Today the NSW Coroner’s Court will hold the final hearing of its inquest into the deaths of four Australians, each of which was linked to the abuse of legally available prescription drugs.
Earlier in the week the court heard the story of Nathan Attard, who died at the age of just 34 as a result of his addiction to a range of legally available pharmaceuticals. Visiting 22 different GPs, Attard was able to buy what turned out to be fatal quantities of the drugs. As a result of cases like Attard’s, which are on the rise across the state, the Coroner’s Court is likely to recommend an improved system of note sharing between doctors.
According to a report in The Sydney Morning Herald, counsel assisting the coroner Kristina Stern told the Court such measures would have helped Attard, as well as the other three subjects of the inquiry. "There can be little doubt that the problems that appear in these four cases could be avoided if a real-time prescription monitoring program [existed],” Stern said.
However, if we want to get serious about tackling prescription drug abuse, and curtailing its devastating effects, we need to undertake thorough qualitative research to help us understand why people are turning to these drugs in the first place.
The rise of powerful codeine and opiate based painkillers is an evocative new phenomenon, sparking a host of documentaries and news reports that chronicle the shocking deprivation of a new breed of addicts. Powerful opiates such as OxyContin are now pejoratively labelled “hillbilly heroin”, as if only marginalised members of our society use opiates.
The reality is that pharmaceuticals are abused by all types, from the small business owner to the office worker, in a variety of ways, from getting through a stressful afternoon at work to injecting them “on the streets”. Australians need to stop pretending that junkies are the only ones who take painkillers in ways their doctor would not approve, and to do this we need to change the way we collect information about drug users.
A fresh approach to researching drug use is needed to both minimise the stigmatisation of the addict population, but also to provide a platform for more strategic services that can address occasional or infrequent drug users as well.
There is a cultural assumption that all drug users are addicted and on a trajectory towards annihilation. The reality, as Oxford University academic Philip Robsons observes, is that the “great majority of people who use drugs never come to the attention of doctors, lawyers, or policemen”. Assuming that the occasional drug user and the long-term drug addict have the same needs for services is entirely misguided.
It’s not good enough for us to simply talk to injecting drug users who live on the street and are in trouble with the law, because they’re clearly not the only people taking these drugs non-medically. Neither would it be smart to label all occasional drug users as sick or mentally unstable.
In my research I have spoken to people from all walks of society. Contrasted with the injecting drug users are those people who take pills, often for completely mundane (some might say trivial) reasons.
One young woman I spoke to used Nurofen pre-emptively at work to avoid a headache and to continue being productive. I talked to a security guard who uses Panadols “like lollies”, just because he “felt like one”. I had a conversation with an office worker who mixes Panadeine Forte with alcohol so she can “get more drunk”. Another young man told me that he used Xanax to “get through” a particularly grim morning after a bad break up.
All of these practices reveal a casualisation of how we use pharmaceuticals in our culture and they require different kinds of responses, some more serious than others. Because these practices are tied to things like productivity, consumerism, legitimate forms of intoxication (with alcohol), and common emotions, they cannot simply be dismissed as unimportant, nor dealt with as though they were as “extreme” as injecting drug use.
Our approach to the painkiller problem needs to make room for more nuance, both in the detail of its description and the range of practices being described.
To do this requires a change in tact on the part of drug researchers. We need to learn more about who exactly is using these drugs and listen carefully to the stories they tell. Surveys, which dominate the field, are not enough to provide this kind of detail.
All major sources of Australian data about non-medical drug use have rather consistently indicated modest increases year after year. The latest National Drug Strategy Household Survey from 2010 report that 4.2 per cent of the population used a pharmaceutical for a non-medical reason during the past year. The report estimates that there was an increase of 100,000 people using pharmaceuticals non-medically between 2007 and 2010. The problem is numbers alone don’t tell us everything we need to know.
What is it about our approach to pharmaceuticals that has made them so casual to consume? How is their use, both medical and non-medical, connected to societal pressure to always be productive at work, be part of consumer culture, get drunk on the weekend and never be unhappy? Because drug use can never exist outside the social context that propels it, drug researchers and service providers need to start paying closer attention to the ordinary parts of people’s everyday lives.
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