Prescription pharmaceuticals are not always our friend, writes JOHN RYAN
Whitney Houston's death has been linked to the benzodiazepine drug marketed as Xanax. Whatever emerges from the results of toxicology tests the message is that pills are not always your friend. With the array of potent prescription and over-the-counter pharmaceuticals we cannot afford to get complacent about taking them.
Benzos can be overused because they affect our mood. If you're feeling anxious, pop a pill. Whitney Houston was reported as saying she took a Xanax before a performance to relax. Xanax has been singled out as a particularly habit-forming drug because it takes effect quickly and wears off fast. Over time it reduces production of our body's own natural sedative, a substance called GABA. If users stop taking Xanax it takes several days for the body to resume producing GABA. In the meantime the withdrawal symptoms are frightful: panic attacks, high blood pressure, racing heart beat, tremors, confusion and seizures.
Two years ago the Medical Practitioners Board warned doctors that Xanax was basically causing more trouble than it was worth and urged GPs to use other means to treat anxiety and panic attacks. Sedatives were often over-prescribed in years past and serious problems ensued.
Just last week a colleague was struck down with severe back pain, a condition that was diagnosed as a pinched sciatic nerve. He was prescribed an opioid drug called Tramadol. Within five days and only halfway through the prescription he is already recognising symptoms of opiate dependency: sweating, nausea, anxiety, and the early stages of the flu.
He was only able to identify the signs of an emerging addiction because of his experience with the drug sector, but most people do not have this level of awareness and can easily become dependent. Another of my staff remembers how as a teenager he was prescribed Valium in sufficient quantities to make him pass out after the day's breakfast dose. It led to decades of drug problems.
Such perilous prescribing may be a thing of the past, but prescription drugs are overtaking heroin as a cause of addiction. The Sydney Medically Supervised Injecting Centre has reported that since 2006 prescription opioids - painkillers - have overtaken heroin as the drug of choice for visitors to the facility.
Heath Ledger died from a combination of prescription painkillers and sedatives that included Xanax.
As arguably the most prominent Australian to die from drug overdose it is easy to pigeonhole the problem as one limited to celebrities and not an issue to concern the average Australian. But that is far from the truth.
Chronic pain is a common avenue middle-class Australians take down the road to painkiller abuse and addiction.
Studies show that in Australia, New Zealand and Europe, five to 10 per cent of patient inquiries at doctors are about severe, persistent pain. In the decade and a half until 2007 prescriptions for opioid painkillers rose threefold to 7 million a year.
Accordingly opioid-type painkillers have swarmed on to the market. Over the same period the number of strong painkillers available has risen from 11 in 1992 to 70 in 2007. It may be because there are more cancer patients under treatment or doctors are just more ready to prescribe addictive drugs.
Pharmacists are worried at the popularity of over-the-counter painkillers. The clients they have who are repeat buyers are mums and dads and not the type normally associated with drug abuse.
We recently ran a Victoria-wide series of training seminars on what we refer to as ''harmaceuticals''. It was completely overbooked as hundreds of people from health services, drug treatment agencies and even police are struggling to understand and deal with the alarming rise in pharmaceutical drug addiction, including increased injection of opioid-based drugs such as MS Contin.
The Pharmacy Guild in Victoria has been calling for a mandatory real-time, online reporting system for ''problem'' drugs.
Tasmania has such a system operating to deal with an alarming pharmaceutical abuse problem there.
Pharmacists built a national network some years ago in response to the diversion of pseudoephedrine from cold remedies for clandestine amphetamines production. For some time they have wanted it to include opiate-type painkillers as well because of reports that common brands like Nurofen Plus are injuring people if taken to excess.
In recognition of the dimension of the problem the Gillard Government this week agreed to spend $5 million on a pharmacy-based monitoring system aimed at opioid drugs. It will enable pharmacies to detect people trafficking in forged prescriptions or ''doctor-shopping'' - visiting many doctors in sequence seeking restricted drugs, the Minister said in a release.
Pharmacy Guild members have applauded the move but say it is a half-measure. Chemists say the plan should also cover doctors to alert them to patients doctor shopping.
Drug links to celebrity deaths are grist to the mill for a public seeking sensational revelations about the glamorous lifestyles of the inaccessibly famous.
But for those involved professionally in reducing the harm from drugs of all descriptions the danger to the wider community is that it may be becoming too complacent about the danger lurking within medicine cupboards.
John Ryan is CEO of Anex, a public health organisation specialising in illicit drug policy.
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