicted to opiates in the tablets but the paracetamol is severely damaging 
his liver in a way that purer opiates wouldn't."

Kidd contends that part of the problem lies in society's attitude to drug 
taking. Because of a general aversion to drug addicts, most are loathe to 
admit they require similar treatment and few admit themselves to support 
clinics without a considerable amount of encouragement. Advisable though it 
may be to seek help from any qualified health practitioner, time 
restrictions and a lack of understanding on the part of GPs means that a 
trip to the local doctor is generally unfruitful. The solution, he says, is 
in a better system of public information.

Some drugs groups believe that ambitions to raise public awareness have to 
be kicked off by the pharmaceutical industry itself. Over the last 10 years 
over 50 substances have been switched from prescription to over the counter 
sales and at present not a single chemist medicine carries a warning of 
dependency on the packet.

But the Proprietary Association of Great Britain, which represents UK 
pharmaceutical manufacturers, claims printing a warning on the box would be 
effectively informing and encouraging people to experiment with the 
medicines in new ways.

The Committee for the Safety of Medicines says the current regulations on 
over-the-counter medicines are sufficient and there is no need to tighten them.

Meanwhile, Alison Strath, chairwoman of the Royal Pharmaceutical Society in 
Scotland, said that even if the figure of 10,000 sufferers in Scotland is 
accurate, it represents a small proportion of the population to be classed 
as a serious problem. "I don't think it is anywhere near the scale of 
alcohol or cigarette addiction in this country. Even the misuse of 
controlled drugs such as heroin is a bigger problem."

She is particularly concerned about the danger of scaring off those who 
would use the products in a safe and beneficial manner and argues that most 
people are capable of knowing how to take medication safely without 
becoming addicted. The need to lighten the burden on GPs and the advantages 
of self treatment are seen to outweigh any action in the name of so few. 
She contends that the current practice whereby pharmacists are aware of the 
'danger' medicines and are encouraged to look out for potential abusers is 
effective enough to help those in trouble.

The British Medical Association on the other hand, recognises this to be a 
real and worrying problem. The chairman of the BMA's Scottish council, Dr 
John Garner, said he was disappointed with the lack of information that is 
made available to both GPs and patients alike.

"Misuse of over-the-counter drugs is becoming more common," he said. "GPs 
are aware that certain drugs can induce dependence and, along with their 
colleagues in pharmacy, provide advice to patients regarding managing their 
medication. However, we are disappointed in the progress made to date by 
the government in providing information to GPs and patients to raise 
awareness of this problem."

At the moment relatively few drug support services deal with OTC addicts in 
Scotland and many GPs do not have an established method of detection or 
treatment.

As with most addictions the dependencies are both physical and 
psychological and addicts have to undergo a full detox programme in order 
to become 'clean ' again. The Over-Count charity offers a three-stage 
programme which involves noting down how many drugs you take in one day to 
become aware of the extent of the problem, changing your way of life, and 
gradually weaning yourself off the medication. Other drugs clinics 
prescribe the sort of detox programme well known for the treatment of other 
drug users.

Abruptly eliminating the drug from the system can be extremely dangerous. A 
Solpadeine addict for example, could suffer from what is known as "Status 
Epilepticus" which is similar to an epileptic fit except that once the fit 
takes hold, it gives way immediately to another and another, and can result 
in death.

For many of course, the best cure lies in prevention. Some people want to 
see a system of registration with pharmacists whereby you can only obtain 
certain medicines from one single pharmacist who is then able to monitor 
your consumption. Others believe that only a tighter regulation on the 
types of medicine that are readily available will have any significant 
effect. Yet others feel an effective solution would be to withdraw all 
medicines from places such as supermarkets and petrol stations.

Being banned from all the pharmacists in her area didn't stop Andrea McKay 
from feeding her addiction. It simply meant she had to go further afield 
for the 60 tablets a day on which she relied.

She is now down to 36, and the back pain which kick-started her dependence 
has gone, but the damage done to her liver and stomach have yet to be 
determined.
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MAP posted-by: Larry Stevens