Prescription Medication Abuse in Ireland
SSRIs Replace Benzos as Mother's Little Helper
Prescription medicine addiction is affecting an increasing number of Irish families and, like all addictions, no section or strata of society is immune from its insidious grip. Whether it is the housewife with a repeat prescription for Diazepam; the young Mother hooked on codeine-based A\analgesics, since it was first prescribed post-childbirth; or the affluent worker relying on over-the-counter (OTC) painkillers to pass the day, all are part of a nationwide trend. Surveys of drug trends repeatedly indicate that health-care professionals in Ireland, are currently facing a growing number of patients presenting with prescription medicine addiction problems.
The prevalence of legal and prescription drugs used in Ireland is reportedly rising at a similar rate to street narcotics use. To a certain extent, prescription drug abuse has been a constant here, but it has been only relatively recently that it has been recognized as a problem per se and given the serious attention it deserves. So-called 'legal highs' and research chemicals are also becoming extremely popular with young people, often as young as school age, who can just about afford to score these readily available substances, presumably with pocket money or using part-time job wages.
In the past, especially during the period known as 'The Troubles', Doctors were often happy enough to prescribe benzodiazepine-based anxiolytics and hypnotics as well as anti-depressants for problems whose cause it was well beyond their ability to treat. This should also be viewed in the context of the universal prescribing practices of the 1970s when 'benzos' were far from being the pharmaceutical pariahs that they are fast becoming today. We have all seen the old adverts by pharmaceutical giant Roche for Valium as "Mother's little helper", which declared that their product enabled one to "do the housework with a smile!"
Nowadays, benzos and opioid analgesics are on most doctors' de facto blacklist, but they will usually hand out prescriptions for Selective Serotonin Re-uptake Inhibitors (SSRIs) quite freely. The likes of Prozac (fluoxetine) or the slightly different Effexor XL, which affects both dopamine and serotonin, are regularly prescribed in Ireland. SSRIs are still prescribed during a patient's first presentation for what constitutes mild clinical depression, despite worrying findings from SSRI research conducted in the USA, not to mention the dangers of serotonin toxidrome when other CNS-affecting medicines are being used together with SSRIs. This is further proof that we should never underestimate the power of the pharmaceutical industry in a physician's prescribing practice.
There had been, until recently, no real demonstrative street-level demand in Ireland for the likes of Oxycontin (oxycodone), which has the street name Hillbilly Heroin in the USA, until the seizure of £750,000 of generic oxycodone allegedly sourced from the Asian subcontinent in August 2014 bound for Ireland. Oxycontin contains oxycodone in a sustained-release form and comes in 10 mg, 20 mg, 40 mg, 80 mg, and even a 160 mg strength. Users crush or chew the tablets to negate the sustained-release coating and will experience a 'rush' similar to IV use. Oxycontin users often crush tablets, then 'cook up' the pills for IV use, in a similar fashion to IV heroin users. There has been an Oxycontin addiction explosion in the USA, where black-market dealers can charge roughly a dollar per milligram when selling the tablets.
However, there would be a niche market in Ireland, for these more potent opioid analgesics in pill form, but it is still relatively small and they would not be widely available on the black market as yet. This again may be due to the reluctance of GP's in Ireland to adhere to the same prescribing practices as the USA, where pharmaceutical giants Purdue has, arguably, been the author of the Oxy pain-pill addiction explosion. IV opiate users would be the main market for illicit oxycodone pills in Ireland.
In the USA, Oxycontin's licensees Purdue are currently being sanctioned by the FDA and are the subject of litigation, for quite incredibly, marketing Oxycontin as a non-addictive opioid painkiller. Recently, they have come up with a non-crush-able and therefore less 'attractive' version of their popular sustained release painkiller, although their instant release and therefore non-crush-able version, has been prescribed here in Ireland, under the brand-name, Oxynorm. Oxycodone is prescribed in Ireland, usually in palliative care but hydrocodone, which is less potent than oxycodone and the active ingredient in Vicodin, Lortab, etc. is not usually available on prescription in Ireland or the UK.
The reality, especially in the North of Ireland's largest urban area, Belfast, is that there is a thriving black market for prescription medication. This is due largely to poverty-driven addiction and the fact that many GP's are doing their uppermost to discontinue, or closely monitor, longstanding patient repeat prescriptions, for the likes of Benzo drugs such as Diazepam, Temazepam or weak Opioid analgesics like Codeine.
Prescription-only 30/500 co-codamol (brands: Kapake, Tylex, Solpadeine, etc) or the synthetic opioid, Tramadol, are also changing hands at street level. In working-class areas of Belfast, the likes of Diazepam, Temazepam, DFF118's (dihydrocodeine instant release tablets) and even the 'Z Drugs' sleeping tablets, zopiclone (Zimovane) or Stillnocht are regularly changing hands at the going rate of £2.00 per tablet. There have been anecdotal reports that the potency of the various Tramadol generics varies widely, to the extent that placebos are often suspected, though this is highly unlikely.
Users also orally crush the sustained/time-release tablet form of dihydrocodeine (which is usually prescribed as DHC Continus, in 60mgs, 90mgs, and 120mgs dosages) for an instant release effect similar to the method used to negate the timed-release feature of Oxycontin. However, the timed-release version of dihydrocodeine aka DHC, due to its pharmacological profile/make-up, would be highly unsuitable for 'cooking-up' for IV use, with abusers potentially facing instantly lethal consequences such as pulmonary edema.
Viagra (sildenafil) is reportedly retailing for £5 a tablet, from similar sources. Illegal dealers situated in Israel and India have been shown to be the source for much of the counterfeit Diazepam tablets, currently being sold by street-level dealers, linked mostly to Loyalist paramilitary groups. Several deaths have been recorded due to the unregulated and therefore, often adulterated nature of their products.
Dr. Damian McNally of the busy Ormeau Health Center inner-city practice has created groundbreaking studies into prescription medicine addiction and other related illnesses, including Diabetes 2. The practice is one of the few with a dedicated Addiction GP and nursing support team. Further uptake of Dr. McNally's programs across more of the Health Service would be greatly welcomed by patients and staff.
Over the Counter
Over the counter (OTC), non-prescription medicine is also a popular source for those seeking legal highs. Low dose codeine preparations are popular with abusers, although with 500 mgs of acetaminophen/paracetamol being a legal requirement to be included in these preparations, abusers can risk serious liver damage or even death, in exceeding the recommended dose.
No doubt some customers, in the pursuit of harm reduction, strain the harmfully toxic acetaminophen/paracetamol via Cold Water Opioid Extraction methods readily available on the internet, from these low-dose codeine products.
A local dentist who became hooked on the non-prescription OTC painkiller, Paramol, which contains a low dose of dihydrocodeine (7.5 mg), reported that he had been consuming 64 tablets per day! This would have amounted to a whopping 32 grams of paracetamol to be passed through the liver. It has been argued that the high doses of paracetamol, which according to government regulation must be included in OTC codeine products, supposedly to prevent abuse, are clearly harming users.
Cough suppressants are also routinely abused. Pharmacies can sell non-prescription Codeine Linctus preparations, provided they are under a certain mg/ml ratio, although most pharmacies prefer not to carry it in OTC form, opting for the less potent Pholcodine Linctus preparations. The brand Gees Linctus is also popular with opiate users, due to it containing tiny amounts of Tincture of Opium, though only a few Pharmacies stocks it nowadays. The various Anhydrous Morphine/Kaolin stomach upset medicines are often purchased by OTC abusers.
Other cough medicines that contain Dextromethorphan Hydrobromide (DXM) such as Covonia Bronchial Balsam, are popular with younger 'tweakers' because of DXMs psychoactive potential. Users report experiencing dissociative Hallucinogenic trips. Antihistamine based OTC hypnotics such as, Phenergan, Nytol, Sominex, and even Piriton, are popular with patients who cannot persuade their doctors to prescribe more orthodox sleeping aids or sedatives, although some users often substitute them as a non-benzodiazepine anxiolytic.
Legal Highs and Research Chemicals
So-called legal highs and research chemicals are growing in popularity in the North of Ireland, especially among young people. A booth in a local shopping center was openly and quite legally, selling Herbal Ecstacy and Kratom leaves, which are a mild, herbal cannabis substitute. Also readily available are Herbal Speed and a plethora of so-called other legal-highs, including various strains of hallucinogenic mushrooms. Many of these products were found to contain various forms of the substance ephedrine, a stimulant that is popular with slimmers and bodybuilders, because of its energizing effects, combined with appetite retardant properties.
Recently some young people in North Belfast had come across an outlet selling near industrial amounts of the local anesthetic, Lidocaine, which was being sold, semi-legally, as 'Legal Cocaine'. Several shops in Belfast city center alone carry these so-called 'Legal-high' products, many of them in shops popular with teenagers such as Emo/Indie music stores and clothes shops.
The no longer legal-high substance known as Mephedrone was extremely popular in Ireland and the UK, for its cocaine-like effects. Retailers of this product got round the legalities by selling it as bath salts, or even plant food, which was not overtly for human consumption. A shopkeeper in Derry who sold so-called legal-highs was badly wounded in a gun attack by anti-drugs vigilantes linked to RAAD (Republicanism Action Against Drugs).
Online pharmacies have a huge market in Ireland, partly due to prescribing directives that have left patients without medications they have come to rely on. Some online pharmacies are operated by regulated and perfectly legal high street outlets, such as Boots. So-called Email-Sources, often based in Romania, Ukraine and Israel who operate without a visible website, are reportedly the real villains of the piece, often operated by fly-by-night, unscrupulous criminal elements.
Very few, if any, of the mainstream online pharmacies, sell controlled medication, such as Oxycontin or Vicodin. The more reputable sites are endorsed by physicians, as a cost-effective alternative for filling 'private' prescriptions. Increasingly, online pharmacies from the Asian subcontinent have stepped into the void, given the mushrooming of generic pharmaceutical manufacturers in the region who have much fewer restrictions or product tracers relating to controlled medicine. Many of the internets mail-order prescription medicines are counterfeit, containing only a fraction of the active ingredient or be little more than placebos (and possibly even worse!)
Harm-Reduction and Regulation, Not Prohibition
Any addiction invariably raises far more 'questions' than definitive 'answers.' It would be fair to say, that there certainly is an ever-growing black-market for prescription medicine in the North of Ireland. Paradoxically, many who would be hopelessly dependent on them would be outraged if one were to suggest that they may have a dependency problem. This is due, in no small part, to the stigma of addiction to anything non-alcoholic that prevails in Ireland. Because of the widespread trauma experienced by victims, families and indeed combatants during the conflict in the North, there are many people who have been forced to cope with a chemical crutch.
It is only fairly recently that benzodiazepine dependency, for example, has been treated with anything like the gravity it deserves, but unfortunately, there are few treatment programmes available in Ireland. Roughly a quarter of outpatients presenting at local community addiction centers are citing prescription medication dependency as their primary problem and the figures are unlikely to abate in the foreseeable future.
The other variable to be taken into consideration, with frequently abused medicines, is that they all have genuine medical uses and in the supposedly enlightened 21st Century, no one should be in pain or mental distress on the basis that they, just might, be getting an illicit buzz off their meds. Furthermore, the levels of prescription medication abuse in Ireland are still dwarfed by the high levels of alcohol abuse, which still remains the ever-present 'elephant' in many Irish living rooms. It is worth noting that 'prohibition' as a concept and measure to prevent abuse of any 'drug', whether it is alcohol (the USA in the early 20th century) or narcotics, has been an abject failure. Increasingly, regulation and harm-reduction are appearing more attractive options in, what is, after all, an imperfect, some would say sick, world.
Help Is Available!
Online Links for Help With Addiction
- Alcoholics Anonymous Ireland
Alcoholics Anonymous is a fellowship of men and women who share their ... Find out more about AA meetings in Ireland, our publications and literature
- Northern Area Narcotics Anonymous
- Northern Ireland Community Addiction Service | Minding Your Head
Treatment for people with drug or alcohol problems, delivered in community settings. Confidential support for people affected by someone else’s drinking or drug use. Also specialist services for older people and their carers
- Belfast Community Addiction Service (BCAS) | Northern Ireland Drug and Alcohol Services
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© 2019 Liam A Ryan