Transcript Cathryn Kemp - APPG for Prescribed Drug Dependence

Prescribed Drug
Misuse:
Patient Perspective
Cathryn Kemp
Chief Executive of
P.A.I.N
Overview
• Lived Experience of Painkiller
Addiction
• How The ‘System’ Failed, How It Could
Succeed
• Formation of the Painkiller Addiction
Information Network (PAIN)
Onset of Acute and Chronic Pain
• Sudden onset of Acute and Chronic Pancreatitis
• 40 hospital admissions in 4 years
• Pain affected every level: mental, emotional, physical
• Describing pain is difficult – issue for GPs/healthcare
service providers
• Impact on my life – living with pain & debility, unable to
make a cup of tea, brush my hair
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Treatment of Pain
• Inpatient – IV morphine, tramadol then IV fentanyl
• Outpatient – oxycodone, tramadol then fentanyl
lozenges
• Withdrawal symptoms being treated in hospital with
tramadol – level of ignorance about effects of opioids
on patients
• Pain clinic – ketamine
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Transition to Addiction
• Repeat prescription for 100 mcg fentanyl patches, 200
mcg fentanyl lozenges (2008)
• Taking the ‘extra’ lozenge
• Slide into dependency – 11, 20, 30, 40, 50, 60 lozenges
per day – all on prescription
• Lying to GP about pain attacks to get prescription
• Hiding lozenges around my cottage “just in case I ran
out”
• ‘Addict’ behaviours
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Experiencing Addiction
• Feeling trapped in a prison of my own making
• Stuck in 3-day cycle – get prescription, binge on
lozenges, eke out remaining dose until the earliest
point so that I could go back to my GP
• Shame and guilt – hid addiction from family and friends
• Desperation – suicide notes to family under my pillow
each night, as I knew was taking a potentially fatal dose
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Intervention
• GP first extra prescriptions, GP aware addiction
after four months (taking 15 lozenges a day)
• No support for GP at crucial point
• No individual support for me as patient until too late
• GP Services
• Electro-acupuncture
• Provocative Therapy
• Charts for withdrawal
• GP ‘cut me off’ (refused to prescribe any more
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Intervention
• Substance Misuse Service
• Offered methadone as outpatient
• I refused as knew I needed inpatient treatment, which
was refused three times
• My denial/resistance to change
• Withdrawal symptoms overwhelming
• Scared of facing the problem
• Still in denial regarding addiction (though of course I knew
I was abusing my painkillers)
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Recognising My Addiction
• Rehab
• Denial/Fighting the label of ‘addict’
• Group therapy – similarities with other ‘street’ drug
users
• Acceptance/facing stigma
• Determination to come off lozenges completely/start of
my recovery process
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How Does it Feel to Enter the Addiction
Treatment System?
• Substance Misuse Service – frightening; homeless
people queuing for methadone, needle exchange
• Stigmatised – felt I was different to ‘street’ users
(though I wasn’t)
• Refused the service
• Couldn’t travel to get methadone daily
• Didn’t want to associate with street users
• Intimidated by the environment
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How Can We Improve Services?
• Education of GPs & Patients
• A primary objective of PAIN – taking responsibility on
BOTH sides
• Open dialogue about Opioid Painkiller Dependence
• Stigma-busting so that addicts feel they can seek help
• Individualised treatment services
• Taking into account circumstances, willingness to change,
patient’s pain needs
• Screening
• Diagnosis tool for primary healthcare providers to identify
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Recovery Context
• How can we improve
patient after-care?
• Is there after-care?
• Close monitoring by
informed GP services
• Dedicated painaddiction teams
• Pain and Addiction
Addiction sponsors who
work within the patient’s
community
On the ground support
taking into account the
patient’s home
life/emotional &
economic context
Walk-in services for pain
and addiction patients
for support
Services working
together
Companionship
• Combined multi-
Help in practicalities such
as retraining, finding
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Formation of P.A.I.N: Aims
• Education To raise awareness among healthcare
professionals and services, people and their lovedones about Opioid Painkiller Dependence (OPD) to
either prescribed or over-the-counter medications.
• Help & Support To signpost advice and resources to
those suffering from dependence to their opioid
painkillers, and their loved ones. Establishing a
helpline for anyone who is worried about developing
possible dependence, or a family member or loved one
• Identification To advise healthcare services on the
possible development and delivery of services
specifically for OPD patients.
Formation of PAIN: Aims (cont’d)
•Advocacy
Lobbying for
change to
www.painkillerfree.co.uk
PAIN Painkiller Addiction Information
Network
@PAINcharity
Cathryn Kemp
T: 07816 780159
E: [email protected]