Elle's answers
(posted on behalf of guest)
Hi everyone! My name is Elle. Thanks for the very interesting questions about prescription medication use.
Dependence & prescribing rates
The use of opioid medication for pain relief has undergone huge changes in the last 10 years. Originally prescribed sparingly except for life ending disease they were then prescribed for every type of pain - acute or chronic, both short term and long term. One thing about these medications that has not changed is their ability to unwittingly create dependence in people. Dependence can create a situation where the absence of symptoms of withdrawal is perceived as analgesia (or absence of pain). This means that although taking this medication has managed the pain in the past, sudden absence of the medication causes a massive increase in pain. Dependence can be defined as neuronal adaptation to repeated drug exposure making functioning only possible in the presence of the drug. In other words a person will begin to need to use the substance to function ‘normally’ or function at all.
Withdrawal
Withdrawal from opioids can include symptoms including anxiety, nausea, vomiting or abdominal pain. It is not life threatening. It can feel awful and endless and is recommended to be done under the care of a medical practitioner. They can help manage the physical symptoms by the prescription of other medications, facilitate referral to a psychiatrist and psychologist to assist with the mood and emotional symptoms and the provision of other supports through a challenging health issue. Depending on the individual and the type of prescription medication utilized they can either start a tapering regime or an opioid replacement therapy using buprenorphine or methadone. It is important to share your history of opioid use with prescribers into the future so that you can work together on an effective pain management plan. This means you should then be able to access the most appropriate health care you need.
Problems with use
Use of prescription and non-prescription medications can be problematic. One is a measured dose with known strength, the other is of unknown dose and strength. Prescription drug related deaths are overwhelmingly associated with the use of benzodiazepines and prescribed/non prescribed medications/alcohol use. Benzodiazepines are prescribed for a number of conditions and they also have potential for dependence. Depending on the length of time used and dose taken they can have a very long and debilitating withdrawal syndrome. Most prominent of the symptoms of this withdrawal syndrome are profound rebound anxiety and insomnia also featuring among the health issues for which they are prescribed. This was very eloquently described by one of the questioners on the forum as “a panic attack x 100”. Again it is important to be monitored and assisted by a medical practitioner during withdrawal from benzodiazepines.
Reconnexion 1300 273 266 is a service that specializes in people experiencing dependency on benzodiazepines. Reduction and tapering of the dose is recommended, but not abrupt stopping.
Antipsychotics
Antipsychotic medications work on the uptake or availability of neurotransmitters serotonin and dopamine and the mucarinic and histamine receptors, the neurochemistry is varied and complicated. Again abrupt withdrawal without medical oversight and care is not recommended and as described the re-emergence of traumatic and distressing symptoms can disrupt the person’s life and health. Use of antipsychotic medications may require ongoing blood testing to ensure their safe use.
Medical support
I would encourage people to find a GP with whom they can have a trusting relationship, someone who you value as a partner in your care and who helps you make informed decisions about how to tackle health issues. Knowing the one practitioner over a period of time helps you both choose wisely and without judgement.
Resources I used in the answers were:
NPS Medicine Wise, &
Safescript.
Was this helpful? We can continue the discussion and talk through any questions below.
