1 00:00:08,100 --> 00:00:11,000 Britain is in the grip of a drug crisis. 2 00:00:11,000 --> 00:00:12,520 Wow. 3 00:00:12,520 --> 00:00:17,480 Each year, more than five million of us are prescribed opioids. 4 00:00:17,480 --> 00:00:21,640 Painkillers which can be as powerful as class A drugs. 5 00:00:22,720 --> 00:00:26,240 You know that it is related to morphine and heroin? 6 00:00:26,240 --> 00:00:28,400 No. 7 00:00:28,400 --> 00:00:32,600 In America, a prescription opioid epidemic accounts for more deaths 8 00:00:32,600 --> 00:00:33,880 than gun crime. 9 00:00:33,880 --> 00:00:36,160 SIREN SOUNDS 10 00:00:36,160 --> 00:00:40,600 Now, a landmark report suggests we may also have a problem. 11 00:00:40,600 --> 00:00:43,440 How many of these tablets were you consuming? 12 00:00:43,440 --> 00:00:46,680 Erm, between 50 and 70... Wow. 13 00:00:46,680 --> 00:00:48,080 ..a day. 14 00:00:48,080 --> 00:00:50,240 I ended up overdosing. 15 00:00:50,240 --> 00:00:52,200 I'm Dr Michael Mosley. 16 00:00:52,200 --> 00:00:54,840 I want to understand just how worried we should be, 17 00:00:54,840 --> 00:00:59,280 because millions of us get stuck on these painkillers long term. 18 00:00:59,280 --> 00:01:01,720 The tablets just destroyed her, really. 19 00:01:01,720 --> 00:01:03,760 When a doctor prescribes them, you take them - 20 00:01:03,760 --> 00:01:07,000 you take whatever, whatever you can take. 21 00:01:07,000 --> 00:01:11,480 I want to find out how easy it is to get hold of these potent drugs. 22 00:01:11,480 --> 00:01:14,440 Pain relief prescriptions, free UK express delivery. 23 00:01:14,440 --> 00:01:16,000 That's for me. 24 00:01:16,000 --> 00:01:18,160 And discover their potential risks. 25 00:01:18,160 --> 00:01:20,600 We're really heading towards a very dangerous place 26 00:01:20,600 --> 00:01:22,840 and we need to do something about it now. 27 00:01:22,840 --> 00:01:26,000 I also want to explore the biology of pain... 28 00:01:26,000 --> 00:01:28,320 I can feel it beginning to burn now. 29 00:01:28,320 --> 00:01:32,160 ..to find out why opioids work for some... 30 00:01:32,160 --> 00:01:33,400 ..but not for others. 31 00:01:33,400 --> 00:01:35,640 They didn't sort the pain out. 32 00:01:35,640 --> 00:01:38,480 What they actually did was turn my beautiful, lovely, 33 00:01:38,480 --> 00:01:41,800 active wife into a zombie. 34 00:01:41,800 --> 00:01:44,480 I think this is a major public health issue up there 35 00:01:44,480 --> 00:01:47,480 with heart disease and cancer. 36 00:01:47,480 --> 00:01:51,280 I want to find out what's gone wrong and whether science can help us 37 00:01:51,280 --> 00:01:53,520 tackle Britain's opioid crisis. 38 00:02:08,800 --> 00:02:11,800 I'm in Hastings, a town that's on the front line 39 00:02:11,800 --> 00:02:13,800 of Britain's opioid problem. 40 00:02:15,640 --> 00:02:18,920 You don't have to look far to find evidence that they are now part 41 00:02:18,920 --> 00:02:22,160 of our everyday lives. 42 00:02:22,160 --> 00:02:23,840 Thanks. 43 00:02:23,840 --> 00:02:28,080 This contains codeine, which is a powerful and effective painkiller. 44 00:02:28,080 --> 00:02:31,400 It is also an opioid which makes it part of the same family 45 00:02:31,400 --> 00:02:33,520 as morphine and heroin. 46 00:02:33,520 --> 00:02:36,200 And that means it can also cause addiction. 47 00:02:36,200 --> 00:02:38,600 Now, this stuff absolutely pales in comparison 48 00:02:38,600 --> 00:02:41,240 to what you can get from your GP. 49 00:02:41,240 --> 00:02:44,080 Your GP can quite legally prescribe you something which 50 00:02:44,080 --> 00:02:47,600 is 300 times more powerful than this. 51 00:02:50,400 --> 00:02:53,720 Here in the Hastings area, around one in seven adults 52 00:02:53,720 --> 00:02:56,440 were prescribed an opioid last year. 53 00:02:57,520 --> 00:03:00,960 But do they know what they're taking? 54 00:03:00,960 --> 00:03:02,560 So any of you on painkillers? I am. 55 00:03:02,560 --> 00:03:04,440 What are you on? Dihydrocodeine. 56 00:03:04,440 --> 00:03:06,840 You know that it is an opioid, 57 00:03:06,840 --> 00:03:09,280 related to heroin and morphine? No. 58 00:03:09,280 --> 00:03:10,840 SHE LAUGHS 59 00:03:10,840 --> 00:03:13,880 Did you know that they are related to heroin and morphine? 60 00:03:13,880 --> 00:03:15,360 Not really, no. 61 00:03:15,360 --> 00:03:17,800 Would that put you off taking them? Of course it would, yeah. 62 00:03:17,800 --> 00:03:19,880 What are you on? Oxycodone. 63 00:03:19,880 --> 00:03:22,280 You know that it is an opioid, related... Yes, I do. 64 00:03:22,280 --> 00:03:24,320 ..to morphine and heroin? Yes, I do. 65 00:03:24,320 --> 00:03:26,560 OK, and does that put you off, at all? No, not at all. 66 00:03:26,560 --> 00:03:29,000 Doesn't turn me off, I still take my tablets. 67 00:03:29,000 --> 00:03:32,040 It doesn't really, I don't touch drugs anyway. 68 00:03:32,040 --> 00:03:34,880 They're a life-saver for me, they get me about. 69 00:03:34,880 --> 00:03:36,120 And do they work? 70 00:03:36,120 --> 00:03:38,920 Erm, they do, but I didn't like the feeling that I had. 71 00:03:38,920 --> 00:03:40,720 What was that? 72 00:03:40,720 --> 00:03:44,000 I just felt a bit, well, my partner call them my happy pills, 73 00:03:44,000 --> 00:03:47,280 because I felt a bit spaced out. 74 00:03:47,280 --> 00:03:51,120 So, plenty of familiarity with opioids in Hastings. 75 00:03:51,120 --> 00:03:53,160 But what of the national picture? 76 00:03:53,160 --> 00:03:55,360 Come on, I'm taking a pound to clear! 77 00:03:55,360 --> 00:03:59,040 I've invited my new friends to my stall in the town market 78 00:03:59,040 --> 00:04:02,600 to demonstrate the scale of our opioid consumption. 79 00:04:02,600 --> 00:04:05,680 OK, ta-da. 80 00:04:05,680 --> 00:04:07,200 Whoo-hoo! 81 00:04:07,200 --> 00:04:10,840 Right, so, imagine this is the amount of opioids 82 00:04:10,840 --> 00:04:16,120 the good old British public was consuming 20 years ago. 83 00:04:16,120 --> 00:04:18,560 How much do you think they're consuming now? 84 00:04:18,560 --> 00:04:20,360 More. More, a lot more? 85 00:04:20,360 --> 00:04:22,400 OK, how much more do we reckon? 86 00:04:22,400 --> 00:04:24,400 I reckon about here. OK. 87 00:04:24,400 --> 00:04:26,480 I think about here. 88 00:04:26,480 --> 00:04:28,520 About here? I reckon it'll be... 89 00:04:28,520 --> 00:04:31,560 I'm asking people to guess how much the total amount 90 00:04:31,560 --> 00:04:34,600 of prescription opioids has increased. 91 00:04:34,600 --> 00:04:36,880 Shout when you think I'm getting close to it. 92 00:04:36,880 --> 00:04:41,400 Whoa! Lots of lovely opioids going in, yeah. 93 00:04:41,400 --> 00:04:42,480 More? 94 00:04:42,480 --> 00:04:44,440 A bit more, keep going. 95 00:04:44,440 --> 00:04:48,040 As the years have gone by, the population's been getting older. 96 00:04:48,040 --> 00:04:51,480 But we certainly haven't been getting this much sicker. 97 00:04:51,480 --> 00:04:54,680 Keep going, we're going, going, going, going, going, going, whoa! 98 00:04:56,520 --> 00:04:59,160 Hurrah, that was 2017. 99 00:04:59,160 --> 00:05:00,360 Wow! 100 00:05:00,360 --> 00:05:03,160 So that is a good doubling in the amount of opioids 101 00:05:03,160 --> 00:05:05,240 that people were consuming 20 years ago. 102 00:05:05,240 --> 00:05:07,240 So that is pretty terrifying, isn't it? 103 00:05:07,240 --> 00:05:08,920 That is terrifying, yes. 104 00:05:09,960 --> 00:05:12,760 There's no doubt that opioids have a vital role to play 105 00:05:12,760 --> 00:05:15,840 in cancer pain, end-of-life care, 106 00:05:15,840 --> 00:05:18,920 or to relieve pain after an operation. 107 00:05:18,920 --> 00:05:22,800 But that doesn't begin to explain the huge surge in prescribing 108 00:05:22,800 --> 00:05:25,200 we've seen in recent years. 109 00:05:25,200 --> 00:05:28,400 I do think it's important to point out that opioids in the right 110 00:05:28,400 --> 00:05:31,680 patients can be absolutely life-changing. 111 00:05:31,680 --> 00:05:35,120 However, a major new report by Public Health England 112 00:05:35,120 --> 00:05:39,600 has revealed that 5.6 million adults in England and Wales 113 00:05:39,600 --> 00:05:43,040 are currently on prescription opioids. 114 00:05:43,040 --> 00:05:46,080 That is an astonishing one in eight of us. 115 00:05:49,320 --> 00:05:51,880 So what are opioids? 116 00:05:51,880 --> 00:05:54,840 Originally, they came from the sap of the poppy plant, 117 00:05:54,840 --> 00:05:56,960 which has been used for thousands of years, 118 00:05:56,960 --> 00:05:59,880 both recreationally and to treat pain. 119 00:05:59,880 --> 00:06:01,640 It gave the world heroin. 120 00:06:04,160 --> 00:06:07,240 They act on the opioid receptors in the brain, 121 00:06:07,240 --> 00:06:10,880 blocking pain signals from the rest of the body. 122 00:06:10,880 --> 00:06:13,920 In fact, they're probably the greatest tool doctors have 123 00:06:13,920 --> 00:06:17,440 for numbing acute pain, like a broken bone, 124 00:06:17,440 --> 00:06:19,680 or an infected tooth. 125 00:06:21,240 --> 00:06:24,200 They're often promoted as a safe and effective way 126 00:06:24,200 --> 00:06:26,120 to treat all manner of pain. 127 00:06:27,320 --> 00:06:30,400 But unfortunately, many patients are discovering 128 00:06:30,400 --> 00:06:32,640 that this simply isn't true. 129 00:06:32,640 --> 00:06:34,640 Nice cup of coffee. Thank you. 130 00:06:37,280 --> 00:06:40,080 I was weighing these books up. 131 00:06:40,080 --> 00:06:43,800 And as I turned, sort of, like, bent slightly sideways to check 132 00:06:43,800 --> 00:06:48,160 the reading, something in my back just went pop! 133 00:06:49,920 --> 00:06:52,120 It was actually heard throughout the office. 134 00:06:52,120 --> 00:06:53,320 It was. 135 00:06:53,320 --> 00:06:57,160 My immediate boss was like, "What the hell was that?" 136 00:06:58,680 --> 00:07:02,920 In 2014, Karen popped a disc in the middle of her spine. 137 00:07:05,040 --> 00:07:08,320 Almost like having a having a red-hot poker 138 00:07:08,320 --> 00:07:10,280 put between your vertebrae. 139 00:07:13,400 --> 00:07:16,080 Painful, very painful. 140 00:07:18,920 --> 00:07:23,000 Research suggests there could be as many as 28 million Brits 141 00:07:23,000 --> 00:07:25,000 like Karen living in chronic pain. 142 00:07:25,000 --> 00:07:28,160 Pain, which is constant or recurring 143 00:07:28,160 --> 00:07:31,080 and has been there for more than 12 weeks. 144 00:07:32,720 --> 00:07:35,160 Karen's doctor's solution? Opioids. 145 00:07:36,400 --> 00:07:39,240 We got on these opiates, 146 00:07:39,240 --> 00:07:42,400 which initially, I was very excited about 147 00:07:42,400 --> 00:07:46,760 because I thought, "Yes, she's going to be pain free." 148 00:07:46,760 --> 00:07:50,280 Sadly, it didn't work out like that. 149 00:07:50,280 --> 00:07:55,560 You got this false sense of illusion that, "Well, actually, 150 00:07:55,560 --> 00:07:59,760 "they must be doing something, even though I'm still in pain." 151 00:08:01,160 --> 00:08:05,040 What, if I stopped them, my God, the pain's going to be horrendous. 152 00:08:06,840 --> 00:08:10,680 Over the course of five years, Karen was put on increasingly 153 00:08:10,680 --> 00:08:16,400 powerful opioids, starting on Tramadol and ending up on morphine. 154 00:08:16,400 --> 00:08:19,040 But they didn't sort the pain out. 155 00:08:19,040 --> 00:08:22,280 What they actually did was turn my beautiful, lovely, 156 00:08:22,280 --> 00:08:24,320 active wife into a zombie. 157 00:08:26,960 --> 00:08:28,920 The curtains were always shut. 158 00:08:28,920 --> 00:08:31,160 The bed was always unmade, 159 00:08:31,160 --> 00:08:34,200 because I was always in it, sleeping. 160 00:08:34,200 --> 00:08:37,080 It was heartbreaking because the girls used to say, 161 00:08:37,080 --> 00:08:39,040 "Where's our mum? 162 00:08:39,040 --> 00:08:41,360 "She's not... she's not here any more." 163 00:08:43,360 --> 00:08:45,680 Yeah, I felt like a drug addict. 164 00:08:47,040 --> 00:08:48,640 Every day was the same. 165 00:08:49,880 --> 00:08:51,960 And it was just sleep, wake, eat... 166 00:08:53,400 --> 00:08:56,200 ..toss and turn, get up. 167 00:08:56,200 --> 00:08:57,960 Sleep, eat. 168 00:08:59,240 --> 00:09:01,200 I felt like there was no hope. 169 00:09:03,680 --> 00:09:06,800 You want it to help, do you know what I mean? 170 00:09:06,800 --> 00:09:08,200 So you kind of... 171 00:09:10,440 --> 00:09:13,520 ..tell yourself it's working. 172 00:09:13,520 --> 00:09:16,320 And it's only people around you say, "Nothing's changed, Karen, 173 00:09:16,320 --> 00:09:18,600 "if anything, now you're mindless." 174 00:09:21,400 --> 00:09:26,200 Long-term opioid use put people like Karen at risk of constipation, 175 00:09:26,200 --> 00:09:30,320 memory loss, addiction, even accidental death by overdose. 176 00:09:31,560 --> 00:09:34,840 And perhaps the most startling finding of the Public Health England 177 00:09:34,840 --> 00:09:39,480 report is that over half a million people have been on opioids 178 00:09:39,480 --> 00:09:42,200 continuously for more than three years. 179 00:09:47,360 --> 00:09:51,400 Doctors have over 40 different opioid painkillers 180 00:09:51,400 --> 00:09:53,400 at their disposal. 181 00:09:53,400 --> 00:09:57,160 Most can be picked up from one of Britain's 11,000 pharmacies, 182 00:09:57,160 --> 00:09:59,400 like this one in south London. 183 00:10:01,600 --> 00:10:03,240 Akash, here? 184 00:10:03,240 --> 00:10:05,480 Just round there? Lovely, thank you. Hi there. 185 00:10:05,480 --> 00:10:07,720 Hi, Akash, Michael Mosley, hello. 186 00:10:07,720 --> 00:10:09,040 Nice to meet you. 187 00:10:09,040 --> 00:10:11,440 Akash Patel is a pharmacist who's agreed to show me 188 00:10:11,440 --> 00:10:13,920 just how powerful opioids can get. 189 00:10:15,040 --> 00:10:17,680 He says all of them are safe if used correctly, 190 00:10:17,680 --> 00:10:20,760 but dangerous if misused. 191 00:10:20,760 --> 00:10:23,400 That's the weakest, which is bog-standard co-codamol 192 00:10:23,400 --> 00:10:25,840 that you can buy over the counter. OK. 193 00:10:25,840 --> 00:10:29,680 The codeine in co-codamol is mixed with paracetamol. 194 00:10:29,680 --> 00:10:32,920 It can be bought from a pharmacy without a prescription. 195 00:10:32,920 --> 00:10:36,520 Even at this strength, codeine can be addictive. 196 00:10:36,520 --> 00:10:39,680 But just how powerful do opioids get? 197 00:10:39,680 --> 00:10:43,200 Akash has offered to demonstrate, using pills to show different 198 00:10:43,200 --> 00:10:45,280 opioids' relative strengths. 199 00:10:46,720 --> 00:10:49,560 OK, so that represents one pill. Yeah. 200 00:10:49,560 --> 00:10:51,200 Yeah, OK, what's next? 201 00:10:51,200 --> 00:10:53,440 Moving on to some codeine, 30 milligrams, 202 00:10:53,440 --> 00:10:55,240 that you can only get on a prescription. OK. 203 00:10:55,240 --> 00:10:57,080 So this is prescription only? Yeah. 204 00:10:57,080 --> 00:11:00,240 And this is the equivalent of having four tablets, is that right? 205 00:11:00,240 --> 00:11:01,320 Yeah. 206 00:11:02,800 --> 00:11:06,000 So these pure codeine pills are far more powerful 207 00:11:06,000 --> 00:11:08,680 than the codeine in co-codamol. 208 00:11:08,680 --> 00:11:11,800 At this strength, you might experience withdrawal symptoms 209 00:11:11,800 --> 00:11:16,360 if you came off it suddenly after long-term use. 210 00:11:16,360 --> 00:11:20,240 From here, the opioid drugs doctors can prescribe 211 00:11:20,240 --> 00:11:22,640 get stronger and stronger. 212 00:11:22,640 --> 00:11:25,000 After this, it's basically into the cupboard. 213 00:11:25,000 --> 00:11:26,560 Into the cupboard, right, OK. 214 00:11:28,560 --> 00:11:30,040 And then, there you go. 215 00:11:30,040 --> 00:11:31,240 Ooh. 216 00:11:31,240 --> 00:11:33,680 Some morphine. Yeah. 217 00:11:33,680 --> 00:11:36,720 You've got 15 milligrams of morphine tablets there. 218 00:11:36,720 --> 00:11:40,360 And that's equivalent to 13 Co-codamols. 219 00:11:40,360 --> 00:11:41,640 Right. 220 00:11:42,800 --> 00:11:46,040 Morphine, the drug Karen was on for her severe pain, 221 00:11:46,040 --> 00:11:49,040 is a close relation to heroin. 222 00:11:49,040 --> 00:11:51,560 It is highly addictive. 223 00:11:51,560 --> 00:11:55,400 And then you can go up to some oxycodone. Right? 224 00:11:55,400 --> 00:11:59,480 Which is equivalent to 75 codeine tablets. 225 00:11:59,480 --> 00:12:00,640 OK. 226 00:12:02,080 --> 00:12:05,240 Oxycodone is one of the most widely-abused prescription opioids. 227 00:12:05,240 --> 00:12:11,160 In the US, it's been implicated in thousands of deaths. 228 00:12:11,160 --> 00:12:13,680 I also have some diamorphine. Right. 229 00:12:13,680 --> 00:12:16,520 Which is more commonly known as heroin. 230 00:12:16,520 --> 00:12:20,680 Heroin? Blimey, no wonder it's locked away. Yeah. 231 00:12:20,680 --> 00:12:23,520 Heroin, which is around the same strength as oxycodone, 232 00:12:23,520 --> 00:12:27,880 is also prescribed for pain, often the end of life care. 233 00:12:27,880 --> 00:12:32,960 But surprisingly, there are opioids that are even stronger than heroin. 234 00:12:33,960 --> 00:12:36,640 The next one, I don't think we should take out 235 00:12:36,640 --> 00:12:38,880 of where we got it, which is the fentanyl. 236 00:12:38,880 --> 00:12:43,520 Which is equivalent to 338 co-codamol. 237 00:12:43,520 --> 00:12:46,560 Wow. 238 00:12:46,560 --> 00:12:48,160 That, I can see the difference. 239 00:12:48,160 --> 00:12:51,080 I mean, when you see that, then suddenly it makes sense, doesn't it? 240 00:12:51,080 --> 00:12:55,120 This is a massively greater dose, 241 00:12:55,120 --> 00:12:59,320 in its kind of morphine-like qualities than something like that. 242 00:12:59,320 --> 00:13:01,200 All of it, one little patch? 243 00:13:01,200 --> 00:13:03,240 One little patch. 244 00:13:03,240 --> 00:13:06,240 Fentanyl is so powerful, it's usually given to patients 245 00:13:06,240 --> 00:13:09,200 via a slow-release skin patch. 246 00:13:09,200 --> 00:13:12,160 What would happen if I slapped one of these on, would it kill me? 247 00:13:12,160 --> 00:13:14,640 Probably wouldn't kill you, but you wouldn't be very well. 248 00:13:14,640 --> 00:13:17,240 You'd probably be in hospital for a few days. 249 00:13:20,240 --> 00:13:23,400 It is a bewildering selection and all of these drugs come 250 00:13:23,400 --> 00:13:25,960 with wide-ranging side effects. 251 00:13:27,400 --> 00:13:30,080 Given what we know about the risks and dangers, 252 00:13:30,080 --> 00:13:33,080 why are doctors so happy to prescribe them? 253 00:13:42,680 --> 00:13:46,080 Salford has significantly higher prescribing rates 254 00:13:46,080 --> 00:13:48,040 than the national average. 255 00:13:49,200 --> 00:13:52,360 I'm here to meet one of its GPs, Dr Nicholas Browne. 256 00:13:52,360 --> 00:13:56,040 Michael? Yeah. Hello, hi. 257 00:13:56,040 --> 00:13:59,120 I've heard one reason opioid use has soared 258 00:13:59,120 --> 00:14:02,760 is because doctors were encouraged by established guidelines 259 00:14:02,760 --> 00:14:06,560 to prescribe ever-higher doses to those in pain. 260 00:14:06,560 --> 00:14:08,840 It's something we commonly see in most surgeries, 261 00:14:08,840 --> 00:14:12,880 someone experiencing an acute level of pain, or ongoing chronic pain. 262 00:14:12,880 --> 00:14:16,360 The, you know, the story we've told, we've almost sold 263 00:14:16,360 --> 00:14:19,400 that we have the ability to conquer pain. 264 00:14:19,400 --> 00:14:21,240 You are the magicians. 265 00:14:21,240 --> 00:14:23,640 We are, and I think we are suffering the consequences 266 00:14:23,640 --> 00:14:25,520 of that optimism. 267 00:14:25,520 --> 00:14:28,120 In the 1980s, The World Health Organisation 268 00:14:28,120 --> 00:14:31,600 came up with something they called the pain ladder. 269 00:14:31,600 --> 00:14:35,240 If a low dose of painkillers didn't work, then go up a step, 270 00:14:35,240 --> 00:14:36,920 give something stronger. 271 00:14:36,920 --> 00:14:39,880 The kind of mantra the WHO pain ladder was find the right drug. 272 00:14:39,880 --> 00:14:42,360 Find the right dose, and find the right timing. 273 00:14:42,360 --> 00:14:45,800 To find that magic dose that managed to keep you pain-free. 274 00:14:45,800 --> 00:14:47,640 That's what we would have been saying, 275 00:14:47,640 --> 00:14:49,480 "We can get you pain-free." 276 00:14:49,480 --> 00:14:51,880 And we would have encouraged you to take regular doses. 277 00:14:51,880 --> 00:14:55,360 If you came back and said, "Listen, almost there, but not quite, 278 00:14:55,360 --> 00:14:58,400 "I'm still struggling certain times of the day, or stopping me 279 00:14:58,400 --> 00:14:59,920 "doing certain things." 280 00:14:59,920 --> 00:15:02,960 Then we would want to probably increase that further. 281 00:15:02,960 --> 00:15:06,120 We would reassure you that, "Listen, the side effects are minimal 282 00:15:06,120 --> 00:15:08,000 "when you take it for chronic pain." 283 00:15:08,000 --> 00:15:10,000 There are certainly things we can do about it. 284 00:15:10,000 --> 00:15:12,200 And what we are aiming for is pain-free. 285 00:15:12,200 --> 00:15:13,880 So, basically, more and more medication 286 00:15:13,880 --> 00:15:16,440 and stepping onto opiates and then more and more opiates? 287 00:15:16,440 --> 00:15:19,120 We would find what dose was right for you, 288 00:15:19,120 --> 00:15:22,560 and if that required us to go up, that is what would be necessary. 289 00:15:22,560 --> 00:15:26,640 Opioids are now so common, it's easy to forget how powerful they are. 290 00:15:26,640 --> 00:15:29,080 Particularly when mixed with drink. 291 00:15:29,080 --> 00:15:31,800 People who have been on it for many years become accustomed to it. 292 00:15:31,800 --> 00:15:35,240 Everyone feels very confident. And, "Well, you've been on it. What harm can it do?" 293 00:15:35,240 --> 00:15:36,760 And people are found dead. 294 00:15:38,000 --> 00:15:39,800 Why is this? Alcohol. 295 00:15:39,800 --> 00:15:43,440 You know, you might go to a party, have slightly more to drink than you would normally do, 296 00:15:43,440 --> 00:15:45,360 and you're taking high-dose opiates. 297 00:15:45,360 --> 00:15:48,800 And then we're adding in more medication that interacts with this medication. 298 00:15:50,720 --> 00:15:55,080 20 years ago, there were 47 drug-poisoning deaths in England and Wales 299 00:15:55,080 --> 00:15:59,120 involving just two drugs - codeine or tramadol. 300 00:15:59,120 --> 00:16:01,520 Last year, it was nearly 400. 301 00:16:01,520 --> 00:16:05,920 Even if that's far from US levels, it is still a worrying trend. 302 00:16:07,120 --> 00:16:09,960 So in America, we've seen an absolute crisis 303 00:16:09,960 --> 00:16:13,920 with, you know, huge numbers of deaths. 304 00:16:13,920 --> 00:16:16,400 Can you imagine the same thing happening in the UK? 305 00:16:17,840 --> 00:16:20,440 Yes, I can. And it is something that's very much on my mind 306 00:16:20,440 --> 00:16:22,160 and very much of a concern and a worry 307 00:16:22,160 --> 00:16:25,560 that we're already seeing signs that that's happening. 308 00:16:25,560 --> 00:16:29,040 And I can see it very easily slipping into that. 309 00:16:29,040 --> 00:16:33,040 Over the not-too-distant future, the medium term, the next five years, 310 00:16:33,040 --> 00:16:35,480 that we will start seeing a progressively-increasing 311 00:16:35,480 --> 00:16:37,680 accidental overdose rate. 312 00:16:44,240 --> 00:16:48,200 It was quite chilling, the fact that he does think it is possible 313 00:16:48,200 --> 00:16:52,200 that things could get as bad here as they have got in the States. 314 00:16:52,200 --> 00:16:56,600 And it was also quite disturbing when you realised how we got into the situation. 315 00:16:56,600 --> 00:16:58,840 It was all the best of intentions. 316 00:17:01,200 --> 00:17:04,640 It would be easy to blame our doctors for overprescribing, 317 00:17:04,640 --> 00:17:08,000 but, of course, they're only doing what they've been trained to do. 318 00:17:09,200 --> 00:17:10,640 Hi, there. 319 00:17:12,280 --> 00:17:14,920 When I was at medical school in the 1980s, 320 00:17:14,920 --> 00:17:18,400 we were taught that opioids can be horribly addictive, 321 00:17:18,400 --> 00:17:20,800 except when patients are in severe pain. 322 00:17:20,800 --> 00:17:24,800 Then it's OK to increase the dose because they won't get hooked. 323 00:17:24,800 --> 00:17:28,280 We now know that advice was hopelessly misguided. 324 00:17:30,560 --> 00:17:32,880 I'm in Oxford to find out what went wrong. 325 00:17:33,840 --> 00:17:35,800 Hi, there. Hello. 326 00:17:35,800 --> 00:17:40,120 This is Dr Jane Quinlan, a consultant in pain management. 327 00:17:40,120 --> 00:17:44,240 So, how do you think we got into the situation where so many people are on opiates? 328 00:17:44,240 --> 00:17:48,600 Yeah, it all goes back to the 1980s, where two things happened. 329 00:17:48,600 --> 00:17:52,120 One of them was that evidence came from palliative care, 330 00:17:52,120 --> 00:17:55,160 looking at patients at end of life and who had pain, 331 00:17:55,160 --> 00:17:58,240 to say that actually, giving patients like that high-dose morphine, 332 00:17:58,240 --> 00:18:00,400 high-dose opioids was safe. 333 00:18:00,400 --> 00:18:02,040 People didn't get addicted. 334 00:18:02,040 --> 00:18:04,720 And you could just increase the dose as much as you needed to 335 00:18:04,720 --> 00:18:06,480 to make sure someone was comfortable. 336 00:18:06,480 --> 00:18:09,600 Which is really important when someone is dying of cancer. Mm. 337 00:18:09,600 --> 00:18:12,200 Equally, at the same time, there was a letter that was published 338 00:18:12,200 --> 00:18:14,160 in the New England Journal of Medicine, 339 00:18:14,160 --> 00:18:16,840 that was a five-sentence letter 340 00:18:16,840 --> 00:18:20,160 looking at about 11,000 patients who were in hospital 341 00:18:20,160 --> 00:18:22,960 and given opioids just for a short time. 342 00:18:22,960 --> 00:18:26,200 And this letter said, "None of our patients got addicted". 343 00:18:26,200 --> 00:18:29,920 The big headline, Addiction Is Rare In Patients Treated With Narcotics - 344 00:18:29,920 --> 00:18:31,960 we now call these opioids. Yes. 345 00:18:31,960 --> 00:18:34,720 And so, this headline message 346 00:18:34,720 --> 00:18:37,560 has then been repeated over 600 times. 347 00:18:38,800 --> 00:18:42,840 But this 100-word letter isn't peer-reviewed research, 348 00:18:42,840 --> 00:18:44,680 it's simply an observation. 349 00:18:46,320 --> 00:18:50,080 And yet it was referenced time and time and time again 350 00:18:50,080 --> 00:18:51,600 in science journals. 351 00:18:53,800 --> 00:18:57,880 And some took the letter's tentative conclusions much too far. 352 00:19:01,760 --> 00:19:05,080 This suited big pharmaceutical companies very well indeed. 353 00:19:05,080 --> 00:19:08,120 And they not only helped fund much pain research, 354 00:19:08,120 --> 00:19:11,080 but began aggressively promoting opioid use. 355 00:19:13,120 --> 00:19:16,400 Some patients may be afraid of taking opioids 356 00:19:16,400 --> 00:19:19,600 because they're perceived as too strong, or addictive. 357 00:19:20,520 --> 00:19:22,840 But that is far from actual fact. 358 00:19:22,840 --> 00:19:24,080 SIREN WAILS 359 00:19:26,000 --> 00:19:28,840 Four out of five heroin users in the USA 360 00:19:28,840 --> 00:19:31,680 started out by misusing prescription opioids, 361 00:19:31,680 --> 00:19:36,080 an epidemic which has now claimed more than 200,000 American lives. 362 00:19:38,480 --> 00:19:41,360 In 2017, the co-author of the original letter, 363 00:19:41,360 --> 00:19:43,800 Dr Hershel Jick, wrote - 364 00:19:54,280 --> 00:19:56,800 Things aren't nearly as bad in Britain, 365 00:19:56,800 --> 00:19:59,440 but I suspect the way this research was deployed 366 00:19:59,440 --> 00:20:02,560 helped drive the overprescribing we've seen here. 367 00:20:05,160 --> 00:20:08,000 Oxycodone, also known by the brand name OxyContin, 368 00:20:08,000 --> 00:20:12,400 was implicated in 79 deaths in England in 2018. 369 00:20:15,160 --> 00:20:18,880 NHS doctors are closely regulated, so it's unlikely opioids 370 00:20:18,880 --> 00:20:21,800 will ever be dispensed as freely here as in America. 371 00:20:24,200 --> 00:20:26,040 But Dr Quinlan is still concerned 372 00:20:26,040 --> 00:20:29,920 about the high levels some people are on. 373 00:20:29,920 --> 00:20:32,360 Some evidence has just come out to say if you're on more than 374 00:20:32,360 --> 00:20:34,400 100 milligrams of morphine equivalent per day, 375 00:20:34,400 --> 00:20:36,840 your risk of death is nine times higher 376 00:20:36,840 --> 00:20:39,040 than someone on 20 milligrams or less. 377 00:20:39,040 --> 00:20:40,680 And that's huge. 378 00:20:40,680 --> 00:20:42,560 That is absolutely vast, isn't it? 379 00:20:42,560 --> 00:20:44,760 Aren't patients aware of the risks they're running? 380 00:20:44,760 --> 00:20:46,720 No, I don't think they've got any idea at all. 381 00:20:46,720 --> 00:20:49,400 And again, they've been assured all these years 382 00:20:49,400 --> 00:20:51,240 when they've been prescribed these drugs 383 00:20:51,240 --> 00:20:53,080 that these are safe drugs to take. 384 00:20:53,080 --> 00:20:55,680 So often, having that conversation at our first consultation 385 00:20:55,680 --> 00:20:57,520 is actually quite difficult for them 386 00:20:57,520 --> 00:20:59,960 because they were unaware of the risks they're running 387 00:20:59,960 --> 00:21:02,000 by being on these high doses, 388 00:21:02,000 --> 00:21:04,040 that they've been taking in good faith, 389 00:21:04,040 --> 00:21:06,880 and they assumed were appropriate doses. 390 00:21:06,880 --> 00:21:09,520 Because they were obviously prescribed them in the first place. 391 00:21:09,520 --> 00:21:10,920 Exactly. Exactly. 392 00:21:17,240 --> 00:21:19,640 If you're one of the many people on high-strength opioids, 393 00:21:19,640 --> 00:21:22,120 please don't just stop taking them. 394 00:21:22,120 --> 00:21:25,000 Your chances of dying from an accidental overdose 395 00:21:25,000 --> 00:21:26,560 remain incredibly small. 396 00:21:28,000 --> 00:21:30,640 Nevertheless, as the Public Health England report reveals, 397 00:21:30,640 --> 00:21:35,320 too many people are on opioids that are too strong for too long. 398 00:21:35,320 --> 00:21:37,240 And that increases risk. 399 00:21:37,240 --> 00:21:42,120 Which begs the question - why aren't we urgently getting people off them? 400 00:21:43,240 --> 00:21:45,920 Unfortunately, it's not as simple as that. 401 00:21:47,880 --> 00:21:50,160 Do you find the swaying helps? Yeah. 402 00:21:50,160 --> 00:21:51,600 OK. Why? I don't know. 403 00:21:51,600 --> 00:21:53,520 I think because if you... 404 00:21:53,520 --> 00:21:55,800 I am beginning to sway with you, I have to say! 405 00:21:55,800 --> 00:21:57,520 THEY LAUGH 406 00:21:57,520 --> 00:22:00,280 Yeah. Yeah. I don't...I don't know. 407 00:22:00,280 --> 00:22:02,560 It just does? Yeah. Yeah. 408 00:22:02,560 --> 00:22:06,240 This is Brenda, at home in Salford with her husband, Roger. 409 00:22:07,760 --> 00:22:11,880 Brenda has been taking high-strength morphine for 15 years to cope 410 00:22:11,880 --> 00:22:15,600 with an injury which was sustained while working at her local hospital. 411 00:22:15,600 --> 00:22:19,400 We were transferring a young stroke patient 412 00:22:19,400 --> 00:22:23,480 and I sort of twisted and went down, but... 413 00:22:23,480 --> 00:22:25,480 And was it very painful? 414 00:22:25,480 --> 00:22:27,440 Excruciating. Yeah. 415 00:22:27,440 --> 00:22:29,760 Out of 10? Er...20. 416 00:22:29,760 --> 00:22:31,680 THEY LAUGH Yeah. 417 00:22:31,680 --> 00:22:33,480 It was horrendous. 418 00:22:34,920 --> 00:22:37,440 Brenda has been left in constant pain. 419 00:22:37,440 --> 00:22:41,160 In fact, her days seem quite unbearable. 420 00:22:41,160 --> 00:22:43,960 I wouldn't wish it on my worst enemy. 421 00:22:43,960 --> 00:22:45,800 It's horrendous. 422 00:22:45,800 --> 00:22:48,640 You've given birth to two kids. How does it compare to that? 423 00:22:49,640 --> 00:22:52,680 Um...giving birth, easy-peasy. 424 00:22:54,960 --> 00:22:59,120 Brenda's story is remarkably similar to Karen's, the first patient I met. 425 00:22:59,120 --> 00:23:03,080 But while Karen's opioids turned her into a zombie, 426 00:23:03,080 --> 00:23:05,120 Brenda swears by them. 427 00:23:05,120 --> 00:23:07,320 And what's the morphine actually done? 428 00:23:07,320 --> 00:23:09,160 It's just magic. 429 00:23:09,160 --> 00:23:11,880 It is for me, anyway. 430 00:23:11,880 --> 00:23:13,560 It really is. 431 00:23:13,560 --> 00:23:15,480 Do you think you could get by without it? No. 432 00:23:16,880 --> 00:23:19,160 And what would you say if someone tried to take it away? 433 00:23:19,160 --> 00:23:20,920 Why? 434 00:23:20,920 --> 00:23:23,760 And what are you giving me that's as good as that? 435 00:23:23,760 --> 00:23:26,840 I couldn't imagine being without it. 436 00:23:26,840 --> 00:23:28,680 There'd have to be a backup to it. 437 00:23:28,680 --> 00:23:32,320 Oh, it would be horrendous, I know it would. 438 00:23:32,320 --> 00:23:34,040 Does it affect your brain at all? 439 00:23:34,040 --> 00:23:35,880 Does it fog you up at all? No. 440 00:23:35,880 --> 00:23:39,200 Have you had any obvious side-effects from it? None at all. 441 00:23:39,200 --> 00:23:42,720 You're taking it without any significant side-effects, as far as you can see? 442 00:23:42,720 --> 00:23:45,120 Yeah, I think so. And it's bringing the pain down? Yeah. 443 00:23:45,120 --> 00:23:48,160 So, for you, it's working really well? Yeah, definitely. 444 00:23:49,320 --> 00:23:51,400 That's... There we go. Are you up? 445 00:23:53,480 --> 00:23:55,040 Are you up? 446 00:23:55,040 --> 00:23:57,200 Oof! Are you going to do a bit more swaying? 447 00:23:57,200 --> 00:23:59,160 Yeah, I'm going in there, swaying. 448 00:23:59,160 --> 00:24:01,360 Thank you very much. Thank you very much. Thank you. 449 00:24:01,360 --> 00:24:03,200 You're welcome. Mwah! 450 00:24:03,200 --> 00:24:04,880 I can say I've kissed a famous person! 451 00:24:04,880 --> 00:24:06,840 THEY LAUGH 452 00:24:11,920 --> 00:24:13,760 I really feel for Brenda. 453 00:24:13,760 --> 00:24:16,080 She's obviously in a bad state 454 00:24:16,080 --> 00:24:19,920 and believes the thing that makes her life tolerable is morphine. 455 00:24:19,920 --> 00:24:22,080 But is she right? 456 00:24:23,080 --> 00:24:25,280 There are hundreds of thousands of people like Brenda 457 00:24:25,280 --> 00:24:29,200 who are taking opioids, but are still in pain. 458 00:24:30,440 --> 00:24:32,640 So, how much are these drugs actually helping? 459 00:24:33,840 --> 00:24:36,720 I need to learn more about the science of pain. 460 00:24:41,480 --> 00:24:45,080 I'm back in Oxford to meet one of the world's foremost pain experts, 461 00:24:45,080 --> 00:24:46,840 Dr Irene Tracey. 462 00:24:48,800 --> 00:24:50,760 To help me get to grips with the subject, 463 00:24:50,760 --> 00:24:53,360 I'm going to take part in a little experiment. 464 00:24:54,960 --> 00:24:57,840 I'm assured it won't be too painful. 465 00:24:57,840 --> 00:24:59,880 OK. 466 00:24:59,880 --> 00:25:02,920 What we're going to start with here is some chilli-pepper cream 467 00:25:02,920 --> 00:25:04,920 that we've had specially made up by a pharmacy. OK. 468 00:25:04,920 --> 00:25:06,560 And we're going to just put a little 469 00:25:06,560 --> 00:25:08,600 area of your skin with it on. OK. 470 00:25:08,600 --> 00:25:10,080 And we're going to let that cook 471 00:25:10,080 --> 00:25:11,840 for about 30 minutes. OK. 472 00:25:14,040 --> 00:25:18,080 This chilli is going to burn my skin and trigger a complex network 473 00:25:18,080 --> 00:25:20,560 of pain sensors in the body. 474 00:25:20,560 --> 00:25:24,840 Rub that in, make sure it's really soaking in for you. 475 00:25:24,840 --> 00:25:28,080 Starting to feel... I can feel it beginning to burn now. Yeah. 476 00:25:29,520 --> 00:25:32,960 You've got these things... Your fibres out there in your arm, 477 00:25:32,960 --> 00:25:35,440 that are going to send the signals in. They then hit your, 478 00:25:35,440 --> 00:25:37,520 sort of, spinal cord. It's at the back there. 479 00:25:37,520 --> 00:25:40,080 Then they enter the brain and the brain puts it together. 480 00:25:40,080 --> 00:25:42,120 But again, the brain's got a capacity to change 481 00:25:42,120 --> 00:25:43,680 how those signals are processed. 482 00:25:43,680 --> 00:25:46,760 It also can change and talk, down to that point where 483 00:25:46,760 --> 00:25:49,240 those signals are first coming into your spinal cord... Right. 484 00:25:49,240 --> 00:25:51,240 ..and turn it up and turn it down. 485 00:25:51,240 --> 00:25:54,720 The sensation I'm feeling now is acute pain. 486 00:25:54,720 --> 00:25:57,120 It's triggered by the nerve fibres in my skin 487 00:25:57,120 --> 00:25:59,160 that are being burnt by the chilli. 488 00:26:00,760 --> 00:26:04,240 What is the key difference between acute and chronic pain? 489 00:26:04,240 --> 00:26:06,560 Chronic pain is just something very different to acute. 490 00:26:06,560 --> 00:26:09,200 The definition of chronic pain is a pain that's still there 491 00:26:09,200 --> 00:26:11,800 beyond normal tissue healing times, so three to four months. 492 00:26:11,800 --> 00:26:13,920 Historically, we thought it was just a continuation, 493 00:26:13,920 --> 00:26:15,840 it was just an ongoing symptom, 494 00:26:15,840 --> 00:26:17,880 an ongoing acute pain. 495 00:26:17,880 --> 00:26:21,920 Now we know that in that transition from acute to chronic, 496 00:26:21,920 --> 00:26:25,520 it's a whole new biology has established itself. 497 00:26:25,520 --> 00:26:31,080 There's been changes in your cells and your genetics, your wiring. 498 00:26:31,080 --> 00:26:33,520 It is a, sort of, disease in its own right. Yeah. 499 00:26:33,520 --> 00:26:36,520 And it's not just a continuation of the acute pain symptom. 500 00:26:36,520 --> 00:26:38,520 It is something different now. 501 00:26:38,520 --> 00:26:42,680 This remarkable discovery, that acute and chronic pain 502 00:26:42,680 --> 00:26:46,080 are fundamentally different, is being modelled right now 503 00:26:46,080 --> 00:26:48,520 on my increasingly sore arm. 504 00:26:48,520 --> 00:26:51,560 If I brush you... Yeah. ..that normal touch is now painful. 505 00:26:51,560 --> 00:26:52,640 Yeah, indeed. 506 00:26:52,640 --> 00:26:56,080 And it's not because that part of the skin is injured, 507 00:26:56,080 --> 00:26:58,720 it's because this injured bit has sent signals in 508 00:26:58,720 --> 00:27:01,640 for the past 30 minutes, it's set off those amplifiers 509 00:27:01,640 --> 00:27:03,760 we spoke about, the spinal cord and the brain. Yeah. 510 00:27:03,760 --> 00:27:05,360 So now, when those signals go in... 511 00:27:05,360 --> 00:27:07,600 HE WINCES Sorry! 512 00:27:07,600 --> 00:27:10,080 ..they are being amplified, literally like a volume button. 513 00:27:10,080 --> 00:27:12,080 More goes into your brain, it hurts more. Right. 514 00:27:12,080 --> 00:27:15,160 That is a really important mechanism in chronic pain. Yeah. 515 00:27:17,400 --> 00:27:20,720 With my pain system now in overdrive, I'm experiencing 516 00:27:20,720 --> 00:27:23,120 burning where there's no chilli cream. 517 00:27:25,680 --> 00:27:27,920 And that's what happens in chronic pain - 518 00:27:27,920 --> 00:27:32,040 you feel it even when there's no longer a physical injury. 519 00:27:32,040 --> 00:27:34,240 I might have this off now. Shall we have this off? 520 00:27:34,240 --> 00:27:36,600 I think we'll have this off, yes. OK, so I'll just peel that off. 521 00:27:36,600 --> 00:27:39,080 Hopefully that won't hurt too much. Not at all. 522 00:27:39,080 --> 00:27:42,520 So, I get that in acute pain, 523 00:27:42,520 --> 00:27:45,200 you have the pain and it has a purpose... Yeah. 524 00:27:45,200 --> 00:27:48,040 ..to teach you to avoid stuff and to protect yourself. 525 00:27:48,040 --> 00:27:52,480 But why do you get these things which switch on and stay on? 526 00:27:52,480 --> 00:27:54,680 Yeah, it's... Well, it doesn't have a purpose. 527 00:27:54,680 --> 00:27:57,200 I think, again, we thought, chronic pain, there was a purpose for it. 528 00:27:57,200 --> 00:27:59,600 There just isn't. It's a system gone wrong. Right. 529 00:28:00,640 --> 00:28:03,640 There's no doubt that opioids are one of the best tools 530 00:28:03,640 --> 00:28:06,520 in our armoury for numbing acute pain. 531 00:28:06,520 --> 00:28:09,800 But this experiment raises an important question - 532 00:28:09,800 --> 00:28:12,480 if chronic and acute pain are different conditions, 533 00:28:12,480 --> 00:28:14,880 is the same treatment - opioids - 534 00:28:14,880 --> 00:28:17,960 likely to be just as effective in both? 535 00:28:17,960 --> 00:28:21,240 It is a critical question, because the majority of opioid 536 00:28:21,240 --> 00:28:24,840 prescriptions handed out in Britain are for chronic pain. 537 00:28:27,680 --> 00:28:31,120 I'm heading to the Royal College of Physicians in London 538 00:28:31,120 --> 00:28:32,960 to meet Dr Cathy Stannard. 539 00:28:32,960 --> 00:28:35,520 She's one of the world's leading experts on pain medicine. 540 00:28:37,680 --> 00:28:41,920 I want to find out just how useful she thinks opioids are 541 00:28:41,920 --> 00:28:44,720 at tackling chronic pain. 542 00:28:44,720 --> 00:28:46,800 Chronic pain is very difficult to treat. 543 00:28:46,800 --> 00:28:50,000 Probably fewer than one in ten people given opioids 544 00:28:50,000 --> 00:28:54,040 for long-term pain will get a useful... 545 00:28:54,040 --> 00:28:57,000 ..clinically useful result from them. 546 00:28:57,000 --> 00:29:01,280 Shockingly, that suggests that in 90% of chronic pain cases, 547 00:29:01,280 --> 00:29:04,400 opioids really aren't helping. 548 00:29:04,400 --> 00:29:08,360 But as I've learned, if the opioids aren't numbing the pain, 549 00:29:08,360 --> 00:29:11,400 doctors have been trained to give more. 550 00:29:11,400 --> 00:29:13,960 So if I give you a drug for blood pressure and your blood pressure 551 00:29:13,960 --> 00:29:16,640 stays high, nobody would argue that it's not working. 552 00:29:16,640 --> 00:29:19,080 But if I give you a painkiller and you come back and say, 553 00:29:19,080 --> 00:29:21,040 "I'm still in pain." What do we do? We double it. 554 00:29:21,040 --> 00:29:23,320 And you come back and say, "I'm still in pain." And we double it. 555 00:29:23,320 --> 00:29:25,920 If you give it and it doesn't work, stop it. 556 00:29:25,920 --> 00:29:28,040 You know, that's what you would do with any other drug. 557 00:29:28,040 --> 00:29:29,560 But why don't we do that? 558 00:29:32,560 --> 00:29:34,280 That was a pretty amazing statistic, 559 00:29:34,280 --> 00:29:37,160 that less than one in ten people 560 00:29:37,160 --> 00:29:40,080 who go on opioids get any benefit from it. 561 00:29:40,080 --> 00:29:43,080 And that does suggest that there are an awful lot of people 562 00:29:43,080 --> 00:29:46,720 out there on high-dose opioids with horrible side effects 563 00:29:46,720 --> 00:29:49,320 who are actually getting no pain relief at all. 564 00:29:49,320 --> 00:29:51,760 And it makes you wonder, why are they on it? 565 00:29:54,960 --> 00:29:57,400 Why ARE they on it? 566 00:29:57,400 --> 00:30:01,360 Who is responsible for so many being put on life-altering, 567 00:30:01,360 --> 00:30:04,760 addictive, potentially dangerous opioids, 568 00:30:04,760 --> 00:30:07,360 especially when it seems in the majority of cases, 569 00:30:07,360 --> 00:30:09,200 they don't actually work? 570 00:30:12,280 --> 00:30:13,920 Hi, there. Hello. 571 00:30:13,920 --> 00:30:16,880 Helen Stokes-Lampard is the country's most senior GP. 572 00:30:17,960 --> 00:30:19,960 I believe GPs have always tried to do their best 573 00:30:19,960 --> 00:30:22,840 for their patients, and if patients have come to see them in pain, 574 00:30:22,840 --> 00:30:25,320 they've used whatever materials they have at their disposal. 575 00:30:25,320 --> 00:30:28,400 Years gone by, there weren't many options, and opioids were high 576 00:30:28,400 --> 00:30:30,960 on the list of what we were encouraged to use. 577 00:30:30,960 --> 00:30:34,080 If now, we are part of a system where people are hooked on things, 578 00:30:34,080 --> 00:30:37,640 we need to do all we can to help de-prescribe for those patients. 579 00:30:37,640 --> 00:30:40,520 But GPs, fundamentally, are trying to do what's right. 580 00:30:40,520 --> 00:30:43,120 But why are they put on it in the first place, if they're useless? 581 00:30:43,120 --> 00:30:45,480 Myriad reasons, because they started with acute pain. 582 00:30:45,480 --> 00:30:47,000 Anything that becomes long-term 583 00:30:47,000 --> 00:30:49,240 started as a new problem once upon a time. 584 00:30:49,240 --> 00:30:52,680 So you start somewhere... And they were stuck on them, presumably, 585 00:30:52,680 --> 00:30:55,320 with not a great deal of evidence that they were going to work, 586 00:30:55,320 --> 00:30:57,800 because I've looked back through the data, and there really 587 00:30:57,800 --> 00:30:59,800 was never any great evidence that they would work. 588 00:30:59,800 --> 00:31:02,240 But there was clear guidance that that's what we should use. Right. 589 00:31:02,240 --> 00:31:05,280 The difficulty is, as a GP, the patient sitting in front of you, 590 00:31:05,280 --> 00:31:08,280 we often don't know which ones are benefiting and which ones aren't, 591 00:31:08,280 --> 00:31:10,400 until you wean them off the medication. 592 00:31:10,400 --> 00:31:12,800 But the reality is, there are half a million people out there... 593 00:31:12,800 --> 00:31:15,840 There are. ..who have been identified as being prescribed 594 00:31:15,840 --> 00:31:17,680 too much of this stuff for too long. 595 00:31:17,680 --> 00:31:18,760 That's a lot of people. 596 00:31:18,760 --> 00:31:21,320 There are a significant proportion of those who would benefit 597 00:31:21,320 --> 00:31:23,920 from being weaned down. I totally agree. 598 00:31:23,920 --> 00:31:26,240 But it's not just about weaning down the medication, Michael, 599 00:31:26,240 --> 00:31:28,280 we need to give these people something to help them 600 00:31:28,280 --> 00:31:31,280 with their pain. 100%. Because to them, their pain is very real. 601 00:31:31,280 --> 00:31:33,760 We weren't having this conversation a couple of years ago. 602 00:31:33,760 --> 00:31:36,160 We're now talking about this, the public are talking about it. 603 00:31:36,160 --> 00:31:38,200 I've had patients come in to me and say, 604 00:31:38,200 --> 00:31:40,840 "Dr Helen, I think I might be addicted to my painkillers." 605 00:31:40,840 --> 00:31:43,600 Wow. We didn't have that a few years ago. 606 00:31:43,600 --> 00:31:46,120 We can't change the past, but we absolutely can work 607 00:31:46,120 --> 00:31:47,320 on this for the future. 608 00:31:50,800 --> 00:31:54,440 It's clear that the message about opioids is starting to get through 609 00:31:54,440 --> 00:31:56,960 to doctors and their patients. 610 00:31:56,960 --> 00:32:01,160 But that's not the whole picture because, of course, 611 00:32:01,160 --> 00:32:05,400 you don't need to see a doctor to get your hands on an opioid. 612 00:32:06,960 --> 00:32:09,360 Which of these are you actually the most worried about? 613 00:32:09,360 --> 00:32:12,080 Surprisingly, this one, the co-codamol. 614 00:32:12,080 --> 00:32:13,960 The one that you can buy over the counter. 615 00:32:13,960 --> 00:32:15,400 It can cause addiction. 616 00:32:15,400 --> 00:32:18,080 It's not restricted. You're only allowed to buy 617 00:32:18,080 --> 00:32:21,480 one box at a time - however, what's stopping you from going 618 00:32:21,480 --> 00:32:24,240 to multiple pharmacies and buying multiple boxes throughout the day? 619 00:32:25,920 --> 00:32:29,160 Co-codamol is just one of the many opioid-based drugs 620 00:32:29,160 --> 00:32:30,800 you can buy at a chemist. 621 00:32:30,800 --> 00:32:32,840 And like prescription drugs, 622 00:32:32,840 --> 00:32:36,280 we have no idea how many are being sold nationally. 623 00:32:36,280 --> 00:32:39,240 And Akash worries these over-the-counter drugs 624 00:32:39,240 --> 00:32:40,360 are being abused. 625 00:32:42,200 --> 00:32:44,960 What sort of things are you supposed to ask me before you're dispensing? 626 00:32:44,960 --> 00:32:48,240 So we have a little way of doing it, which is called WWHAM. 627 00:32:48,240 --> 00:32:49,400 So you start off with, 628 00:32:49,400 --> 00:32:52,120 who, what, how long, action taken, 629 00:32:52,120 --> 00:32:54,160 and any medication. 630 00:32:54,160 --> 00:32:56,600 OK, so that's WWHAM? That's the basic... 631 00:32:56,600 --> 00:32:58,240 So I should get WWHAM'd? 632 00:32:58,240 --> 00:33:00,840 You should get WWHAM'd, yeah. In every pharmacy I go to. Yeah, OK. 633 00:33:00,840 --> 00:33:02,880 Thanks a lot. It's been very enlightening. 634 00:33:04,560 --> 00:33:07,160 Pharmacists WWHAM customers to make sure the painkillers 635 00:33:07,160 --> 00:33:08,920 they're selling won't be misused. 636 00:33:10,360 --> 00:33:12,640 So how effective is WWHAM in limiting 637 00:33:12,640 --> 00:33:14,280 the number of pills I can get? 638 00:33:15,880 --> 00:33:19,160 Hello, yes, can I get some Solpadeine Max, please? 639 00:33:19,160 --> 00:33:21,720 There wasn't any kind of conversation about why I wanted it 640 00:33:21,720 --> 00:33:24,240 or what I was going to do with it or anything like that. 641 00:33:24,240 --> 00:33:26,240 So, failed WWHAM test, I'm afraid. 642 00:33:28,840 --> 00:33:32,880 Do you have any Nurofen Plus or Solpadeine Max, please? 643 00:33:32,880 --> 00:33:34,800 She was much more thorough, I have to say. 644 00:33:34,800 --> 00:33:38,240 I got my 12.9 milligrams, again, of codeine. 645 00:33:38,240 --> 00:33:41,080 She did look deeply suspicious, I have to say. 646 00:33:43,720 --> 00:33:45,080 She asked me what it's for. 647 00:33:45,080 --> 00:33:46,960 She asked me if I'd tried other things. 648 00:33:46,960 --> 00:33:48,320 Basically, she passed. 649 00:33:51,640 --> 00:33:55,360 That was, kind of, the shortest conversation of them all so far. 650 00:33:55,360 --> 00:33:57,360 Essentially, "Yeah, sure." 651 00:33:57,360 --> 00:33:59,480 The only conversation I had about it was whether it had 652 00:33:59,480 --> 00:34:00,600 caffeine in it or not. 653 00:34:02,880 --> 00:34:04,080 Well... 654 00:34:04,080 --> 00:34:07,520 So that guy gave me absolutely no conversation, 655 00:34:07,520 --> 00:34:09,840 he said nothing at all. So I just asked for another one, 656 00:34:09,840 --> 00:34:12,120 since I was in there. And if I had asked for three, 657 00:34:12,120 --> 00:34:14,000 he might have given it to me, I don't know. 658 00:34:14,000 --> 00:34:16,600 No warnings, no why do you want it, nothing. 659 00:34:16,600 --> 00:34:19,680 And he really, really failed the WWHAM test, by a long way. 660 00:34:19,680 --> 00:34:22,520 One, two, three, four, five, 661 00:34:22,520 --> 00:34:26,720 six, seven, eight boxes of the stuff. 662 00:34:26,720 --> 00:34:28,400 So, yeah, I've been going 40 minutes 663 00:34:28,400 --> 00:34:31,040 and I've got eight boxes of the stuff, 664 00:34:31,040 --> 00:34:33,480 at 30 tablets a time, 665 00:34:33,480 --> 00:34:36,760 is around 240 tablets, I have scored. 666 00:34:36,760 --> 00:34:40,600 And to be honest, really, only two people asked me 667 00:34:40,600 --> 00:34:42,520 all the questions you're supposed to ask. 668 00:34:42,520 --> 00:34:45,520 So I guess it just shows you how easy it is 669 00:34:45,520 --> 00:34:48,480 to get these over-the-counter drugs, if you really want to. 670 00:34:50,800 --> 00:34:53,280 In a few minutes, I bought enough codeine, 671 00:34:53,280 --> 00:34:56,120 at least in theory, to give me an opioid hit 672 00:34:56,120 --> 00:34:59,280 stronger than the incredibly powerful fentanyl patch 673 00:34:59,280 --> 00:35:00,920 Akash showed me earlier. 674 00:35:01,920 --> 00:35:05,800 The thing is, pills like this not only contain codeine, 675 00:35:05,800 --> 00:35:09,040 but other painkillers like ibuprofen and paracetamol, 676 00:35:09,040 --> 00:35:12,680 which make them even more dangerous in large quantities. 677 00:35:12,680 --> 00:35:15,520 And of course, some people buy codeine for reasons 678 00:35:15,520 --> 00:35:17,560 that have nothing to do with pain relief. 679 00:35:17,560 --> 00:35:21,080 People who will use these medicines quite reasonably 680 00:35:21,080 --> 00:35:23,360 to self-manage their pain will do what they can, 681 00:35:23,360 --> 00:35:27,120 go to the chemist and buy a painkiller. 682 00:35:27,120 --> 00:35:28,960 Now, where the problem arises is, 683 00:35:28,960 --> 00:35:31,800 you might quite like the sensation that these medicines give you, 684 00:35:31,800 --> 00:35:33,280 so that is what the driver is 685 00:35:33,280 --> 00:35:35,040 for continuing to take these drugs 686 00:35:35,040 --> 00:35:37,280 after your acute pain has settled. Right. 687 00:35:37,280 --> 00:35:40,760 Because it makes it easier to get through the day. 688 00:35:43,160 --> 00:35:45,800 "It makes it easier to get through the day". 689 00:35:45,800 --> 00:35:48,840 That seems far removed from managing pain. 690 00:35:50,880 --> 00:35:52,760 It's a big, unrecognised problem 691 00:35:52,760 --> 00:35:54,760 because people just do not seek advice, 692 00:35:54,760 --> 00:35:57,000 I think largely because of the stigma. 693 00:35:57,000 --> 00:35:59,400 Do you have any idea of the scale? We don't. 694 00:35:59,400 --> 00:36:01,040 I mean, that's the problem. 695 00:36:01,040 --> 00:36:03,080 But what I would say is that 696 00:36:03,080 --> 00:36:06,080 it's interesting that I have seen so few people 697 00:36:06,080 --> 00:36:08,400 who are addicted to these medicines. 698 00:36:08,400 --> 00:36:09,760 And when I have seen them, 699 00:36:09,760 --> 00:36:13,440 they are all very high-achieving people in busy jobs, 700 00:36:13,440 --> 00:36:15,480 busy lives, coping well, 701 00:36:15,480 --> 00:36:17,720 coping well despite their addictions, 702 00:36:17,720 --> 00:36:21,360 so a masked addiction, high-functioning, if you like. 703 00:36:27,120 --> 00:36:30,440 With the pharmacies, it would be a case of finding out 704 00:36:30,440 --> 00:36:31,920 what time they opened. 705 00:36:31,920 --> 00:36:35,000 Could I get there before I started my shift at work? 706 00:36:35,000 --> 00:36:39,040 Could I get there after? Could I get there in my lunch break? 707 00:36:39,040 --> 00:36:40,480 And it was all very calculated, 708 00:36:40,480 --> 00:36:43,320 especially with the chemists that were surrounding at work. 709 00:36:43,320 --> 00:36:45,760 This is Vicky. 710 00:36:45,760 --> 00:36:48,400 For years, she held down a steady office job 711 00:36:48,400 --> 00:36:52,640 while secretly relying on over-the-counter codeine 712 00:36:52,640 --> 00:36:54,720 to get her through the day. 713 00:36:54,720 --> 00:36:57,720 Initially, it was pain relief. 714 00:36:57,720 --> 00:37:00,520 I came out of hospital with kidney stones, 715 00:37:00,520 --> 00:37:03,600 so they gave me codeine for pain relief. 716 00:37:03,600 --> 00:37:06,240 The more I took, the better I felt. 717 00:37:06,240 --> 00:37:08,280 It gives you like a warm, fuzzy feeling 718 00:37:08,280 --> 00:37:10,920 and a feeling that you can conquer the world, if you like. 719 00:37:10,920 --> 00:37:15,120 So that's how I found that the more I took, the better I felt. 720 00:37:15,120 --> 00:37:17,040 What does it do? What does it feel like? 721 00:37:18,640 --> 00:37:20,040 It feels like... 722 00:37:20,040 --> 00:37:23,320 You know when you're really, really thirsty, for example, 723 00:37:23,320 --> 00:37:26,560 and you have that refreshing drink 724 00:37:26,560 --> 00:37:30,000 and you just go, "Oh, wow, I really needed that". 725 00:37:30,000 --> 00:37:31,840 That's how it feels. 726 00:37:31,840 --> 00:37:35,120 If I had a job interview, I'd take them because if I was nervous, 727 00:37:35,120 --> 00:37:39,960 they would make me feel a lot better and more confident in myself 728 00:37:39,960 --> 00:37:42,000 and the warm buzz that you get, 729 00:37:42,000 --> 00:37:45,440 it's like a quilt, almost, around you. 730 00:37:45,440 --> 00:37:47,960 It's nice. It's a nice feeling. I'm not going to lie. 731 00:37:47,960 --> 00:37:50,320 I can't sit here and lie and say it's not. 732 00:37:50,320 --> 00:37:52,360 It is, it's a nice feeling. 733 00:37:52,360 --> 00:37:55,800 At your peak, how many of these tablets were you consuming? 734 00:37:55,800 --> 00:37:58,640 Between 50 and 70. 735 00:37:58,640 --> 00:37:59,880 Wow. A day. 736 00:38:01,320 --> 00:38:04,320 50 tablets contain 25g of paracetamol, 737 00:38:04,320 --> 00:38:07,200 enough to put you in hospital. 738 00:38:07,200 --> 00:38:09,640 I ended up overdosing in November. 739 00:38:09,640 --> 00:38:11,560 I did, you know, the treatment 740 00:38:11,560 --> 00:38:14,080 where they literally just flush your kidneys 741 00:38:14,080 --> 00:38:16,000 and make sure everything's OK. 742 00:38:16,000 --> 00:38:19,760 And I decided that it was now time to go into detox, 743 00:38:19,760 --> 00:38:25,600 which was the scariest but most epic time ever. 744 00:38:25,600 --> 00:38:28,960 People were in there for heroin, crack, alcoholism, 745 00:38:28,960 --> 00:38:31,240 loads of different stuff. 746 00:38:31,240 --> 00:38:33,200 And you were there for over-the-counter drugs. 747 00:38:33,200 --> 00:38:35,000 I was there for over-the-counter drugs, yeah. 748 00:38:35,000 --> 00:38:36,640 And they were looking at me going, 749 00:38:36,640 --> 00:38:38,280 "Why are you even here?" 750 00:38:38,280 --> 00:38:40,120 Like, you know, why? 751 00:38:40,120 --> 00:38:44,560 In the end, it was because codeine is a part of the heroin family. 752 00:38:44,560 --> 00:38:46,360 So it's an addiction. 753 00:38:46,360 --> 00:38:48,160 It doesn't matter what addiction. 754 00:38:48,160 --> 00:38:50,040 It's addiction. 755 00:38:50,040 --> 00:38:51,680 And it was hard. 756 00:38:57,160 --> 00:38:59,640 Vicky has been off codeine for three months now, 757 00:38:59,640 --> 00:39:02,640 but she'll always be battling her addiction. 758 00:39:02,640 --> 00:39:03,920 I'm pleased she's on the mend. 759 00:39:03,920 --> 00:39:07,320 But I also wonder how many codeine addicts are out there. 760 00:39:07,320 --> 00:39:09,200 These days if you want opioids, 761 00:39:09,200 --> 00:39:13,600 you don't have to go to the chemist to get them. 762 00:39:13,600 --> 00:39:18,080 You can now buy far stronger prescription opioids on the web. 763 00:39:19,080 --> 00:39:22,000 So how easy is it to buy codeine online? 764 00:39:22,000 --> 00:39:24,360 Well, I'm in a cafe, got my laptop 765 00:39:24,360 --> 00:39:27,600 and I also have my own favourite psychoactive drug. 766 00:39:27,600 --> 00:39:28,680 That's caffeine. 767 00:39:29,760 --> 00:39:30,960 And here we go. 768 00:39:30,960 --> 00:39:32,800 Right. We're online. 769 00:39:33,720 --> 00:39:34,880 There we go. 770 00:39:34,880 --> 00:39:37,360 OK. That came up pretty fast. 771 00:39:37,360 --> 00:39:40,360 Pain relief prescriptions, free UK express delivery. 772 00:39:40,360 --> 00:39:41,440 That's for me. 773 00:39:41,440 --> 00:39:45,080 Discretion and confidentiality, 100% all guaranteed. 774 00:39:45,080 --> 00:39:49,280 Of course, you can buy almost anything on the internet. 775 00:39:49,280 --> 00:39:52,360 And there's no shortage of sites offering me codeine. 776 00:39:52,360 --> 00:39:57,080 But I won't be advertising the name of this particular vendor. 777 00:39:57,080 --> 00:40:01,320 It's dispensed by registered UK pharmacies, it says. 778 00:40:01,320 --> 00:40:03,160 That looks good. 779 00:40:03,160 --> 00:40:06,200 And then it says, "Start consultation". OK. 780 00:40:08,480 --> 00:40:11,480 "Are you registered with a GP practice in the UK?" Yes. 781 00:40:11,480 --> 00:40:15,760 "Do you give us consent to write to your GP for approval?" No. 782 00:40:15,760 --> 00:40:18,760 I don't want my GP to know. 783 00:40:18,760 --> 00:40:21,480 No problem, it seems. 784 00:40:21,480 --> 00:40:24,960 Instead, 12 hours later, they approve my form themselves. 785 00:40:26,480 --> 00:40:27,760 Right. 786 00:40:27,760 --> 00:40:31,080 Final thing is, I've got to register myself. 787 00:40:31,080 --> 00:40:36,480 I think I might go with a fake name, James Reid. 788 00:40:36,480 --> 00:40:38,120 That sounds plausible. 789 00:40:40,080 --> 00:40:45,800 They did do an ID check, but mine didn't say James Reid. 790 00:40:45,800 --> 00:40:48,040 Let's see if that bothers them. 791 00:40:51,120 --> 00:40:53,560 It does not. That's marvellous. OK. 792 00:40:53,560 --> 00:40:55,960 So finally, let's buy. 793 00:40:55,960 --> 00:40:57,840 There we go. 794 00:40:57,840 --> 00:41:01,280 And now, really, let's see if it actually comes through. 795 00:41:01,280 --> 00:41:02,600 Will they deliver? 796 00:41:05,200 --> 00:41:07,360 And deliver they do. 797 00:41:09,080 --> 00:41:13,640 So here we go, two packages in the name of the fictional James Reid. 798 00:41:13,640 --> 00:41:16,320 And I have to say, they have come very promptly, 799 00:41:16,320 --> 00:41:19,520 because I only ordered them two days ago. 800 00:41:19,520 --> 00:41:21,960 OK, so this is the one which comes 801 00:41:21,960 --> 00:41:26,440 from a properly regulated British company based here in the UK. 802 00:41:27,480 --> 00:41:30,920 Here we go. Codeine phosphate tablets. 803 00:41:30,920 --> 00:41:32,520 That shouldn't have happened. 804 00:41:32,520 --> 00:41:34,600 And I got really enthusiastic, 805 00:41:34,600 --> 00:41:39,000 and I wanted to see whether I could also order it from online services 806 00:41:39,000 --> 00:41:40,720 which are not based in the UK. 807 00:41:40,720 --> 00:41:44,120 And I decided to go for some really high-dose codeine. 808 00:41:44,120 --> 00:41:45,920 And yeah, here it is, 809 00:41:45,920 --> 00:41:50,600 two packets of 20 tablets each. That's 40 tablets of codeine. 810 00:41:51,600 --> 00:41:53,800 Now, this stuff is really serious. 811 00:41:53,800 --> 00:41:57,120 It is pure codeine, and that means it is a class B drug. 812 00:41:57,120 --> 00:41:58,240 And in the UK, 813 00:41:58,240 --> 00:42:02,200 that means that simply possessing it without a proper prescription 814 00:42:02,200 --> 00:42:05,280 means that I could go to jail for up to five years. 815 00:42:05,280 --> 00:42:07,920 Time, I think, to go and talk to the regulator 816 00:42:07,920 --> 00:42:11,080 about how easy it is to get hold of this stuff. 817 00:42:13,360 --> 00:42:15,400 All Britain's chemists are regulated 818 00:42:15,400 --> 00:42:18,280 by the General Pharmaceutical Council. 819 00:42:18,280 --> 00:42:20,920 So what do they make of my online shopping? 820 00:42:20,920 --> 00:42:24,000 I'm sitting here and I've got codeine phosphate 821 00:42:24,000 --> 00:42:26,360 and this is a class B drug, isn't it, in terms of codeine? 822 00:42:26,360 --> 00:42:27,480 It's not something 823 00:42:27,480 --> 00:42:29,640 that people should be flogging over the internet. 824 00:42:29,640 --> 00:42:31,680 Absolutely not. As a controlled drug, 825 00:42:31,680 --> 00:42:33,880 there are important restrictions in place 826 00:42:33,880 --> 00:42:35,480 which are there to protect people. 827 00:42:35,480 --> 00:42:37,800 It took me about 15 minutes to buy the stuff, though. 828 00:42:37,800 --> 00:42:40,200 I really shouldn't be allowed to do that, should I? No. 829 00:42:40,200 --> 00:42:42,520 It's important that there are checks on identity... 830 00:42:42,520 --> 00:42:45,280 They were pretty pathetic at that! 831 00:42:45,280 --> 00:42:49,320 ..that the patient or consumer is asked for consent 832 00:42:49,320 --> 00:42:50,560 so that the GP can be... 833 00:42:50,560 --> 00:42:53,120 Indeed, they just said, "Do you want us to contact your GP? 834 00:42:53,120 --> 00:42:54,840 I said no. And they said, "Fine". 835 00:42:54,840 --> 00:42:57,240 Ethically... That's not fine, of course. 836 00:42:57,240 --> 00:42:59,280 That is not acceptable practice, 837 00:42:59,280 --> 00:43:01,560 which is why we're taking action to tackle it. 838 00:43:01,560 --> 00:43:03,560 There's a physical pharmacy behind that website 839 00:43:03,560 --> 00:43:05,160 which is registered with us. 840 00:43:05,160 --> 00:43:07,640 We have a team of inspectors who are pharmacy professionals 841 00:43:07,640 --> 00:43:10,080 who will go and visit that building. 842 00:43:10,080 --> 00:43:11,880 It's serious stuff. 843 00:43:11,880 --> 00:43:14,520 And you're rightly highlighting an important issue, 844 00:43:14,520 --> 00:43:18,560 which we are working on with all the effort 845 00:43:18,560 --> 00:43:20,000 that you would expect of us. 846 00:43:20,000 --> 00:43:24,680 And what of the foreign opioids that I bought just as easily? 847 00:43:24,680 --> 00:43:27,920 If people are using a pharmacy service 848 00:43:27,920 --> 00:43:31,560 that's not registered with us in this country, 849 00:43:31,560 --> 00:43:35,240 then they are really in a very dangerous situation. 850 00:43:35,240 --> 00:43:39,280 We would absolutely discourage anybody from accessing medicines 851 00:43:39,280 --> 00:43:40,520 through an overseas website. 852 00:43:40,520 --> 00:43:42,240 You never know what you're going to get. 853 00:43:42,240 --> 00:43:45,120 Well, you don't know in terms of counterfeit, in terms of safety. 854 00:43:45,120 --> 00:43:47,640 You don't know what the product is. 855 00:43:47,640 --> 00:43:50,480 The danger is, if people are desperate, they'll do it anyway. 856 00:43:50,480 --> 00:43:52,680 It is dangerous. 857 00:43:52,680 --> 00:43:53,880 That is for sure. 858 00:43:55,560 --> 00:43:58,720 The regulator did indeed take action a week later. 859 00:43:58,720 --> 00:44:03,880 The UK-registered pharmacy I'd used was banned from selling opioids. 860 00:44:03,880 --> 00:44:07,320 The overwhelming majority of other UK licensed sites I tried 861 00:44:07,320 --> 00:44:08,960 refused to sell me them. 862 00:44:16,040 --> 00:44:20,120 I suppose at this stage of my journey, one thing is clear. 863 00:44:20,120 --> 00:44:25,800 We have been well and truly warned of our national opioid predicament. 864 00:44:25,800 --> 00:44:29,680 We may not know the scale of illicit purchasing from abroad 865 00:44:29,680 --> 00:44:32,200 or of over-the-counter meds abuse, 866 00:44:32,200 --> 00:44:35,360 but at least we recognise there is a problem. 867 00:44:36,920 --> 00:44:39,400 What's more, the Public Health England report 868 00:44:39,400 --> 00:44:43,680 identifies in meticulous detail the risks of overprescribing. 869 00:44:45,160 --> 00:44:48,560 But identifying the problems doesn't solve them. 870 00:44:55,240 --> 00:44:58,320 I'm back in Salford where, in 2018, 871 00:44:58,320 --> 00:45:02,560 one in six adults were prescribed an opioid. 872 00:45:02,560 --> 00:45:04,520 So how do you persuade patients 873 00:45:04,520 --> 00:45:08,040 who've been stuck on opioids for years to come off them? 874 00:45:10,080 --> 00:45:14,200 Local GP Tom Hodson is wrestling with this challenge. 875 00:45:14,200 --> 00:45:17,200 Three years ago, he was signing off repeat prescriptions 876 00:45:17,200 --> 00:45:21,080 at his new practice when something caught his attention. 877 00:45:21,080 --> 00:45:23,360 There was a prescription for some morphine 878 00:45:23,360 --> 00:45:24,880 that I had a bit of a look at 879 00:45:24,880 --> 00:45:28,160 and the dose seemed to be a little bit higher than I would expect. 880 00:45:28,160 --> 00:45:30,160 We didn't really know if that was just a one-off 881 00:45:30,160 --> 00:45:33,880 or there was lots of other patients that had an issue like that. 882 00:45:33,880 --> 00:45:37,920 So we worked with our pharmacist to search the whole surgery, 883 00:45:37,920 --> 00:45:39,560 go through all of our patients 884 00:45:39,560 --> 00:45:41,560 and just find anyone that was taking a dose 885 00:45:41,560 --> 00:45:43,440 higher than we thought was effective. 886 00:45:43,440 --> 00:45:48,080 We were expecting maybe two or three patients. 887 00:45:48,080 --> 00:45:50,400 We ended up finding that it was about 30. 888 00:45:50,400 --> 00:45:51,560 So it was a surprise 889 00:45:51,560 --> 00:45:54,560 that the problem was as big as it was at our surgery. 890 00:45:56,840 --> 00:46:00,880 Dr Hodson called the patients in for a chat. 891 00:46:00,880 --> 00:46:02,360 So how did the conversation go? 892 00:46:02,360 --> 00:46:06,080 How does it go? So I come in, I've been on massive doses. 893 00:46:06,080 --> 00:46:07,960 I've still got terrible back pain. 894 00:46:07,960 --> 00:46:09,400 My back pain is terrible. 895 00:46:09,400 --> 00:46:11,000 And then you go...? 896 00:46:12,040 --> 00:46:14,280 We've got to take your painkillers away, yes. 897 00:46:14,280 --> 00:46:15,520 So it was about saying... 898 00:46:15,520 --> 00:46:17,320 we obviously needed longer appointments 899 00:46:17,320 --> 00:46:19,960 because you can't drop a bombshell like that in ten minutes 900 00:46:19,960 --> 00:46:21,320 and let them leave. No. 901 00:46:21,320 --> 00:46:24,240 Sometimes you needed more than two appointments. 902 00:46:24,240 --> 00:46:26,680 Sometimes you'd start this conversation, 903 00:46:26,680 --> 00:46:27,960 patients would be upset. 904 00:46:27,960 --> 00:46:29,720 They'd go away, have a think and come back. 905 00:46:29,720 --> 00:46:31,520 But most of the patients, 906 00:46:31,520 --> 00:46:35,280 when you show them the evidence and you show them the risks 907 00:46:35,280 --> 00:46:36,640 and you say, you know, 908 00:46:36,640 --> 00:46:39,520 "This probably isn't doing very much for you," 909 00:46:39,520 --> 00:46:41,320 were willing to give it a go. 910 00:46:41,320 --> 00:46:43,080 Once we started the reduction 911 00:46:43,080 --> 00:46:45,960 and some of the patients didn't see any increase in their pain, 912 00:46:45,960 --> 00:46:48,640 you know, they were actually quite motivated to do it. 913 00:46:48,640 --> 00:46:52,440 And by the end, the majority of people that did this 914 00:46:52,440 --> 00:46:55,120 by the end were quite positive about it. 915 00:46:55,120 --> 00:46:57,120 People on high-strength opioids 916 00:46:57,120 --> 00:47:00,080 can develop a physical dependency on them. 917 00:47:00,080 --> 00:47:04,040 Coming off quickly results in an unpleasant withdrawal, 918 00:47:04,040 --> 00:47:05,080 or cold turkey. 919 00:47:06,880 --> 00:47:11,200 So Dr Hodson spends months slowly reducing each patient's dose, 920 00:47:11,200 --> 00:47:13,200 managing their withdrawal. 921 00:47:14,440 --> 00:47:17,240 This is basically a record of the prescribing at the surgery. 922 00:47:17,240 --> 00:47:21,400 So this is all the prescriptions for opioids 923 00:47:21,400 --> 00:47:23,360 at a dose over 120 milligrams. 924 00:47:23,360 --> 00:47:26,760 We started the work about here. 925 00:47:26,760 --> 00:47:28,840 OK. 926 00:47:28,840 --> 00:47:30,440 So that's an impressive decline. Yes. 927 00:47:30,440 --> 00:47:33,080 Once patients were sort of with us and wanted to reduce it, 928 00:47:33,080 --> 00:47:35,840 you can see this is the steep curve 929 00:47:35,840 --> 00:47:37,760 once they started to want to reduce them. 930 00:47:39,240 --> 00:47:42,040 90% of Dr Hodson's high-dose patients 931 00:47:42,040 --> 00:47:45,040 have now either reduced their opioid use 932 00:47:45,040 --> 00:47:46,920 or come off them entirely. 933 00:47:49,760 --> 00:47:52,720 And Dr Hodson isn't alone. 934 00:47:52,720 --> 00:47:56,240 Across the country, including back here in Hastings, 935 00:47:56,240 --> 00:47:59,760 GPs are running de-prescribing programmes. 936 00:47:59,760 --> 00:48:02,560 Now, after 20 years of relentless growth, 937 00:48:02,560 --> 00:48:06,040 there is finally some real grounds for hope. 938 00:48:06,040 --> 00:48:11,480 Opioid prescribing has levelled off nationally and since 2017, 939 00:48:11,480 --> 00:48:14,520 in most places, it's actually begun to fall. 940 00:48:16,960 --> 00:48:18,440 But it's not all good news. 941 00:48:18,440 --> 00:48:20,240 The Public Health England report 942 00:48:20,240 --> 00:48:23,400 found that it's people living in deprived areas 943 00:48:23,400 --> 00:48:26,520 who are more likely to get prescribed opioids. 944 00:48:26,520 --> 00:48:28,960 And unfortunately, it's these deprived areas 945 00:48:28,960 --> 00:48:33,040 which have also proved to be relatively resistant to change. 946 00:48:35,680 --> 00:48:39,560 Hastings is one of the most deprived towns in the south of England, 947 00:48:39,560 --> 00:48:42,760 so de-prescribing has been far from easy. 948 00:48:42,760 --> 00:48:46,560 People here tend to have poorer health and less money to invest 949 00:48:46,560 --> 00:48:48,320 in their wellbeing. 950 00:48:48,320 --> 00:48:49,680 And the grim fact is, 951 00:48:49,680 --> 00:48:52,520 people in more deprived areas tend to suffer 952 00:48:52,520 --> 00:48:54,160 from more chronic pain. 953 00:48:57,080 --> 00:48:59,960 I can't even get out of the house 954 00:48:59,960 --> 00:49:02,680 unless I really have to, like... 955 00:49:04,640 --> 00:49:07,560 thingy ahead, plan ahead. 956 00:49:09,360 --> 00:49:14,400 Until ten years ago, Malcolm lived an active, sporty life. 957 00:49:14,400 --> 00:49:16,720 But then he started suffering severe pain 958 00:49:16,720 --> 00:49:20,360 caused by complications from an old appendix operation. 959 00:49:22,200 --> 00:49:25,000 The pain goes into my groin, 960 00:49:25,000 --> 00:49:27,680 into my hip and down my right leg. 961 00:49:30,040 --> 00:49:35,760 I would rather be dead than in the pain that I'm in now. 962 00:49:38,240 --> 00:49:40,480 I split up with my wife. 963 00:49:40,480 --> 00:49:42,080 We sold the house. 964 00:49:43,480 --> 00:49:44,760 I left my job. 965 00:49:46,360 --> 00:49:47,560 It just... 966 00:49:48,560 --> 00:49:49,600 It's a horror. 967 00:49:51,200 --> 00:49:52,280 It's a horror. 968 00:49:53,680 --> 00:49:56,680 If it isn't the injury that gets you, 969 00:49:56,680 --> 00:49:58,400 it's the mentalness. 970 00:50:01,200 --> 00:50:02,400 By his own admission, 971 00:50:02,400 --> 00:50:03,920 Malcolm is depressed. 972 00:50:03,920 --> 00:50:05,640 He can hardly get out of the house. 973 00:50:05,640 --> 00:50:06,960 He can't work. 974 00:50:06,960 --> 00:50:09,400 He is caught up in a vicious cycle. 975 00:50:09,400 --> 00:50:11,960 People like him, unable to work, on low incomes 976 00:50:11,960 --> 00:50:13,760 and in poor mental health, 977 00:50:13,760 --> 00:50:18,040 are much more likely to become high-dose, long-term opioid users. 978 00:50:19,240 --> 00:50:24,120 Malcolm was on 180 milligrams of morphine every day 979 00:50:24,120 --> 00:50:25,960 for seven years. 980 00:50:25,960 --> 00:50:27,920 It made your day better. 981 00:50:27,920 --> 00:50:33,480 You was happier with certain things that you were able to do. 982 00:50:33,480 --> 00:50:37,640 You was happier with... just everything. 983 00:50:37,640 --> 00:50:41,600 But it was a dangerously high dose. 984 00:50:41,600 --> 00:50:43,880 So the doctors in Hastings persuaded him 985 00:50:43,880 --> 00:50:46,960 to taper right down to 30 milligrams. 986 00:50:46,960 --> 00:50:51,000 They implanted instead a device in his spine, a Tens machine, 987 00:50:51,000 --> 00:50:54,600 to help block the pain signals going to his brain. 988 00:50:56,200 --> 00:51:00,480 It helps me. It helps me so much with standing up and walking. 989 00:51:01,720 --> 00:51:03,920 It doesn't stop the pain. 990 00:51:03,920 --> 00:51:07,400 It just sort of helps you deal with the pain. 991 00:51:08,640 --> 00:51:10,240 But even with the Tens machine, 992 00:51:10,240 --> 00:51:14,320 Malcolm finds life without high-dose morphine almost unbearable. 993 00:51:15,880 --> 00:51:20,120 I've found that I'm suffering more since reducing the opiates, 994 00:51:21,400 --> 00:51:22,640 so, um... 995 00:51:24,480 --> 00:51:27,920 I would like to increase my opiates again. 996 00:51:27,920 --> 00:51:30,840 But, um... 997 00:51:30,840 --> 00:51:33,840 The doctor won't do it. 998 00:51:36,840 --> 00:51:38,920 Coming off opioids would be easier 999 00:51:38,920 --> 00:51:41,120 if there were effective alternatives. 1000 00:51:41,120 --> 00:51:44,600 But despite the best efforts of the pharmaceutical industry, 1001 00:51:44,600 --> 00:51:47,360 there's currently no drugs that can effectively handle 1002 00:51:47,360 --> 00:51:48,640 all chronic pain. 1003 00:51:50,040 --> 00:51:53,720 There is, however, hope for Malcolm and thousands like him 1004 00:51:53,720 --> 00:51:58,800 thanks to pioneering research being done in places like Oxford. 1005 00:51:58,800 --> 00:52:00,640 When Professor Irene Tracey 1006 00:52:00,640 --> 00:52:03,480 isn't burning volunteers with chilli paste, 1007 00:52:03,480 --> 00:52:06,120 she's busy inflicting other kinds of pain on them 1008 00:52:06,120 --> 00:52:10,760 while looking at their brains in an FMRI scanner, 1009 00:52:10,760 --> 00:52:13,840 and one of Irene's experiments 1010 00:52:13,840 --> 00:52:15,640 showed that what we feel 1011 00:52:15,640 --> 00:52:18,560 affects how much pain we feel. 1012 00:52:18,560 --> 00:52:21,400 This is the overview to enable us to localise more... 1013 00:52:21,400 --> 00:52:26,120 Irene's team wanted to see if changing a volunteer's mood 1014 00:52:26,120 --> 00:52:27,480 and making them sad 1015 00:52:27,480 --> 00:52:31,520 would change the actual level of pain they were experiencing. 1016 00:52:32,840 --> 00:52:35,920 So she made them listen to melancholic music 1017 00:52:35,920 --> 00:52:38,000 and read depressing phrases. 1018 00:52:50,720 --> 00:52:54,440 And the changes they found were extraordinary. 1019 00:52:54,440 --> 00:52:56,160 So if you see here the orange and yellow, 1020 00:52:56,160 --> 00:52:58,480 which is the brain reacting and being active. 1021 00:52:58,480 --> 00:52:59,920 The blue is being suppressed. 1022 00:52:59,920 --> 00:53:03,000 You can see a marked increase in activity when you're sad. 1023 00:53:03,000 --> 00:53:05,840 They look very, very different. Really different. 1024 00:53:05,840 --> 00:53:09,480 So if you see here, this is the same burn. OK. 1025 00:53:09,480 --> 00:53:11,280 And that, if I'm honest with you, 1026 00:53:11,280 --> 00:53:13,880 I'd have to probably burn them several degrees more 1027 00:53:13,880 --> 00:53:15,600 to drive the brain up that much. 1028 00:53:15,600 --> 00:53:19,240 And that's just kind of from not being really depressed, 1029 00:53:19,240 --> 00:53:21,040 just listening to sad music. 1030 00:53:21,040 --> 00:53:22,880 Exactly. It proved something 1031 00:53:22,880 --> 00:53:25,520 that, without imaging, is difficult to prove, 1032 00:53:25,520 --> 00:53:28,000 that when somebody is sad or depressed or anxious 1033 00:53:28,000 --> 00:53:30,440 and they describe their pain as more painful, 1034 00:53:30,440 --> 00:53:32,080 it's easy to jump to the conclusion 1035 00:53:32,080 --> 00:53:33,720 that they're just exaggerating. 1036 00:53:33,720 --> 00:53:35,160 It's the way they describe it. 1037 00:53:35,160 --> 00:53:37,520 What you're able to do with, say, these techniques 1038 00:53:37,520 --> 00:53:40,360 is prove that it's physiological. If you're sad, 1039 00:53:40,360 --> 00:53:43,200 the way your brain then processes those signals is different. 1040 00:53:43,200 --> 00:53:45,040 Could that explain why, you know, 1041 00:53:45,040 --> 00:53:47,480 you see much higher prescription rates 1042 00:53:47,480 --> 00:53:49,520 for opioids and opiates in deprived areas? 1043 00:53:49,520 --> 00:53:52,800 And presumably there are higher rates of depression in those areas 1044 00:53:52,800 --> 00:53:55,600 and therefore, that could be driving demand. 1045 00:53:55,600 --> 00:53:57,520 Yeah, there's no studies to prove that. 1046 00:53:57,520 --> 00:53:59,080 But it's a sensible hypothesis. 1047 00:53:59,080 --> 00:54:01,480 You know, it's always been a challenge to understand. 1048 00:54:01,480 --> 00:54:03,080 Does one cause the other? Yeah. 1049 00:54:03,080 --> 00:54:05,360 Do you become depressed because you're in chronic pain 1050 00:54:05,360 --> 00:54:06,800 or is there something underlying 1051 00:54:06,800 --> 00:54:09,400 that tips you into one or the other, or is it just really 1052 00:54:09,400 --> 00:54:12,640 actually quite overlapping physiology and mechanisms? 1053 00:54:15,080 --> 00:54:20,520 Dr Tracey's research offers fresh hope for chronic pain sufferers. 1054 00:54:20,520 --> 00:54:24,200 If she's right, then focusing on ways to improve people's mood 1055 00:54:24,200 --> 00:54:25,440 may be more effective 1056 00:54:25,440 --> 00:54:28,480 than giving them increasing doses of painkillers. 1057 00:54:30,720 --> 00:54:32,720 This has certainly worked for Karen, 1058 00:54:32,720 --> 00:54:35,800 who I met in Hastings at the start of my journey. 1059 00:54:35,800 --> 00:54:40,080 She is now on nothing stronger than paracetamol. 1060 00:54:40,080 --> 00:54:42,360 This is life after opiates. 1061 00:54:43,920 --> 00:54:47,640 Before, she wouldn't have even been out here. 1062 00:54:47,640 --> 00:54:50,240 She would have been lying upstairs on her bed. 1063 00:54:52,480 --> 00:54:56,760 When they finally started bringing her off these tablets, 1064 00:54:56,760 --> 00:54:59,760 she... came back to normal. 1065 00:54:59,760 --> 00:55:02,040 I had my mum, I could talk to her again. 1066 00:55:02,040 --> 00:55:03,440 We have family times together. 1067 00:55:03,440 --> 00:55:04,640 It has affected us. 1068 00:55:04,640 --> 00:55:07,720 It's affected all of us right down to the grandkids, 1069 00:55:07,720 --> 00:55:11,160 because they always want to know where their grandma is. 1070 00:55:11,160 --> 00:55:12,800 But, yeah, now it's so much better. 1071 00:55:12,800 --> 00:55:14,600 I'm so glad that she's not on 'em no more. 1072 00:55:14,600 --> 00:55:16,880 With help from her family, 1073 00:55:16,880 --> 00:55:20,720 Karen has managed to come off the opioids completely, 1074 00:55:20,720 --> 00:55:24,000 using a surprisingly low-tech intervention... 1075 00:55:25,760 --> 00:55:28,800 ..group therapy sessions. 1076 00:55:28,800 --> 00:55:31,240 Joining different groups 1077 00:55:31,240 --> 00:55:35,800 that have different ideas on how to live with pain 1078 00:55:35,800 --> 00:55:40,520 can make a huge difference to where you go with your pain medication. 1079 00:55:45,320 --> 00:55:47,680 I think we've got one more to come, probably. 1080 00:55:47,680 --> 00:55:52,600 The group is run by addiction worker Rob Ralph to provide pain sufferers 1081 00:55:52,600 --> 00:55:54,840 with an alternative to opioids. 1082 00:55:54,840 --> 00:55:58,720 This is Michael, everybody. Hello! Hi, there. 1083 00:55:58,720 --> 00:56:01,520 You've managed a massive dose reduction 1084 00:56:01,520 --> 00:56:05,600 from a really dangerous dose of opiates down to a much safer dose. 1085 00:56:05,600 --> 00:56:07,360 I'd rather not take them. 1086 00:56:08,320 --> 00:56:10,480 But because we had such a laugh... 1087 00:56:10,480 --> 00:56:13,600 Karen has now been off the opioids for a year, 1088 00:56:13,600 --> 00:56:16,000 but she still attends the weekly group. 1089 00:56:16,000 --> 00:56:18,320 And after being recruited by Rob, 1090 00:56:18,320 --> 00:56:21,640 Malcolm is also finding solace at the meetings. I know. 1091 00:56:21,640 --> 00:56:23,600 So I'm looking for answers. 1092 00:56:23,600 --> 00:56:26,400 I'm looking for anything that will help me. 1093 00:56:27,680 --> 00:56:28,960 I'm going to see you, 1094 00:56:28,960 --> 00:56:31,000 going to see the doctors. 1095 00:56:31,000 --> 00:56:34,200 They're all things that could possibly help me. 1096 00:56:34,200 --> 00:56:37,720 I go through phases of pain I can't bear. 1097 00:56:37,720 --> 00:56:40,520 And to be in pain like you are, I know, 1098 00:56:40,520 --> 00:56:42,560 cos I've seen it in your face, 1099 00:56:42,560 --> 00:56:45,200 I've got to say, that's a tough one. 1100 00:56:46,680 --> 00:56:51,520 I've got a good group of people that I go to the pain group with. 1101 00:56:51,520 --> 00:56:56,720 We share our stories and comfort each other, really. 1102 00:57:00,640 --> 00:57:03,320 And that helps a whole lot. 1103 00:57:03,320 --> 00:57:06,120 It's the one thing I do every week. 1104 00:57:06,120 --> 00:57:10,400 I end up being knocked out for five hours when I come home, 1105 00:57:10,400 --> 00:57:12,800 but it's worth doing, you know? 1106 00:57:12,800 --> 00:57:15,040 I don't think you ever missed an appointment with me 1107 00:57:15,040 --> 00:57:18,920 or a group at the surgery. You've never missed a group here. 1108 00:57:18,920 --> 00:57:22,160 No, I was late for one. Well, we'll let you off that. 1109 00:57:24,520 --> 00:57:27,640 Rob's programme has been a great success. 1110 00:57:31,160 --> 00:57:33,560 Half the 235 people he's worked with 1111 00:57:33,560 --> 00:57:38,000 have either stopped or significantly reduced their opioid use. 1112 00:57:39,040 --> 00:57:43,920 Imagine if more schemes like this were rolled out nationwide. 1113 00:57:43,920 --> 00:57:45,440 But the sad truth is, 1114 00:57:45,440 --> 00:57:48,160 running successful courses like Rob's 1115 00:57:48,160 --> 00:57:50,400 is harder and more expensive 1116 00:57:50,400 --> 00:57:54,200 than prescribing opioids to people like Malcolm. 1117 00:57:59,120 --> 00:58:00,800 On this journey, 1118 00:58:00,800 --> 00:58:04,880 I've come to realise the true nature of our opioid crisis, 1119 00:58:04,880 --> 00:58:07,920 that too many have been prescribed opioids 1120 00:58:07,920 --> 00:58:10,440 that are too strong for too long, 1121 00:58:10,440 --> 00:58:13,840 even though they rarely work for chronic pain. 1122 00:58:13,840 --> 00:58:16,840 I have been shocked by just how easy it is 1123 00:58:16,840 --> 00:58:20,040 to get opioids over the counter or online. 1124 00:58:20,040 --> 00:58:23,120 I do think we need to do more to tackle the link 1125 00:58:23,120 --> 00:58:27,280 between deprivation, mental illness and opioid prescribing, 1126 00:58:27,280 --> 00:58:30,120 and we do desperately need alternatives to opioids 1127 00:58:30,120 --> 00:58:32,680 when it comes to treating chronic pain. 1128 00:58:32,680 --> 00:58:35,080 I think we owe it to the millions of people 1129 00:58:35,080 --> 00:58:38,360 who have got hooked on opioids through no fault of their own 1130 00:58:38,360 --> 00:58:41,400 and who are now desperately trying to come off.