Prescription Drug Abuse, or pill addiction as it is commonly called, and, ultimately, ‘pill withdrawal’ have been with us since doctors began prescribing drugs, but has become more widespread since the advent of the ‘repeat prescription’ or ‘refill’, whereby patients can have a prescription renewed without having to visit their doctor. This can be as simple for many people as visiting a pharmacy and filling out a form giving their name, address and the drug they want. This is then returned to the surgery for the doctor to countersign. The problem is that these can often be signed as routine, rather than consideration being given to the need, and so facilitating prescription drug abuse.
If a certain patient begins to request repeats more often, would this be noticed? Theoretically it should, but in practice it is frequently not. Not, that is, until the next review. Frequently, twelve repeats are allowed before the patient must again speak to the doctor personally to review the treatment. Prescription drug abuse, and resultant pill withdrawal symptoms, are generally overlooked by the medical profession.
The type of prescription drugs which lead to pill addiction are wide and varied, and not just tranquilisers such as diazepam (Vallium) and nitrazepam (Mogadon). Common ones are codeine and codeine-containing painkillers such as cocodamol, and even over-the-counter codeine based painkillers such as Solpadeine which has its own addiction support group. Most prescription drug abuse is of one or other of these two types of drug: tranquilizers or painkillers. Tranquilizer pill withdrawal is very common in developed countries.
People involved in prescription drug abuse show any of a number of symptoms which are common to all patients suffering from pill withdrawal.
The main symptom of pill addiction is an increased tolerance to the drug, so that the user needs an increased amount to get the same effects they were used to. More and more of the drug is required, and four times is not uncommon. This leads to many problems, not the least of which is that it becomes difficult to control the symptom for which the drug was being taken in the first place. For example, it becomes increasingly difficult to control pain.
Those who suffer from pill addiction have not done so deliberately. Unlike other drug addicts, they have not taken increasing doses simply to get a ‘buzz’. It happens to them gradually, over an extended period of time taking the same drugs to treat their condition. Cocodamol is commonly used in the treatment of arthritis, for example, and prescription drug abuse in such cases is hardly abuse in the real meaning of the word.
The pain-killing effect reduces as the body becomes more and more used to the drug, so the patient must take more or suffer increasing pain, resulting in pill addiction. It is not deliberate, but once it starts the patient can often do little about it due to the pill withdrawal symptoms compelling them to keep taking more and more. They know it is wrong but can do little about it, and try to hide how many they are taking from their family. They reach a stage where they are frightened to admit it, and are terrified to ask their doctor for help in case the drugs are stopped altogether.
Prescription drug abuse leads to physical dependence, and the person cannot function normally without a supply of the drug. The body adapts to the presence of the drug and can function while it is being supplied, but once the course of treatment is over, the patient suffers from pill withdrawal symptoms. These can be severe, including physical illness, mood swings and aggression, and depression. Ultimately pill addiction can lead to death through overdose. Paracetamol based painkillers containing codeine, for example, can be dangerous. The patient overdoses for the codeine content, but the paracetamol is insidious and can cause severe liver damage over a period of time.
The most obvious sign of prescription drug abuse is that the persons affected cannot stop taking them. They will increase the frequency of presentation of repeat prescriptions on a pretext such as needing extra since they are shortly going on holiday, or will resort to doctor hopping. The internet has also made it easy to purchase prescription drugs online, without a prescription from the patients own doctor being required. As has been previously explained, this type of pill addiction is not their fault and more could be done to control the circumstances which cause it.
Doctors, and in some cases the pharmacists, should be aware of the potential problems of long term use of such drugs, and give advice and help once the time has come to stop them. The dose should be reduced gradually rather than suddenly stopping the supply. Prescription drug abuse and pill withdrawal are becoming a serious problem in otherwise innocent law-abiding people. It should be possible to find a means of regularly changing the chemical nature of the drugs an individual has been prescribed with in order to reduce the possibility of this type of pill addiction.
Once dependence has been confirmed, or better still, admitted by a patient, steps can be taken to treat the addiction. Kicking prescription pill addiction is not easy, but better than a lifetime habit, and the doctor can help make it easier to achieve by using gradual withdrawal techniques.
Copyright 2006 Peter Nisbet