Tripping on medicine

As the details of Michael Jackson’s medication come out in the open, it reminds us that it’s not just narcotics that can addict us but prescription drugs, too, can be just as addictive.

Dr Shrikant Shinde is a 25-year-old post-graduate medical student with a reputed Pune hospital for a specialisation in pediatrics — hardly the addict kind. Yet, his addiction to painkillers has followed a similar path.

Shinde first experimented with Fortwin, an analgesic opiad, injected to relieve pain, during his internship years. “I had a girlfriend who used to administer a combination of Fortwin and Diazepam (a benzodiazepine derivative drug, formerly marketed as Vallium) intravenously. She claimed it gave her a high and asked me to try it. And I did,” says Shinde.

The doctor tried the deadly drug cocktail during his ICU duties at the hospital. First came its calming effect on the body; then the dreamlike state and finally deep sleep. “The addiction came six months later,” recalls Shrikant. “I tried to fight it. But when I went back home to Beed, I used my doctor’s card to get the drug. And when I joined my PG in Pune, I once again used the ICU stock.”

Talking to people in the medical fraternity makes it apparent that abuse of prescription drugs is common among doctors and paramedical staff. The reason being the easy availability of drugs. But, with the ease with which prescription drugs can be obtained in India, everyone  is getting hooked. “I’ve seen children of 14 years and 60-year-old adults addicted to prescribed drugs,” says Dr Sharita Shah, woman and child psychiatrist at Bombay Hospital.

Painkillers, sleeping pills and cough syrup are the most abused prescribed medication in the world. According to a WHO estimate, addiction to prescription drugs is 10 times more rampant than abuse of illegal drugs the world over. Possible, if you consider the millions of prescriptions and refills written each day across the globe.

“Everyone can afford drugs like sleeping pills and cough syrups,” points out Dr Kersi Chavda, president of Bombay Psychiatrist Society and consultant with Hinduja hospital.
Although legal, the prescribed drugs market in India is largely disorganised. There are laws that state that pharmacists should not sell medicines without prescriptions and that these prescriptions should not be old. But rules are often flouted and over-the-counter drug sales are a regular feature in India. “Most chemists are known to the patients and have access to the drugs. Also drugs such as Crocin or cough syrups don’t need a prescription. You can always buy them and store them at home,” says Dr Chavda.

A loophole Mrs Nisha Krishnan took advantage of. A housewife and mother of two, Mrs Krishnan got her dose of cough syrup from the neighbourhood chemist. Her first dose was at college and she revisited the ‘high’ again when alone at home “getting bored”. “Soon I was hooked. There came a point when I had five bottles of cough syrup a day,” says Mrs Krishnan, who after counselling is now clean.

Prescribed drug abusers — just like other addicts — develop a tolerance. There comes a time when a single bottle of cough syrup or an intramuscular injection is not enough. The high then comes only after many doses of the drug.

“When I started, I would inject 1ml of Fortwin. By the time I went to Muktangan Rehabilitation Centre in Pune, I was on 12-15 ml of the drug,” says Shrikant.

There are two kinds of abusers: those who experiment with prescription drugs and those who get hooked after being prescribed such medication for an ailment. But the effects are the same.

“We use similar therapy for both types of addiction: a complete stoppage of the drug use, medication for the symptoms and counselling,” says Mukta Puntambekar, deputy director of Pune-based Muktangan Rehabilitation Centre.

The decade-old centre has seen the problem grow over the years. “Add to this the fact that addicts emotionally manipulate both society and their families by ‘faking’ illness,” says Puntamber, adding that of the 100 patients registered with them every month, at least ten are hooked on to prescribed drugs.

The perils of prescribed drug abuse are not just psychological or social. Research has shown that in the long term it, leads to cognitive impairment or brain damage, cross addiction to other drugs, psycho-motor problems, depression and suicidal ideation, apart from a whole range of physiological effects. “Many suffer from kidney, gastric and liver problems. High doses can affect the the heart and the nervous system. Frequent use of injections can also damage the veins and there is always the fear of contracting AIDS,” says Dr Shah.

Prescription drugs are a double-edged sword — life saving yet damaging. Shrikant realised this soon enough. “When I reached 12 ml of Fortwin a day, I didn’t recognise myself and decided to go clean. I have been off the drug for months now and I am married. I haven’t told my wife but I will tell her one day. I’ll tell her the truth — that I will never be cured of it but will be vigilant about it,” says Shrikant, who still walks into the ICU at his PG college hospital with his doctor’s card and the knowledge that his “poison” is just a prescription away.