Prescription Medicines in the Dock – Who is to blame for the increasing drug deaths in our society?

Ireland bucks the UK trend in drug overdose deaths; here they are more likely to result from “prescription medicines” than “illegal drugs”. Coroners locally implicate; tramadol, oxycodone or fentanyl in overdose more frequently than in England, Scotland or Wales where deaths are mainly linked to; heroin or cocaine. One implication is that prescription medicines are more readily available and, extending this logic, doctors and pharmacists are in some way involved; if we did our jobs better drug deaths would be fewer.  But another explanation is that our patient lobby groups, in their naivety and in what they see as promoting patients’ interests, are inadvertently creating the problem.

Drug deaths are more common where patients are addicts and opioids, either from prescription medicines; codeine, morphine, fentanyl, tramadol, or from illicit drugs; heroin and carfentanil, are the most likely cause.  But for addicts the source is unimportant; from a pharmacy dispensed by a pharmacist in a white coat and produced by a Fortune 500 Company or from up a dark alley, sold by a bloke in a hoodie and produced by a South American Cartel.

In the US last week, for a change, President Trump did something right and declared the US opioid addiction crisis a “public health emergency”.

We can be the generation that ends the opioid epidemic,” he said, adding somewhat Obamaesquely “We can do it.”

State-side drug overdose death is a massive problem.  More than 64,000 US citizens died in 2016, the figure was 33,000 in 2015 and from 1999 to 2016 was 200,000; a majority linked to opioids.

America has a problem yet the President, having done possibly the only good thing of his presidency in calling the emergency, could not help himself and quickly returned to type.

An astonishing 90 percent of the heroin in America comes from south of the border where we will be building a wall,” he said.   I am not disagreeing with the amount of illicit heroin coming from the Americas but  I disagree that the main drug killing US citizens is illegal heroin. Yes, it kills Americans but the main drugs are those manufactured in the US by the Pharmaceutical Industry providing good-paying American jobs.  Oh the irony!

The explosion of US addiction deaths is linked to the:  Ensuring Patient Access and Effective Drug Enforcement Act, an Act strongly lobbied for by the Pharmaceutical Industry.

The background to this Act is the mobilisation of patient groups to lobby claiming there was an “unmet need” for better access to pain treatments and following the Act more people were treated with more and stronger opioids.  Some became addicted, continued use under the guise of medical need and often took more as tolerance kicked in.  They also, when necessary use illicit heroin but ultimately the source of their addiction and overdose deaths, is “prescription medicines”.   Congressman Tom Marino was a lead advocate on the Act and understandably in the face of criticism, he has had to rule himself out when The President identified him as a possible Drug Czar.

And yet “unmet need” in pain management was false; objective pain measurement in US citizens did not increase between 1999 and 2016.  In this time-frame prescriptions for oxycodone, a powerful prescription opioid, quadrupled as did oxycodone related deaths.  It seems that “unmet need” was merely a marketing ploy to increase medicines sales and industry profits.

We are experiencing a similar problem; not yet on the US scale thank goodness.  But patient groups with direct support from Big Pharma are lobbying and more and more patients are getting unnecessarily exposed to more and more powerful opiates.  We are seeing a rise in the numbers addicted and as a consequence, we will begin to see a rise in drug deaths.  And this is a problem compounded by poverty and social inequalities where the poor will suffer disproportionately.

Doctors and pharmacists do their best to counter this surge in demand but we are powerless to kick back against the persuasive posturing of the lobbyists.  N. Ireland might be bucking the UK trends in what opioids we use but sadly, unless something is done, we will not buck the US overdose death trajectory.

I am a pharmacist in Belfast.