“A quick smack never did me any harm.” So said my gran.
This week, the bottoms of Australia’s doctors got a collective smack. We had been asked nicely but we wouldn’t stop; we were threatened with the naughty corner, but still we carried on.
For years we’d been told we’re prescribing too many opiates, people are dying, be more careful. Did we listen?
If we did, we didn’t change what we were doing. In 2016-17 (the latest year for which figures are available), 15.42 million scripts for opiates were dispensed, a rise of 11% (on a per-capita basis) compared with 2012-13.
For many years Australia has had a prescription medication crisis. Between 2010 and 2016, 8421 people died due to prescription opioids. When you realise that in the same period 1721 people died from heroin overdose, it’s clear our prescription medications are doing a lot of harm.
Also in the same period 8769 people died on Australian roads. And just as with road deaths there are dozens — not counted — injured and traumatised, so it is with prescription medication misuse.
‘The drugs stole my soul’
Drug addiction, whether licit or illicit, is a full-time occupation for many sufferers; it dominates their lives. “The drugs stole my soul,” was how one recovered user put it to me.
So we got the smack we deserved. From Monday June 1, standard pack sizes for most opiate medications were reduced. If we want to prescribe larger quantities, or the stronger opiates, the hoops we have to jump through are higher and tighter. If we want the fortius, we now have to go altius — which will be tardius, not citius. Smack.
Doctors often blame patients, and it’s easy to see why. Once hooked, many become desperate and resort to subterfuge and, at times, threats. The drugs become like oxygen — without them, they can’t breathe. If your head is held under water you’ll scratch, claw and do anything to get free to take that breath. So it is with addiction.
But just as the longest journey starts with a single step, the road to prescription medication addiction starts with one script. One that a doctor has issued. Followed all too often by a second, and a third…
We write the scripts, and we have to accept responsibility for knowing when not to write them. So far we have failed.
Reducing access generally reduces use. Make cigarettes more expensive, fewer people smoke. When codeine went prescription-only last year, its use dropped by 50% — as did the rate of codeine overdoses.
Since we doctors were doing nothing to stop people’s access to opiates, it’s been done for us. I suspect this is one time my gran was right: this smack won’t do us any harm, and it could just do others a lot of good.