"On Panorama tonight..." "Can I have my drugs, please?" "..the NHS clinic offering detox for people hooked on prescription drugs." "I'll just take that medication and lock it into the treatment room." "For the first time, we follow patients trying to quit the medication their doctors gave them." "I just feel slightly clammy, and it is uncomfortable, and I feel slightly sick." "GPs are prescribing record doses of potentially addictive painkillers." "There has been a doubling in the number of prescriptions." "Doubling?" "A doubling." "Around 4 million people in the UK are now taking drugs from the same family as heroin." "And that...is the highest dose I've ever seen." "And we find out what happens when prescription turns to addiction." "I'd gone into rehab and they turned around and said," ""You do realise you're a heroin addict?"" "I was like, "Hello, I've got really nice boots on, I can't possibly be!"" "Watergate Bay, Cornwall." "The weather is beautiful and I'm in one of the most scenic parts of the country." "It's a perfect day, if you are able to get out and enjoy it." "Helen Derici lives just a few miles from the sea, but it might as well be another world." "We used to spend all of our summer holidays on the beach." "Like nearly 8 million other people in the UK," "Helen suffers from chronic pain." "A complex spinal problem, osteoarthritis and fibromyalgia have changed her life completely." "I was a primary school teacher." "I had to leave that job because I couldn't walk any longer," "I couldn't sit and I can't stand for a period of time." "What is the pain like?" "It's throughout my entire body." "So, it's my fingers, my wrists, my elbows, my knees, my ankles, my toes." "Helen now rarely leaves the house." "A good day is when she can get out of bed." "When I turned 50 last year," "I realised that I'd spent most of my 40s lying on a bed, here." "Each day begins with a large number of different drugs." "First, it's co-codamol, then the next is Valium." "Tramadol, a drug called gabapentin." "The next one is slow-release morphine." "Ibuprofen, amitriptyline." "For breakthrough pain, I have liquid morphine." "I would imagine I take that two or three times a day, depending on, kind of, my pain levels." "Morphine and tramadol are opioids, painkillers which are either derived from the opium poppy, or are man-made, but with similar effects." "There are many different opioids, all closely related to heroin." "Once, they were reserved mainly for cancer patients, and for people recovering from operations." "But not any more." "There has been a doubling in the number of prescriptions." "Doubling?" "It is a very significant increase." "That doubling of opioid prescriptions has occurred since 2006." "Roger Knaggs analysed the records of 5 million patients to find out where the increase is coming from." "The purple bars show cancer patients receiving prescriptions of strong opioids." "They've increased gradually, but non-cancer patients getting prescriptions increased sixfold in just ten years." "This is so dramatic." "It's just continuously..." "There is a very significant rise." "What this seems to represent is a culture shift in medicine, in prescribing." "It's a very big change in the way in which these medicines are being used." "The research suggests that about a third of patients who take opioids will be on them for years." "And long-term use can, for some, lead to the nightmare of addiction." "I, basically, behaved like a complete monster with my GP." "I would lie to him." "I would shout." "I would scream." "People in the waiting room would have heard me screaming that I was not a drug addict, I was not an addict, and I wanted that prescription because I was in excruciating pain." "Cathryn Kemp has written about her experience of becoming addicted to prescription pain killers after being diagnosed with pancreatitis." "She was prescribed an opioid drug called Fentanyl and was supposed to take eight lozenges a day." "Her problem started when she exceeded the dose." "Within that first month, I was up to 11 lozenges a day." "I slipped very quickly into needing that 11 lozenges and needing 12 a day, needing 15 a day." "So, less than two years later," "I was on 60 lozenges a day - all of them on prescription from my GP." "Cathryn's life descended into chaos." "She thought her addiction would kill her." "By the end, the last couple of months," "I was writing a note and putting it under my pillow every night saying to my family and friends, basically, "I'm really sorry." ""I don't know what to do." "I don't know how to come off these drugs."" "And I was leaving it under my pillow in case I died overnight because I was taking a fatal dose every day." "Southmead Hospital in Bristol, home to an NHS pain clinic and renowned specialist Dr Cathy Stannard." "Cathy, hi." "Hi, Declan." "Nice to meet you." "Welcome to the pain clinic." "She often sees patients on high doses of opioids." "If I gave you that amount of oral morphine as a single dose now, that would almost certainly kill you." "This amount of oral morphine would kill me?" "If you drank it now." "200 milligrams can be fatal." "But patients build up a tolerance - often they end up on pills, patches and liquids." "We quite frequently see patients who are on 5,000 milligrams of morphine equivalent a day." "So, this amount of morphine?" "Yeah." "That's how much somebody might be having." "In a day?" "In a day." "The team oversees the care of thousands of chronic pain patients, often with complicated health histories." "Dr Stannard has strong views about opioids." "She thinks they're unsuitable for many patients with chronic pain in the long-term." "The scientific studies suggest that opioids have very little use." "There is very little evidence that these drugs work in the long-term, at all." "A few patients do derive benefit taking these drugs over long periods, but only if the doses are low, and probably, only if the drug is taken intermittently." "We're going down into room three, which is this way." "OK, thanks." "Today, Helen is arriving for a two-week stay at the clinic." "Thank you." "The team at Southmead are planning to take away the cocktail of opioid pain killers she's been relying on for years." "I'll take that medication and lock it into the treatment room." "OK." "OK?" "Yeah." "I feel that I've relinquished control of what is a big part of my life, because my life has been ruled by drugs for the last seven or eight years." "Coming off opioids can be traumatic." "To help Helen cope with her withdrawal, she'll be given methadone, a drug normally used to wean addicts off heroin." "We've calculated her a dose of 15 milligrams." "It's a starting point." "It may need to be adjusted depending on how her experience of the drug goes." "The idea is that she'll ask for a dose if she's in pain, or possibly, if she's feeling that she's going into withdrawal." "A few days later," "Helen's body is craving the prescription opioids she's used to." "The morphine withdrawal, I can feel it." "It's kind of like a... wave of heat that comes from my feet and all the way through my body and I just feel slightly clammy." "And it's uncomfortable and I feel slightly sick." "Hi." "Um, can I have my drugs, please?" "I'll just go and check when you're next due them on your chart." "OK." "We've got Helen's medication chart here." "So, we can see what she's been given and when and how long she's going, and also, how we've been recording her withdrawal." "She's actually doing really well." "And today is the worst." "She's got sweating and hot and cold flushes." "At the moment, I'm just waiting to be given my next dose of methadone, and it's now been increased to see if that is more effectful..." ""Effectful"? "Effectful"?" "Yes?" "What is it? "Effectful"?" "Effective." "I told you, my brain has turned to mush." "No-one should stop taking medications like this without medical help." "Lovely!" "You can go and have some supper now." "Mm-hm." "Helen's withdrawal symptoms are relatively mild." "Without methadone, it can be far worse." "Muscle cramps all over my body, sweating, shaking, tremors, hallucinations." "At one stage, I remember telling my counsellor in rehab that I could hear an orchestra coming from the plug point in my room." "I really thought I was going insane." "For me, it took a long time, actually." "It took about three months before I felt in any way that the withdrawals had kind of passed." "When it comes to opioids, the dangers of physical dependency are well known." "So, why are doctors now handing out more than 22 million prescriptions a year?" "We have an ageing population." "We have a society that wants to keep active." "Sometimes pain killers allow you to do that." "We also have a basic need to relieve pain, as well." "Doctors therefore prescribe things that help to relieve that." "But doctors haven't always used opioids for chronic pain." "The change in medical thinking began in America." "It was here, in the late '80s, research first suggested that opioids could be more widely used without a significant risk of addiction." "It was a radically different way of thinking and for the pharmaceutical companies, it opened up a market that was worth billions." "New opioids were developed for chronic pain, like OxyContin." "Some patients may be afraid of taking opioids because they're perceived as too strong." "Or addictive." "But that is far from actual fact." "But it turned out the new drugs were far more addictive than the marketing had suggested." "Prescription rates quadrupled and pills flooded the black market." "REPORTER: 'Armed robbers are going into pharmacies, 'pulling out guns and saying, "Give me all your OxyContin."'" "People crushed, snorted and injected the drugs." "Kentucky was one of the worst-hit states." "Sean Riley, the Deputy Attorney General, says the state was devastated by the opioid epidemic." "This is unlike anything that Kentucky has grappled with before." "This is a highly addictive, highly dangerous substance." "You would see grandmas who had a hip replacement who had become addicted." "Or you'd see stereotypical soccer moms who had a knee injury would be given OxyContin, and they'd become addicted." "Rural Kentucky." "These are the very hills which first spawned the term "hillbilly"." "The drugs were so widely used around here, they became known as "hillbilly heroin"." "I'm driving up into the heart of the Appalachian Mountains in eastern Kentucky." "Now, this place has been described as ground zero for the epidemic of prescription opioid abuse." "Many of these small, rural coal-mining communities have been completely ravaged by these drugs." "Coal once was king in these parts." "But there's a different growth industry now." "Rehab." "The first time that I ever experienced the feel from overdoing the medication was my back was hurting me real bad one night, and so, I took an extra one." "About an hour after I took them," "I had this warm feeling coming all over me." "It made me feel like Superman." "I was prescribed four per day, and as I got used to them," "I'd take eight a day." "It wouldn't do nothing for me " "I'd still feel the pain, so I just kept taking more." "Both Justin and Mark ended up turning to the black market to feed their habits." "They lost their jobs and stole to get the money." "I got in trouble with the law." "My wife, she's never experienced any kind of addiction." "She's working, going to college, raising my two boys right now, while I'm here." "This area now has a massive prescription-drug problem." "The police say that crime has soared with it." "When I started, years ago, a gas-station robbery, a service-station robbery, something like that was unheard of." "Now, it's become commonplace, once a week, a couple of times a week." "Just like last week, we had two." "Sergeant Peppi says that prescription painkillers have transformed the place where he grew up." "It's all classes of society." "This addiction does not recognise any class, it doesn't matter how much money you've got, how poor you are, it affects all, and it has no boundary." "Dr Bill Fannin knows that only too well." "He began describing opioids to his patients after being assured by drug reps that there was no significant risk of addiction." "But he soon realised that something was wrong." "Patients were lying to me." "They were manipulating and they were trying to get prescriptions filled before they were due." "It just started growing and growing and growing." "Individual tablets were changing hands on the street for up to $50 each." "Bill Fannin's son, Sean, started using them when he was just a teenager." "Over time, he became addicted to the very drugs his father had been prescribing to his patients." "One night, Sean bought opioids and took them, and another drug, in his bedroom." "We were sitting there, watching something on TV." "And my wife looked around at me and she said, "There's something wrong."" "She got up and went upstairs to check on Sean." "And I heard her screaming." "Sean was dead from an overdose." "His father now believes that some of the drugs he prescribed may well have found their way onto the black market and ended up in his own son's hands." "Some of them were diverted, I know they were." "Whether he ended up with them or he didn't end up with them, it's all the same big pool of dealers." "And so, could have been mine, could have been somebody else's, but it was the same story." "It must have been an extremely difficult thing for you to come to terms with, that you, as a doctor, were disseminating these drugs, and yet, this drug led to your son's death?" "Yes, sir." "Yes, sir." "Purdue Pharma, the makers of OxyContin, say they have "accepted responsibility" for the actions of some staff in the '90s and are now "combatting prescription drug abuse", including making pills with "abuse deterrent properties"." "They say that courts across America have "dismissed numerous cases" against them because the evidence didn't establish their marketing caused the alleged harm." "The UK also has a problem." "1.8 million people have admitted misusing prescription painkillers." "So, could what happened in America happen here?" "I think we have to be very aware of the situation in the States." "I think the health care system is, however, in the UK, totally different." "A GP acts as a wonderful gatekeeper." "So, I think the GP situation is completely different, that would stop the escalation that we had in the States." "Patients with chronic pain are hard to deal with." "But, surprisingly, it's left to individual doctors to decide which opioids, and in what doses, they should prescribe their patients." "If you take diabetes and asthma, the GPs have excellent guidelines." "They know how to monitor those patients." "But opioids are not like that." "So, are you saying that it's completely up to the GP to try and work out, by themselves, how much opioids somebody needs?" "Yes, at the moment." "That's astonishing, isn't it?" "It is." "The Government is planning new guidance." "HE KNOCKS" "Simon?" "Hello." "'This is Simon England." "'He suffers from a painful condition called colitis.'" "He's been taking massive doses of prescription painkillers for years." "You could look at it," "I'm dependent on it or addicted to it." "I don't like the word "addiction"." "But, to all intents and purposes, if you need to take it...?" "I have to take it." "Then, you could be said to be addicted to it?" "Yes." "Well, I mean, "dependent" is just another way of saying "addiction"." "How do you feel about that, thinking of yourself as being addicted to it?" "Is that something you could have foreseen yourself being?" "No, never." "'Simon no longer trusts himself with the drugs." "'So, his family controls them for him.'" "Job done." "That's it, simple as that." "I'm disgusted with myself." "I really don't like myself." "But I'm in a corner." "There's nothing I can do about it." "It's not something I chose." "Simon is now desperate to come off the prescription opioid drugs." "How old are you now?" "50." "50?" "Yeah." "In pain terms, where's your main pain?" "Today, he and his wife, Sarah, have come to the pain clinic." "So, on a bad day, you are taking...7,200mg." "And that...is the highest dose I've ever seen." "Yeah?" "Simon is taking the morphine equivalent of 9,000 non-prescription co-codamol tablets a day." "You are going to be able to help me?" "I think our best bet for you is to do what we usually do, convert you, temporarily, to a drug called methadone." "Have you heard of that?" "Yeah." "Places at the clinic are in such demand that it could be months before Simon is admitted for detox." "But at least today, for the first time in a long time, there is hope." "Very pleased." "There's a light on at the end of the tunnel." "Yeah, there's a little glimmer at the end of the tunnel." "Hope." "Hope." "We can get out." "We can." "We can." "Mm." "Thank you." "Bye, take care." "Helen is coming to the end of her stay." "Thanks a lot." "Staff here have been working on different ways of addressing her pain, from physiotherapy to counselling, and even, simply getting her a good night's sleep." "We have identified that your sleep-wake cycle could easily be modified." "She's said that after a good night's sleep, she's not in as much pain." "And then you look at her sleep, and her sleep has been completely disrupted for the past nine years." "Helen will be on methadone for some time." "But already, she feels like a new person." "I can't stress enough how much better I feel." "Really?" "Yeah." "I want to get some normality back into my life." "I want to get back into the water." "Surfing, body boarding?" "Body boarding, I'm going to try." "I don't think I'll be able to surf." "Maybe just even getting into the water." "OK, I'll make you a deal" " I will come and visit you, in a few weeks' time and I'll go bodyboarding with you." "How does that sound?" "That would be quite good, actually, it would be quite funny." "Living without opioid drugs isn't always easy." "And coming off them should only happen under medical supervision." "For Cathryn Kemp, it was a terrifying step." "But it's one she feels she had to take." "Living with pain is really difficult, and there isn't necessarily a fairy-tale ending." "Anyone out there who's going through it and who is terrified of coming off their drugs," "I really urge them to think about it." "You know, because there is the possibility that you can live with your pain." "And how is it now, compared to how it was then?" "I can honestly say, actually, that I think the pain is currently almost exactly the same as when I was taking all of those painkillers." "I don't feel that there's much difference." "But life is better?" "Well, I'm actually LIVING now." "Even though I'm in pain, every day is a million times better than being on all of those opiate drugs." "NHS England says that high prescribing GPs are monitored, but that pain needs to be treated, and that opioids should be available for patients they'll benefit." "Opioids may be excellent short-term painkillers." "But the question now is, are we using them too much for chronic pain?" "One of the things we have to be aware of is when to say "no" and when to try and bring in other resources." "Do you believe that we're not saying "no" enough?" "I agree." "We're not saying "no" enough at the moment, because GPs like to help their patients." "I think, if you are treating somebody with opioids and they're not working and the patient still has pain, even if there is nothing else to offer that patient, it's better coming off their drugs." "Back in Cornwall, I've got a promise to keep." "Helen, how are you?" "Not too bad." "Can you believe we're going body boarding?" "Not really, no!" "SHE LAUGHS" "Do you feel different?" "Yes." "You must feel different." "Yes, hugely different." "I just feel so much better." "My thought processes are clear and my speech isn't slurred any more and I can think clearly." "Helen is still on methadone." "But the plan is, that, too, will gradually be taken away." "I seem to have more motivation than I had before." "I'm able to think about what I'm going to do tomorrow, and the day after, which before, I wasn't doing." "Helen's future will still involve pain." "But she hopes to manage it without a cocktail of opioid painkillers." "And for Helen, at least, taking that plunge has made all the difference."