For 34-year-old Louise*, it all started with a twinge in her lower back four years ago. Her GP recommended she start taking paracetamol and ibuprofen to cope with the pain, but after 12 weeks she knew she needed something stronger. Feeling increasingly fed up with the ongoing discomfort, she describes breaking down in front of her doctor. Louise was prescribed co-codamol, a mixture of paracetamol and the highly addictive opiate codeine, and just over a month later, the more potent tramadol.
"I was in pain," Louise tells Refinery29, but it was her mood and state of mind that benefited most from the pills – not her back. "The drugs were helping by making everything feel numb, so I could cope with the daytime and cope with life." Despite clearly communicating her despair and melancholy to her GP, Louise says she was never asked about her mental health or if she was on antidepressants during her back appointments. She remembers how easy it was to exaggerate her physical symptoms to receive a higher dosage during the year she was on tramadol. "I told him I was off work – I wasn’t."
Painkillers are an essential part of short-term pain management for most of us – after an accident, surgery or childbirth, for instance – but there’s now evidence showing they’re doing more harm than good for a number of people who become addicted. Strong opioids, like morphine, oxycodone, fentanyl and methadone are used to treat moderate to severe pain when more common over-the-counter (OTC) types, like paracetamol or ibuprofen, or weaker opioids such as codeine just won’t do. Many experts believe a US-style opioid crisis – more than 130 people die from overdosing on opioids every day in the country – is spreading across the UK, and that it’s women, like Louise, who are at the sharp end of the problem.
The number of deaths linked to opioid painkillers in the UK has risen by 41% to 2,000 each year – that’s more than five people each day – over the last decade, according to an analysis of ONS data by the Times. Experts put this rise down to an increase in overdoses as well as a higher number of GPs prescribing the drugs. The number of prescriptions issued for opioids in England and Wales rose drastically from 14 million in 2008 to 23 million last year, according to the Department of Health, resulting in a situation where more than 113,000 opioid prescriptions are now being given out daily, according to NHS data. In April, health secretary Matt Hancock announced that all opioid medicines would carry prominent warning labels to highlight the risk of addiction and protect users from "the darker side of painkillers" (a measure that one addiction counsellor called the "tip of the iceberg").
"There are well recognised sex differences in the prescription of opioids in population studies and some evidence that women are more likely than men to misuse prescription opioids," says Dr Paul McLaren, consultant psychiatrist and medical director at Priory’s Hayes Grove hospital near Bromley, Kent. "Women are more likely to ask for professional help with chronic pain syndromes, which means they will be more likely to be prescribed opioids," he adds, which may explain their higher rates of prescribed opioid misuse.
But here's the kicker: research has found these drugs to be ineffective for many of the long-term conditions they’re being used to treat, such as back ache and other chronic pain. "Nobody checked my back. At the beginning I probably had a slipped disc and maybe was prone to a weak back," Louise says. Could her years of suffering have been avoided with a more thoughtful initial diagnosis?
It made me feel numb. Bad things don't feel as bad. If you’re stressed you don’t feel as stressed.
Doctors' prescriptions are only half the story, though. "The main way people bypass doctors' surgeries to buy opioids is online," explains Dr Rachel Britton, lead clinical pharmacist at the drug and alcohol charity Addaction, citing the "shady online pharmacies that write people prescriptions for powerful opioids with very little scrutiny over whether the drug is suitable". Stronger versions of these lethal drugs are also available on the black market and from countries like China on the dark web, while other addicts "turn to trying street opioids like heroin and even crime to fund their addiction," says Eytan Alexander, CEO of the private addiction treatment firm UKAT.
To stockpile supplies, Louise would lie to her GP that she'd lost her prescription, order her prescription online and enlist her family to lie about existing health conditions and pick up painkillers. "Nobody checks, nobody questions you," she says. (In the UK it's illegal to give prescription drugs to someone else, knowingly or otherwise.)
When you're in the grip of an addiction, it's impossible to be objective about how the drugs are affecting you and how you're feeling, Louise says. "It made me feel numb. Bad things don't feel as bad. If you’re stressed you don’t feel as stressed. If you’ve got a busy day, you can cope with it that bit better," she recalls. "But when I changed onto the stronger tramadol, which lasts for 12 hours, that was a massive change – I felt like I was out of it, like I wasn’t even in the room. I started spending more time in bed, because you can’t function on that level of opiates."
The physical effects of an opioid addiction are manifold, explains Dr Britton. "In the short term, opioids can make people drowsy and less able to concentrate," affecting users' ability to do everything from driving to basic tasks at work. "In the long term, opioid use can make pain worse, through a condition called opioid induced hyperalgesia, leading to a cycle where use increases to deal with increasing pain."
Then there are the social and psychological effects: "If someone’s drive to use them outweighs other things they value then this can have big consequences on their relationships," Britton adds. "Long-term opioid use is a way of papering over the cracks of a much deeper, more complex emotional problem. Without proper psychological support, eventually the foundations holding up someone’s life will start to crumble."
Louise worked for herself from her home in northwest England at the height of her addiction so she wasn't at risk of losing her job, and her husband's salary was enough to keep them afloat – but they're still working on rebuilding their relationship. "It tested us because he couldn’t understand why I wasn't truthful with him," she admits, adding that the impact would have been even worse if she'd resorted to the black market for tramadol or gone to a dealer. "It’s been tough with the guilt and the shame and knowing what I’ve put people through."
Louise accepts responsibility for her addiction, and her experience of private treatment – which she knows she's lucky to be able to afford – has given her time and space to reflect. "The fault lies with me, but what scares me is how easily I was allowed to do it. I wasn’t warned that this is highly addictive and can shorten your life." In her current treatment programme at The BONDS Clinic in Bradford, Louise says she's received more information about her health and addiction than she ever did from the NHS. "When you understand what you're feeling and why you're feeling it, then you’re able to help yourself."
Louise is now managing her anxiety and depressive symptoms with a holistic approach that doesn't involve drugs alone (though naltrexone, a medication used to manage opioid dependence, plays a big part). Through therapy and various tests, she's developed a better understanding of her feelings and health symptoms. "Tablets have a place, but they’re not always the complete answer," she believes. "I also found out I had a severe vitamin D deficiency, which affects mood, and my thyroid was low, which makes you depressed and lethargic. None of this was picked up by doctors."
Given the current trend towards GPs prescribing opioids and the ever-increasing strain on the NHS (doctors' practices simply don't have the time to comprehensively analyse a patient's health holistically in the same way private centres do), is the UK heading for a crisis of US proportions? Yes, according to UKAT's Eytan Alexander. "It’s frightening to see that unfortunately the UK is already on the same path as the US and we now need to harness learnings from the opioid crisis [there] and act fast to try to avoid the epidemic here worsening."
Alexander believes the main way to prevent a US-style opioid crisis would be by "investing in public treatment services to support those already in addiction, implementing an IT system that will red-flag those on repeat opioid prescriptions and to offer support to those people to, where possible, stop taking the opioid drugs and to explore alternative pain therapies or non-opioid medication instead."
Dr Britton, from Addaction, believes there's less chance of a catastrophic crisis as "the UK has far more scrutiny on prescribing opioids than America," but that we shouldn't be complacent. "We need stronger checks on people’s history of mental health issues when prescribing and should be very careful when deciding to prescribe opioids for longer term pain," she finishes. "We also need to invest more in long-term support so that we have something else to offer people beyond a quick fix."
*Name has been changed to protect the interviewee’s identity.