'We were powerless to save him': Australia's losing battle with prescription drugs
Prescription drug abuse kills many more Australians than illicit drugs. Advocates argue real-time prescription monitoring could save lives
Simon Millington with his daughter Maddie. Millington died of a prescription drug overdose in 2010.
It was the absence of two phone calls, 16 years apart, that signalled the start and tragic end of Simon Millington’s struggle with prescription drug addiction.
As midnight approached one winter night in 1994, his mother, Margaret Millington, began to panic as she waited for the call to explain his absence, usually made without fail.
“When it got to 4am or 5am, I knew that something was seriously wrong,” Margaret says.
She was right. Not far away, on a quiet farm road near Nhill in Victoria’s western hinterland, Simon lay trapped in his crushed car, with critical injuries to his pelvis and legs.
When he was eventually discharged from hospital, doctors gave him a kit bag of powerful and addictive opioid painkillers for the debilitating pain.
The medications began a downward spiral of prescription drug abuse that would eventually end his life and threaten to tear his family apart.
“We all got swept up in the addiction, and the more Simon used, the more concerned I became, the more trouble he would get in with the law,” Margaret says.
“Our life was just unruly, but mine became obsessed. I was obsessed with saving Simon because I knew he was really, really ill, and he was dependent on the medication.”
Prescription drug abuse kills far more Australians than illicit drugs. The number of deaths surpasses the road toll in some states, yet it receives a fraction of the attention.
Australia’s use of opioid-based painkillers has quadrupled in the past decade, and prescription drugs were responsible for 71% of all drug-related deaths in 2014, research by the Penington Institute found.
Benzodiazepines, like Valium or Xanax, killed 438 people in 2014, and oxycodone, morphine and codeine overdoses killed 411. In comparison, ecstasy and amphetamines were linked to the deaths of 188.
The Therapeutic Goods Administration announced on Tuesday it had decided painkillers with codeine, an opiate, will no longer be available over the counter. The move is designed to reduce its oversupply and overuse, which can be addictive and cause serious health problems, particularly when used long-term or with other drugs.
But pharmacists have warned that making codeine prescription-only will simply clog up GP clinics without giving doctors any way of detecting patients who are addicted. It can also compound the problems associated with prescription drug abuse.
In early 2010, Simon failed a second time to make an expected call. This time it was to his recently estranged partner on her birthday, a call he had made without fail every year since they had met. “He was a very caring and compassionate young man like that,” says Margaret. “He’d never let you down.”
It wasn’t long before Simon was found. He had accidentally overdosed on a cocktail of prescription drugs.
The preliminary toxicology reports would show Simon’s body contained high levels of oxycodone, an opioid, and oxazepam, an anti-anxiety drug, as well as trace levels of Citalopram and Nordiazepam.
By then Margaret had lost two other children, a two-year-old daughter and an 18-year-old son. “I never thought that I’d lose Simon,” she says. “I thought Simon would turn his life around and everything would be fine. But in the end it’s just so hard.
“We knew that even the nurture and the love and support we had given Simon all of his life, it still wasn’t enough. We were powerless, as he was over his addiction, to save him.”
ScriptWise, a not-for-profit group campaigning to prevent prescription drug abuse, is lobbying for states and territories to introduce a system of real-time prescription monitoring. This would allow doctors to check a patient’s immediate prescription history, preventing them from doctor shopping – a practice of visiting multiple doctors to obtain multiple prescriptions.
A ScriptWise board member, Dr Richard Kidd, a practising GP, says it would be a huge help for doctors. “If we can see that someone has just actually got their script just yesterday or today ... and in some cases has already got it three or four times in one day, we can reach out a hand to help them,” Kidd says.
“[We can say,] ‘Look you may not realise this at the moment, but the amount you’re taking ... is putting you in real danger, it could kill you, and we’d like to help.’ ”
At the peak of his addiction, Simon would travel across state borders to find unsuspecting doctors, driving to Renmark, Mildura and then home. An entire box of Serepax, used for anxiety, would be gone in two days.
Doctors were swayed by his depression, and his noticeable scarring and obvious limp from the crash. They had no idea what he had already been prescribed.
Prescription monitoring has been introduced in Tasmania, and Victoria has committed to follow suit. The federal health minister, Sussan Ley, has pushed other states and territories to participate in a national system, raising the issue at the recent council of Australian governments meeting. The movement from other states has been slow.
Real-time prescription monitoring is expensive to set up and to manage. Victoria has earmarked $30m in this year’s budget. But Kidd says governments should see prescription monitoring through a different lens, as an investment which will relieve pressure on hospitals.
“The real cost from these things are people ending up in hospitals, intensive care, or they’re found dead,” he says. “If we can prevent a lot of those cases, and we should be able to with real time monitoring, we should be able to save a lot of money.”
But others aren’t sure prescription monitoring alone will solve the problem.
Dr David Caldicott, an emergency consultant at Calvary hospital in Canberra, was part of a team that studied the acute poisoning deaths of 90 children in the decade to 2013. The study, due to be published in the journal Addiction, found prescription opioids were the most common cause of the deaths: 24% of the 90 cases.
“To me, that tells me a great deal about the availability of opiates around Australia,” Caldicott says. “Kids overdose on stuff because it’s lying around. We’ve got so many opiates being prescribed in Australia that they’re lying around so children can eat them.
“So those who say we don’t have a problem in Australia, that it’s all under control ... are either ignorant or complicit in the problem.”
Caldicott says solutions must focus on reducing general supply and improving prescribing practices. He says that’s a tough ask for increasingly time-poor GPs.
“A lot of the problem is that our colleagues in primary care are being asked to do more and more with less and less,” he says. “One of the most common causes to see your GP is pain. So if you’re being told you only have five minutes to see a patient, that’s a really small amount of time.
“So you can definitely understand why time-poor doctors might choose to prescribe a painkiller, because they just don’t have the resources to put in the intensive coaching that might be required.”
Margaret hasn’t given up fighting for change since Simon’s death, lobbying politicians, speaking to the media, and working with a Victorian taskforce set up to establish prescription monitoring.
“I live in hope, but will only stop taking action when the [real-time monitoring system] is implemented in all states and territories,” she says. “We do this in memory of Simon so that his death will not have been in vain.”
