I’m reading in the papers that America’s opium crisis is on its way here. And it’s worst up north. Apparently, ten percent of Blackpool’s population are on prescribed opiates, such as Co-codamol, tramadol and morphine. Ten percent! And that’s not including anti-anxiety drugs, antidepressants or all the illegal drugs people take to get by.
Opiates are powerful stuff and highly addictive. It doesn’t just numb your pain; it dampens your soul. Opiates gulp down, not only passion, good and bad, but also time.
At first, you fail to notice, then to care. Jaded weeks become months, turning into years. They can quite easily steal your life.
Just the other day, I looked after an unfortunate cookie who’d done well in her attempt to mask her beauty through covering herself in ugly tattoos, including tacky poems slithering up her neck like sad snakes. The girl, whose procedure had been the extraction of one tooth, was now in such excruciating pain, she said, that I ended up giving high doses of intravenous morphine, all while her eyes eagerly followed my hands every movement, as they worked their way through the drug administration.
It soon transpired that she was taking morphine and tramadol most days for different pains and aches. Poor girl, she was only twenty-something. I had the doctors to review of course, and after giving her what already felt like too much, we simply stopped, forcing her to accept that ‘we can’t do more’ (and thereby possibly contradicting both nursing literature; “pain is what the patient says it is” and the local discharge criteria; “patient is comfortable and the pain well controlled.”
Opiates have worked their way into our acceptance. In this country, as opposed to virtually any other, heroin (diamorphine) is routinely administered in obstetrics, paediatric A&E’s (where the children get it sprayed up their noses) and palliative care. A large trauma hospital in London, routinely sends children home with several doses of oral morphine after having a tonsillectomy, a standard and common procedure.
Earlier on this site, an older gentleman told his story of how he became addicted to oral morphine less than a month after having been discharged from the hospital after knee surgery. He forced himself, with the help of his family, to go cold turkey, a process triggering violent physical reactions that can scare the bravest. For a weakened hard-core addict, cold turkey can be fatal. Our man made it through, but thought during the peak, with its vomiting, diarrhoea and shivering, that “he was going to die”.
Codeine is the strongest component in the common drug Co-codamol, which, in milder forms, is sold over the counter. Codeine is partly transformed into morphine when metabolised in the body and it works on the same receptors in our brains as any other opiate .
That it’s addictive is now well known and already ten years ago guidelines on how to package and label these drugs changed. Still, where I work, we dish out Co-codamol to patients who had minor procedures done and almost always it’s 30/500; the maximum strength. It’s by far the most common painkiller we dispense. We give them a couple of boxes and advise them to go to the GP if they need more. The patients might or might not get warned about addiction.
Our fear and intolerance of pain and maybe lack of patience with demanding patients and situations are, I think, part of the reason behind cold facts such as that, during the last ten years, prescriptions of opiates in Britain have increased by thirty percent.
Trading pain for addiction is bad a deal. Maybe we ought to invite the northerners down a bit more; opiate prescription is four times lower in London.
Or maybe we simply have to accept that life hurts.
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