GP warns of Xanax and prescription drugs for sale on Cork streets
Get rid of the higher dose tablets of benzodiazepines to help stamp out the street dealing of such drugs.
That is the message from Cork GP Dr Nick Flynn, who is concerned by the high number of people of all ages, who are addicted to benzodiazepine prescription drugs such as Valium.
Dr Flynn operates in Hollyhill Surgery, with Dr George O’Mahony. The surgery has 5,000 medical card patients assigned to it — of whom, up to 700 have a dependency on benzodiazepines.
Dr Flynn explained that some of those were inherited from another practice which closed down in recent years, which Hollyhill Surgery took over.
And he says that on a yearly basis, five or six young people attached to his surgery die from overdoses of drugs including heroin, methadone or benzodiazepines and alcohol — or a combination of drugs.
The users of the drugs, known as benzos or BZPs, are all ages, with some on them for up to 40 years. Brand names of benzodiazepines include Valium and Xanax — well-known drugs used by people across all generations. Indeed, doctors regularly see people coming into their clinics having been given benzodiazepines from other family members, who are using them to help them sleep.
While many become addicted to benzodiazepines after being prescribed them to tackle anxiety, others become addicted after first coming across them on the streets.
On the streets, a 10mg benzodiazepine tablet is worth €2, while a 5mg tablet attracts 50c. The 2mg tablet is worthless.
As a result, 10mg tablets are particularly lucrative for someone wanting to sell them on the streets.
Dr Flynn explained: “A 10mg tablet is worth €2. It is a lot because if you have someone on three 10s a day, that is 84 a month which is €168 a month. If you are on social welfare, getting around €200 a week, it is a bonus if you are managing to sell that many on the street.”
A patient who is desperate to get their hands on prescription tablets to sell is easily identifiable, according to Dr Flynn. They will be anxious to get the 10mg tablet and will give several excuses on why they don’t want the smaller dosage. Others will come back to their doctor before their prescription is up, with excuses that their medication was lost accidentally.
One way of dealing with such patients is to offer them a phased prescription, which will require them having to go to their chemist on a weekly basis to get their drugs. This means they will not have a large amount of tablets at a time, thereby limiting their ability to become dealers of the drug.
However, some patients who are addicted, or who want to secure high amounts of tablets to sell on the streets, will go to a number of doctors in order to get the amount of medication they want. Dr Flynn is hopeful that plans to introduce the unique health identifier number which would mean that a patient’s medication is stored centrally will help combat so-called doctor shopping. The northside area of Cork city was highlighted in a recent documentary called Medication Nation as having the highest prescription rate in the country for Valium in 2012.
Dr Flynn said: “The main reason why people in poorer areas use more medication than those living wealthier areas is that we have what you would call a disease burden.
“It starts aged 20 so people living in poorer areas start to develop multi-morbidity, which is many medical problems in the same patient because of things like poor food and education. They develop multiple medical problems 10 years earlier in the poorer areas.” He added that people with many medical problems are more likely to have psychiatric problems.
But he said the problem of addiction can be rooted in the prescribing of benzodiazepines many decades ago.
He explained: “I am qualified as a GP for 15 to 20 years, and I would have patients who are on benzodiazepines for 30 or 40 years. The reason for that is that when you go back to the 1940s and 1950s, benzodiazepines were thought to have been very effective as anxiety and anti-depressant medication. We did not have the data or the knowledge that we have now that they are addictive, you develop tolerance of them, you need higher doses for the same effect, and you get withdrawals, that they can even cause death, and there is the mental sluggishness that comes with long-term use of benzodiazepines.”
And he said that the medication was originally targeted at women, being marketed as “mother’s little helper”.
He elaborated: “There is a group of patients who, when they started, thought it to be a good medication. There was a generation of doctors who thought they were ok as well. Now, any practising doctor is very aware of the dangers of them.”
However, Dr Flynn stressed that there is a need at times to prescribe benzodiazepines to tackle anxiety in patients — particularly when interventions such as counselling are not immediately available. He outlined: “There are times when if you can’t keep the patient going, you end up giving him a prescription, even though you are not happy about that. The challenge is not to make that a long-term prescription.”
But patients are not always willing to accept their GP’s decision not to continue giving them benzodiazepines on a long-term basis. On one occasion, a patient spat at a secretary working in the Hollyhill surgery. And in another incident some years ago, a patient tried to stab a colleague during a consultation.
While Dr Flynn says that people are addicted to other drugs such as codeine, such addictions are not as serious.
He concluded: “I have two or three patients who are on methadone as a result of codeine addiction — going around from shop to shop for Nurofen Plus.
“Yet, codeine is way down there in the burden of harm because it creates very few problems for society.”
With people of all ages now addicted to prescription drugs, Ann Murphy talks to a Cork GP who loses an average of five young patients a year to drug overdoses.
