Ooioid addiction - parliament.qld.gov.au€¦ · an addict, just as not every person who plays Blackjack will become a gambler. He says opioids are regularly used for very valid reasons,

Ooioid addiction

SPRiNG 2014 Private Hospital 23

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Dr Christian Rowan

Dr Rowan said treating co-morbid pain and addiction conditions should focus on use of therapies other than conventional painkiller drugs, such as education, cognitive-behavioural therapy, physiotherapy and occupational therapy.

He suggested better data collection systems, further research at state and federal levels, real time monitoring systems, engagement with the pharmaceutical industry, and enhanced availability of pain and addiction treatment clinics and services could help address the issue. 011

contain morphine, and limit the use of benzodiazepines,” Dr Rowan said.

Dr Rowan said 30 per cent of the Australian population will experience chronic pain in their lifetime, and this, coupled with an ageing population, is contributing to the rise in use of prescription opioid painkillers.

Other factors contributing to the issue include increased prevalence of mental health problems, lifestyle-related chronic conditions, and industry marketing of pharmaceutical products.

Addiction expert Dr Christian Rowan highlights the growing issue of pharmaceutical abuse

rise, from 4.2 per cent in 2010 to 4.7 per cent in 2013.

Addiction Medicine Specialist Dr Christian Rowan confirmed pharmaceutical abuse is a growing problem in Queensland.

Addressing the 2014 Australian Winter School Conference in Brisbane in late July, Dr Rowan said the increased prevalence of chronic pain and growing use of prescription and over-the-counter painkillers is contributing to higher rates of addiction and substance dependency.

Dr Rowan said there was a need for public education and health professional awareness of the dangers of becoming dependent on prescription and over-the- counter medication, and a greater need for multidisciplinary services for chronic pain sufferers, particularly in the public health sector.

“Opioids are often marketed and prescribed as the drug of choice to treat chronic pain. However, there has been a lack of awareness of the risk of addiction with some of these drugs, where their use may be appropriate for short-term pain management, but not as a long-term solution.”

Dr Rowan, who is the medical director of Addiction Sciences Queensland and director of medical services at St Andrew’s War Memorial Hospital, said “doctor shopping” was an ongoing issue, with some patients receiving prescriptions from multiple doctors and gaining access to unsafe quantities of prescription drugs.

“Where possible, GPs should avoid prescribing pain management drugs which

“Where possible, GPs should avoid prescrib ing pain mauagement drugs which contain morphine, and limit the use of benzodiazepines”

he Australian Institute of Health and Welfare National Drug Strategy Household Survey results showed that the misuse of pharmaceuticals is on the

t

27 Jul 2016-9:20am

27 Jul 2016 - 8:41 AM UPDATED 27 Jul 2016 - 9:20 AM

Opioid painkiller addictions don't discriminate between the young and old or the rich and poor. The father of the late Hollywood actor, Heath Ledger, speaks to SBS about his son's death in a bid to raise awareness about opioid addictions and the dangers of mixing prescription drugs.ByYasmin Noone

When your treatment turns into an opioid addiction

“I really didn’t understand what the effect was of mixing one type of prescribed drug with another, and on top of that, mixing prescription drugs with a sleeping tablet, which tragically put Heath to sleep permanently.

“After Heath passed away in 2008, we were so preoccupied with losing a loved one,” says Kim Ledger, father of the Australian actor Heath Ledger, who died of an accidental intoxication from prescription drugs.

“I believe that Heath [didn’t know much about the issue of opioid addiction or misuse]... I am only just quietly educating myself recently, and have been for about three years. The facts shock you and the numbers are unbelievable.”

“The fact is that absolutely anyone can become dependent on opioids: it does not discriminate according to your age or gender."

“After Heath passed away in 2008, we were so preoccupied with losing a loved

Common prescription and non-prescription opioids include codeine, heroin (synthesized from morphine), dihydrocodeine and oxycodone. A study published in 2015 shows oxycodone is one of the Australia’s most commonly abused drugs. It was also one of the drugs found in Heath Ledger’s system when he died.

The research also finds that there were 806 oxycodone-related deaths in Australian from 2001 to 2012. More than half of all deaths recorded from oxycodone were accidental and most were caused by combined drug toxicity.

Almost 40 per cent of patients who died from an oxycodone-related death had legitimate prescriptions, mostly for non-cancer related chronic pain. In about 75 per cent of all deaths recorded, the patient’s opioid use was also deemed ‘appropriate’ by the prescriber.

Despite this belief, new survey results released today show that over 30 per cent of Australians think opioid painkiller addictions only happen to ‘junkies’. The online survey of 1000 Australians, commissioned by ScriutWise, also highlights that only around 20 per cent of

According to the National Opioid Pharmacotherapy Statistics Annual Data, over 48,000 Australians were being treated for an opioid dependence on a typical ‘snapshot’ day in June 2015.

“The fact is that absolutely anyone can become dependent on opioids: it does not discriminate according to your age or gender,” says Ledger. “Opioid dependence goes right across Australia and its scope is very broad.”

respondents believe high-income earners or career-focused professionals could become dependent on opioid painkillers.

My drug addiction; From IT consultant to ice addict and back36-year-old Jarrod was just like any other professional before he became addicted to ice. He had a well-paying job, a great life partying on weekends with mates, a loving wife and a child. So what went wrong?

Dr Rowan also says that despite stereotypes, not every person who uses opioids will become an addict, just as not every person who plays Blackjack will become a gambler.

He says opioids are regularly used for very valid reasons, by millions of people around the world to adequately and legally treat their chronic pain.

Medical director at Addiction Sciences Queensland, Dr Christian Rowan, has been working in the field of addiction services for 14 years and regularly treats people from all walks of life with opioid dependencies.

“When these medications are taken appropriately, there’s a positive effect. Not only do opioids relieve pain, they have a strong effect on mood, memory and subjective learning. By using an opioid, you not only relieve your pain but you will feel better and experience a bit of euphoria.

“The bottom line is that opioid addiction is a health issue, not a social problem.

“We see opioid addiction on a weekly basis, people who are seeking treatment because of a addiction to prescription or over the counter drugs. It might be a man who has been off work because of an injury and has since developed a mild depression because of the psychological issues associated with living with chronic pain, or a young woman who buys opioids over the counter to deal with chronic menstrual pain or endometriosis. Before you know it, she’s increased the number or frequency of her painkillers.

“We don’t know or hear much about opioid addiction or misuse is because there’s a stigma attached to it,” says Ledger. “But we know that when people are dependent on opioids, they seem to be less likely to discuss it openly with others but instead, suffer quietly for fear of being labelled a junkie.”

“But when things worsen, when a person is developing anxiety or depression or post- traumatic stress disorder, then the positive effect of the drug can reinforce [the need to take the drug regularly] and an increased tolerance to get the desired effect then becomes necessary. This is cycle that some people can fall into.”

“The bottom line is that opioid addiction is a health issue, not a social problem."

1

“The people with opioid addictions that we are talking about here are accidental addicts,” says Dr Rowan. “They become accidentally addicted because of the pain and psychological issues they are experiencing.

He recommends that doctors and patients remain mindful of the need to manage the risks, harms or unintended consequences of opioids, which includes dependency and addiction issues.

For more information about opioid reliance, misuse or addiction, or to access support, visit turntohelp. com, au

“If anyone has concerns about themselves or a friend or family member who is reliant on medication, then they should be assessed and have their health and wellbeing monitored.”

“These medications [created to treat chronic pain] have an appropriate place in clinical care but are not without their risks. Like any medications, they can have potential side effects and one side effect is dependency.”

k

OR ^GaTaOOs’

Carmall Cas^, main and left, with Maxine Piper, a friend and a source of support through Casey's addiction to opioids and battle with chronic pain. Centre: Casey with an old packed tapentadol. Below; David Tonkin pets Ned, his son Matthew’s cat, which now sleeps onthe sleeping bag Matthew used in Afghanistan. PHOTOS: AP

“Because its fragmented, people haven't had a line of sight as to whaf s happening,” he says.

Australia's government insists it is now taking the problem seriously. The opioid codeine, which used to be available over the counter, was restricted to prescription-only in 2018. And last month, the exjuntr/s drug regulator, the Therapeutic Goods Administration, announced tougher opioid regulations, including restricting the use of fentanyl patches to patients with cancer, in

palliative care, or under “exceptional circumstances”.

“I can't speak for the past,” says Greg Hunt, who became the federal Health Minister in 2017. *1 can speak for my watch and ray time where this has been one of my absolute priorities, which is why we’ve taken such strong steps. My focus has been to make sure that we don't have an American-style crisis.”

In the US, drug companies such as OxyContin maker Purdue Pharma are facing more than 2000 lawsuits accusing them of overstating the benefits of opioids, downplaying their addictiveness and

Tonkin called for an ambulance and started CPR. As he pumped his son’s chest, the dispatcher counted out the beats.

4

between 1990 and 2014, says Sydney University researcher Emily Karanges.

Dr Jennifer Stevens, a pain specialist, saw the surge with startling clarity while working at St Vincents Hospital in Sydnor.

A few years ago, a pharmacist at the hospital told her they needed to hire an extra person just to handle all the prescriptions they were handing out for Endone, a brand of oxycodone. Stevens discovered that the hospital's Endone prescriptions had increased 500 per cent in eight years, with no decrease in other opioids dispensed. Further study revealed that 10 per cent of patients were still taking opioids three months after surgery, though the drugs are generally onty recommended for shorttermuse.

Just like in the US, as opioid prescriptions rose, so did fatal overdoses. Opioid-related deaths jumped from 439 in 2006 to 1119 in 2016, a rise of 2.2 to 4.7 deaths per 100,000 people, according to the Australian Institute of Health and Welfare. Most of those deaths were related to prescription opioids, rather than illegal opioids such as heroin.

More than 3 million Australians, an eighth of the country’s population, are getting at least one opioid prescription a year, according to the latest data.

The numbers and the warnings may have been grossed over partly because of Australia's piecemeal system of data collection and reporting, says Dr Christian Rowan, an addiction spedalist in the state of Queensland. Data is reported by various states, coroners and agencies, and often includes only prescriptions filled through government-subsidised drug system not private prescriptions.

The (kroner’s sense of futility was dear, as he investigated the death of yet another Australian killed by prescription opioids. “For what it is worth, I add my voice to the chorus pleading for urgency,” Western Australia coroner Barry King wrote in his report,

delivered in May.Coroners nationwide have long urged

officials to address Australia's ballooning opioid addiction and to create a tracking system to stop people from collecting multiple prescriptions from multiple doctors. Yet even as thousands died, the coroners’ pleas were met largely with silence.

Australia has failed to heed the lessons of the United States, and is facing slyrocketing rates of opioid prescriptions and related deaths. Drug companies faring scrutiny for their aggressive marketing of opioid in America have turned their focus abroad, working around marketing regulations to push the painkillers in other countries. And as with the US, Australia’s government has been slow to respond to years of warnings from health experts.

In dozens of interviews, doctors, researchers and Australians whose lives have been upended by opioids describe a plight that now stret^es from coast to coast Australia’s death rate from opioids has more than doubled in just over a decade. And health experts worry that without urgent action, Australia is on track for an even steeper spike in deaths like those seen in America, where the epidemic has left 400,000 dead.

In Tasmania, general practitioner Dr Bastian Seidel and his colleagues are immersed in what he calls a “nightmare scenario”. Two years ago, when he was president of the Royal Australian College of General Practitioners, Seidel dubbed Australia’s opioid problem a “national emergency”. Today, he wonders if anyone was listening.

“Its depressing at times to see how we, as practitioners, literally messed up our communities,” he says. “Its our signature on the scripts. But the pressure being put on by the drug companies, by certain health sectors - thats the situation that we are facing now.”

Australia knows the extent of the problem, he says. The country knows addiction is devastating its (tommunities. And yet, he says, nobody is doing anything.

Opioids were once reserved for treating pain that was short-term, terminal or related to cancer. But in the 1990s, pharmaceutical companies began aggressively marketing them for chronic pain.

Starting in 2000, Australia began approving and subsidising certain opioids for use in chronic non-cancer pain. Those approvals coincided with a spilte in opioid consumption, which nearly quadrupled

encouraging doctors to prescribe the drugSL. to more patients in higher amounts.

In Australia, pharmaceutical companies 'i Ity law cannot directly advertise to con- | sumers but are free to market the drugs to medical professionals. And they have done ! so, aggr^sivety and effectively, Ity sponsor- i ing swanky c(>nferences, running doctors' training seminars, funding research papers, giving money to pain advocacy groups and meeting with doctors to push the drugs for chronic pain.

“If the relevant governing bodies had ensured that the way the product was being marketed to dextors especially was different, I don't necessarily think we would see what we’re seeing now,” says Bee~ Mohamed, who until recently was the CEO of Script\\^, a group devoted to reducing prescription drug deaths in Australia. “We’re trying to undo 10 years of what marketing has unfortunately done.”

David Tonkin blames his son’s death on a system that allowed him to see 24 doctors and get 23 different medications from 16 pharmacies, all in the spare of six months. Between January and July 2014 alone, Matthew Tonkin got 27 prescriptions just for oxycodone.

The addiction that ultimately ended Matthew’s life began in 2012, after he was injured while serving with the Australian. army in Afghanistan. When the 22-year-old arrived on leave at his father’s home in Perth, he held up a stack of OxyGjntin pill strips. The drugs had been prescribed to him by American doctors in Afghanistan for his injured hip and ankle.

Matthew was 14 kilograms lighter than the last time his father had seen him. He vras suffering from post-traumatic stress disorder from the horrors of A^hanistan, including the death of his best friend, a fellow soldier. He w^ also suffering from a growing addiction to opioids. The addiction escalated after the army sent him to recover in Queenland, where doctors put him on an opioid called tramadol.

Matthew soon discovered how easy it was to getwhatever prescriptions he wanted. He forged his doctor’s signature. He told one doctor he’d knocked a bottie of pills into the toilet and needed more.

In August 2013, another doctor prescribed him more oxycodone after Matthew said he was suffering from PTSD and hip pain.

A few weeks later, Matthew had his first oxycodone overdose. A few months after that, he was discharged from the array.

One doctor called a hotline for medical professionals to report Matthew’s apparent misuse of prescription drugs. But when Matthew moved back to Perth to live with I Tonkin, doctors there had no way of knowing his drug use had been flagged in Queensland. When Tonkin told Matthew to Continued p44

ADDICTION NIGHTMAREHITS HOMEPainkillers Australia has failed to heed the lessons of the United States, and is facing skyrocketing rates of opioid prescriptions and related deaths, writes Kristen Gelineau.

Weekend Pin ”7-8 September 2019 wwwifr.com I The Australian Financial Review

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Ne^help?

Solution to crossword 2995

COMPILED BY DAVIS SnCKLEY SOLUTION NEXT WEEK

attacls. And her pain got worse.Desperate, she saw other doctors. They

sent her away with more prescriptions for more opioids: fentanyl, codeine, oxycodone, tramadol, buprenorphine, tapentado^ Targin.

An estimated 20 per cent of Australians suffer chronic pain. But in poor, rural areas, access to pain specialists can be logistically and financial^ difficult Wait lists are long, and a few sessions with a physiotherapist can cost hundreds of dollars. Under the government-subsidised prescription benefit plan, a pack of opioids costs as little as $6.50.

Casey tried to quit the painkillers. But eventual^, the pain would grow unbearable, so she’d take the drugs again.

In June, she told her^lf: enough. She returned the remaining pills to her pharmacist

She found a surgeon who took her seri- ousty. And she got an appointment with a physiotherapist who is teaching her exercises to manage her pain.

She doesn’t know what she’ll do when the pain returns. But she says she will never return to opioids.

'Tm not going hade,” she says and begins to weep. Tm not” SO

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that has made opioids the cheap and easy alternative for Australians, particular^ the poor.

“I became an addict without knowing,” Casey says.

This is Australia’s poorest state and the counoy’s epicentre for opioids. Tasmania has die nation’s highest rate of opioid packs sold per person: 2.7 each, One region has the highest number of government-subsidised opioid prescriptions in Australia: more than 110,000for every100,000 people.

"Ten years ago, while working as a dairy farmer, Casey jumped off a truck and felt her knees give way. An operation provided temporary relief, but the pain came back. She was told she had osteoarthritis.

A doctor prescribed her opioids to ease her pain. When she stuck the first patch on her skin, it felt like heaven.

But the agony eventually returned, so the doctor upped the dosage. The side effects were hell: depression, anxiety, panic

outskirts of Paris. Lottie Consalvo’s work

atDominikMersch Gallery is part of her yearlong Desires project, for which she signed a selfdevised contraetto live out her desires. While living in France she planted seeds

l^dscapes” - painted in Ibiza, Spain, where the artist has spentthe past 18 months - can be found at Jan Murphy Gallery.

AtGaUerysmith.you will find Lynda Draper’s clay filigree works, which were inspired by a recent

of water colour and gouache or scratches film to create her monstrous beauties.

Julian Meagher’s landscapes will be at Olsen Gallery. The artist quit his medic ̂career lOyears agotopainlfuU-time.

reflecting bn the flowers she never saw grow.

In addition to works in galleries there are workshops, guided tours, panel discussions and performances.

The Performance Contemporary program

guito riffs firom her ROCK GATE sculpture of Marshall’s iconic amplifiers. When: September 12-15 Where: Carriageworks, 254'V\nison Street, Eveleigh, and galleries across Sydnqr.

From page 39Addiction nightmare hits home

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hand over his pills. Matthew shoved Tonkin across the kitchen into the cupboard. Then he pinned his father to the floor and began to choke him.

Tonkin thought he was going to die.Matthew eventually let go and both men

went to the hospital for treatment Two days later, Matthew called his father. “Do you still love me, Dad?” he asked.

And of course he did. So Tonkin kept trying to save him, right up until July 3,2014, when he returned home from a walk and realised Matthew hadn’t come out of his room all morning.

Tonkin walked into his son’s room. Time to get up, mate.”

There was no answer.

He placed a hand on Matthew, His body was warm. But he had no pulse.

Tonkin called for an ambulance and started CPR. As he pumped his son’s chest the dispatcher coimted out the beats.

One. Two. Three. Four.

Nothing. Nothing. Nothing Nothing.

Five. Six. SevenEight

Nothing David Tonkin's son <The conclusion

from King the coroner, was blunt had a prescription tracking system been in place, Matthew would not have been given the oxycodone that killed him.

King’s findings on Matthew’s death were delivered at least a dozen years after the first coroner^ reports began warning of a growing opioid problem. As early as 2007, a coroner had suggested that someone look into why the opioid prescription rate in Tasmania was so high.

Two states, Tasmania and Victoria, developed their own prescription tracking systems, but they only monitor opioid prescriptions within their respective states, and neither is mandatory.

The development of a national system has been mired in bureaucratic delays. In 2017, the government committed $16 million to creating one, and Hunt, the Health Minister, later said it would be ready by the end of 2018. It has yet to be rolled out

Hunt blamed the delay on the states. The national framework is ready, he said, but the slates must connect to it

From her home in rural north-west Tasmania, 51-year-old Carmall Casey seethes over a system she says pushed her and so many others into addiction. It is a system

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WORLD & NATION

Australia faces opioid crisis as companies push drugs abroad

By ASSOCIATED PRESS

Coroners nationwide have long urged officials

crisis and to create a tracking system to stop p

multiple doctors. Yet even as thousands died,.

SEP. 5, 20199:55 AM

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by reviewing our Privacy Policy. Close

BLACK RIVER, Australia — The coroner’s sense of futility was clear as he investigated the

death of yet another Australian killed by prescription opioids.

Carmall Casey, right, is embraced by Maxine Piper, a longtime friend and a source of support through Casey’s addiction to opioids and battle with chronic pain, at her home in Black River, Australia, in July. (David Goldman / Associated Press)

SCIENCE

In dozens of interviews, doctors, researchers and Australians whose lives have been upended by

opioids described a plight that now stretches from coast to coast. Australia’s death rate from

opioids has more than doubled in just over a decade. And health experts worry that without

urgent action, Australia is on track for an even steeper rise in deaths like those seen in America,

where the epidemic has left 400,000 dead.



Half a world away, Australia has failed to heed the lessons of the United States and is now

facing skyrocketing rates of opioid prescriptions and related deaths. Drug companies facing

scrutiny for their aggressive marketing of opioids in America have turned their focus abroad,

working around marketing regulations to push the painkillers in other countries. And as with

the U.S., Australia’s government has also been slow to respond to years of warnings from

worried health experts.

How the prescriptions doctors wrote may have helped fuel the U.S. opioid crisis

Sep. 4, 2019

On an island off the coast of Tasmania, Dr. Bastian Seidel and his colleagues are immersed in

what he calls a “nightmare scenario.” Two years ago, when he was president of the Royal

Australian College of General Practitioners, Seidel dubbed Australia’s opioid problem a

“national emergency.” Today, he wonders if anyone was listening.

“For what it is worth, I add my voice to the chorus pleading for urgency,” Western Australia

coroner Barry King wrote in his report, delivered in May.

“If only Australia could understand how quickly this can get out of hand. We’re not immune to

it,” says Jasmin Raggam, whose brother Jon died in 2014 of an opioid overdose and whose

brother-in-law is now addicted to the opioid OxyContin. “I was screaming from the

mountaintops after Jon died and I’d started doing my research. And it was like I’m screaming

and nobody wants to hear me.”

“It’s depressing at times to see how we, as pra

he says. “It’s our signature on the scripts.... Bi

companies, by certain health sectors — that’s 1

Australia’s opioid addiction

Starting in 2000, Australia began approving and subsidizing certain opioids for use in chronic,

non-cancer pain. Those approvals coincided with an increase in opioid consumption, which

nearly quadrupled between 1990 and 2014, says Sydney University researcher Emily Karanges.

Australia knows the extent of the problem, he says. The country knows addiction is devastating

its communities. And yet, he says, nobody is doing anything.

Dr. Jennifer Stevens, a pain specialist, saw the surge with startling clarity while working at St.

Vincent’s Hospital in Sydney.

A few years ago, a pharmacist at the hospital told her they needed to hire an extra person just to

handle all the prescriptions they were handing out for Endone, a brand of oxycodone. Stevens

discovered that the hospital’s Endone prescriptions had increased 500% in eight years, with no

decrease in other opioids dispensed. Further study revealed that 10% of patients were still

taking opioids three months after surgery, even though the drugs are generally only

recommended for short-term use.

Opioids were once reserved for treating pain that was short-term, terminal or related to cancer.

But in the 1990s, pharmaceutical companies began aggressively marketing them for chronic

pain.



Just like in the U.S., as opioid prescriptions rose, so did fatal overdoses. Opioid-related deaths

jumped from 439 in 2006 to 1,119 in 2016 — a

according to the Australian Institute of Healtf

to prescription opioids rather than illegal opic

“Unfortunately, in Australia, we’ve followed the bad example of the U.S.,” he says. “And now we

have the same problem.”

“We were just pumping this stuff out into our local community, thinking that that had no

consequences,” says Stevens, a vocal advocate for changing opioid prescribing practices. “And

now, of course, we realize that it does have huge consequences.”

6 deaths per 100,000 people 4.74

2.2 -2

0

Source: Australian Institute of Health and Welfare

More than 3 million Australians — an eighth of the country’s population — are getting at least

one opioid prescription a year, according to the latest data.

The numbers and the warnings may have been glossed over partly because of Australia’s

piecemeal system of data collection and reporting, says Dr. Christian Rowan, an addiction

specialist in the state of Queensland. Data are reported by various states, coroners and agencies,

and often include only prescriptions filled through the government-subsidized drug system and

not private prescriptions.

Australia’s opioid overdose deaths(Rate of opioid overdose deaths per 100,000 population)

“I can’t speak for the past,” says Greg Hunt, w. By continuing to use our site, you agree to our Terms of Servic

can speak for my watch and my time where th and Privacy Policy. You can learn more about how we use coc

why we’ve taken such strong steps.... My focus reviewing our Privacy Policy. Close

American-style crisis.”

“Because it’s fragmented, people haven’t had a line of sight as to what’s happening,” he says.

Australia’s government insists it is now taking the problem seriously. The opioid codeine, which

used to be available over the counter, was restricted to prescription-only in 2018. And last

month, the country’s drug regulator, the Therapeutic Goods Administration, announced

tougher opioid regulations, including restricting the use of fentanyl patches to patients with

cancer, in palliative care or under “exceptional circumstances.”

^8 ’69”^ ’

The drug companies

When Rustic Lassam thinks of the drug companies that pumped opioids into Australia’s

market, she thinks of her infant son’s agonized wails as he went through withdrawal.

In Australia, pharmaceutical companies by law cannot directly advertise to consumers, but are

free to market the drugs to medical professionals. And they have done so, aggressively and

effectively, by sponsoring swanky conferences, running doctors’ training seminars, funding

research papers, giving money to pain advocacy groups and meeting with doctors to push the

drugs for chronic pain.

In the U.S., drug companies such as OxyContin maker Purdue Pharma are facing more than

2,000 lawsuits accusing them of overstating the benefits of opioids, downplaying their

addictiveness and encouraging doctors to prescribe the drugs to more patients in higher

amounts.

For years, doctors had told her that opioids would help her back pain, which led to an all

consuming addiction. During her pregnancy, she swallowed nine high-dose OxyContin tablets

every day. So when she thinks about the way pharmaceutical companies have marketed those

drugs to doctors, she weeps with rage and grief.

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“We’re living in a country that is oblivious to what’s going on,” she says. “Why aren’t we

learning from America’s mistakes? Why don’t we learn?”

“If only they knew what addiction did to people, how really it affects us to the very core of who

we are,” she says. “And there they are, making all this money off the back of my broken life.”

But for Sue Fisher, whose 21-year-old son Matthew died in 2010 of an overdose, it’s too little,

too late. The crisis is here, along with what she calls a “crisis of ignorance.”

Mundipharma, the international arm of Purdue, has received particular criticism for its

marketing tactics in Australia. In 2018, addiction specialist Dr. Simon Holliday filed a

complaint against the company over a marketing pamphlet for its drug Targin, a painkiller

designed to prevent the constipation that is common with other opioids.

The brochure cited 2009 guidance from the Royal Australian College of General Practitioners

that says weak opioids are less effective than strong ones. But in a statement, the doctors’ group

said the ad was misleading and that Mundipharma anneared to have deliberatelv ignored its

updated clinical guidelines.

“If the relevant governing bodies had ensured that the way the product was being marketed to

doctors especially was different, I don’t necessarily think we would see what we’re seeing now,”

says Bee Mohamed, who until recently was the CEO of ScriptWise, a group devoted to reducing

prescription drug deaths in Australia. “We’re trying to undo 10 years of what marketing has

unfortunately done.”

By continuing to use our site, you agree to our Terms of Servic and Privacy Policy. You can learn more about how we use coc

by reviewing our Privacy Policy. CloseHolliday filed a complaint with Medicines Auj

But membership to Medicines Australia is not mandatory, and Mundipharma declined to

Carmall Casey finds an old pack of tapentadol while going through her box of medicine in her kitchen in Black River, Australia. (David Goldman / Associated Press)

participate in the complaints process because it had dropped out as a member.

This year, Mundipharma has faced scrutiny over a promotional campaign that critics say

violates the spirit of Australia’s law banning drug marketing to consumers.

In a statement to the Associated Press, Mundipharma said that the guidelines it referenced were

current at the time the pamphlet was in circulation. “The material was balanced, accurate, fully

supported by the product information, consistent with the approved indication, and contained

adequate safety information,” the company said.

Holliday then went to the Therapeutic Goods Administration. He got nowhere. So he wrote to

Hunt, the health minister, and other lawmakers. He received no response.



In a statement, Mundipharma said the campaign was a “disease awareness initiative” that did

not violate the spirit of any law and did not market any medication.

WORLD & NATION

Johnson & Johnson helped fuel opioid crisis in Oklahoma and must pay $572 million, judge rules

Aug. 26, 2019

The campaign, which encouraged people suffering painkiller-induced constipation to talk to

their doctors, never mentions Targin by name, because it legally can’t. But the advertising

agency Mundipharma hired described on its website how they worked around that regulation,

by using print, radio and online ads to target regions where pain medication use was high.

Google search data showed that people looking for information on constipation from painkillers

used terms like “blocked up,” so the agency used the phrase “blocked pipes.”

In an interview. Hunt said he has asked the Therapeutic Goods Administration to investigate

both marketing campaigns, along with some of Mundipharma’s other activities in Australia. Among those activities: the company’s “Pain MactP,- ri5icc<ic” fnr dnrtnrc tBp

classes, which have provided training to more

praised by some as helpful for physicians seeh

condemned by others as a conflict of interest,

painkillers.

How the government fell short


Stevens, the Sydney pain specialist, has pushed back against several drug companies over their

marketing tactics. A couple of years ago, she says, Mundipharma was marketing Targin to

surgeons at her hospital, reassuring them that they could prescribe higher doses. Unlike pain

specialists, surgeons are generally not well-educated on the intricacies of opioids, she says.

In a statement, Mundipharma said it strictly adheres to the Medicines Australia code of conduct

and has always been transparent about the risks associated with opioids. Still, in a submission

last year to the TGA as it considered tougher restrictions on opioids, Mundipharma appeared to

minimize the severity of Australia’s problem.

Stevens complained to Mundipharma and they stopped the practice. She says they have become

much more cooperative since.

David Tonkin blames his son’s death on a system that allowed him to see 24 doctors and get 23

different medications from 16 pharmacies — all in the space of six months. Between January

and July 2014 alone, Matthew Tonkin got 27 prescriptions just for oxycodone.

Mundipharma said the classes cover non-opioid treatment options and “strongly emphasize”

that opioids are only appropriate after a comprehensive assessment.

“We acknowledge that there is an issue associated with opioid misuse,” the company wrote.

“However to describe the Australian situation as a ‘crisis’ is alarmist and risks stigmatizing

patients who have a legitimate need for opioid analgesics to manage their pain.”

The addiction that ultimately ended Matthew’s life began in 2012, after he was injured while

serving with the Australian army in Afghanis!

father’s home in the western Australian city oJThe drugs had been prescribed to him by Ame •’V reviewing our Privacy Policy. Close

and ankle.

“Marketing, on the whole, is very clever and very successful — otherwise it wouldn’t be done,”

she says. “We love a freebie.... We’re no different from other members of the population. It’s

just that we are targeted more.”

Matthew was 30 pounds lighter than the last time his father had seen him. He was suffering

from post-traumatic stress disorder from the horrors of Afghanistan, including the death of his

best friend, a fellow soldier. He was also suffering from a growing addiction to opioids. The

addiction escalated after the army sent him to recover in Queensland, where doctors put him on

an opioid called tramadol.

Matthew soon discovered how easy it was to get whatever prescriptions he wanted. He forged

his doctor’s signature. He told one doctor he’d knocked a bottle of pills into the toilet and

needed more.

“Look, Dad,” he said. “The Yanks really know how to look after you.”

In August 2013, another doctor prescribed him mnrp nwpndnnp aftpr Matthpw said Tip was

suffering from PTSD and hip pain. By continuing to use our site, you agree to our Terms of Servicand Privacy Policy. You can learn more about how we use coc

by reviewing our Privacy Policy. CloseA few weeks later, Matthew had his first oxycc

discharged from the army.

David Tonkin holds a photo of his late son, Matthew, in his room at their home in Perth, Australia. (David Goldman / Associated Press)

I



David begged Matthew’s doctors and pharmacists to stop giving him OxyContin. Matthew just

went to other doctors.

He hopped around clinics collecting prescriptions for opioids. The doctors were largely

oblivious to what he was doing because Australia has no national, real-time prescription

tracking system.

Back at home after the service, David told Mai

David across the kitchen into the cupboard. T

choke him.

One doctor called a hotline for medical professionals to report Matthew’s apparent misuse of

prescription drugs. But when Matthew moved back to Perth to live with David, doctors there

had no way of knowing his drug use had been flagged in Queensland.

At a solemn gathering to honor military personnel on April 25, 2014, two of Matthew’s friends

had to hold him upright.

David Tonkin looks over the coroner's report on his son. Matthew, as Matthew's friend, Ivo Kinshela, looks on in Perth, Australia. (David Goldman / Associated Press)

David thought he was going to die.

There was no answer.

David placed a hand on Matthew. His body was warm. But he had no pulse.

One. Two. Three. Four.

Nothing. Nothing. Nothing. Nothing.

Five. Six. Seven. Eight.

Nothing.

Warnings ignored

The night before, Matthew had been sick. David had cleaned the vomit off his son’s bedroom

floor and changed his sheets. Matthew took a shower, thanked his father and climbed into bed.

And of course, he did. So David kept trying to save him, right up until July 3, 2014, when he

returned home from a walk and realized Matthew hadn’t come out of his room all morning.

Matthew eventually let go and both men went to the hospital for treatment. Two days later,

Matthew called his father. “Do you still love me. Dad?” he asked.

David called for an ambulance and started CPR. As he pumped his son’s chest, the dispatcher

counted out the beats.

By continuing to use our site, you agree to our Terms of Servic and Privacy Policy. You can learn more about how we use coc

by reviewing our Privacy Policy. CloseKing’s findings on Matthew’s death were deli\

reports began warning of a growing opioid problem. As early as 2007, a coroner had suggested

that someone look into why the opioid prescription rate on the island of Tasmania was so high.

The conclusion from King, the coroner, was blunt: Had a prescription tracking svstem been in

place, Matthew would not have been given the

David walked into his son’s room. “Time to get up, mate.”

The development of a national system has been mired in bureaucratic delays. In 2017, the

government committed $11 million to creating one, and Hunt, the health minister, later said it

would be ready by the end of 2018. It has yet to be rolled out.

In March, New South Wales coroner Harriet Grahame warned that Australia’s opioid deaths

could reach many thousands over the next five years.



After Matthew died, and for years to come, David would suddenly awaken at 10 p.m. — the

same time that Matthew used to call from Afghanistan. Now, instead of his son’s voice, there is

only silence.

In an interview, Hunt blamed the delay on the states. The national framework is ready, he said,

but the states must connect to it.

Two states — Tasmania and Victoria — developed their own prescription tracking systems, but

they only monitor opioid prescriptions within their respective states, and neither is currently

mandatory.

“We appear to have few coordinated strategies to address this problem,” Grahame wrote in a

report. “Lowering the rate of opioid overdose is clearly achievable but it will require a

government willing to listen to health experts and to act decisively on their advice.”

The poor pay the price

David Tonkin sits in his kitchen at his home. He blames his son's death on a system that allowed his son to see 24 different doctors and get 23 different medications from 16 different pharmacies — all in the space of six months. (David Goldman / Associated Press)

From her home in rural northwest Tasmania, 51-year-old Carmall Casey seethes over a system

she says pushed her and so many others into addiction. It is a system that has made opioids the

cheap and easy alternative for Australians, particularly the poor.



“I became an addict without knowing,” Casey says.

Here in Tasmania, there are echoes of American Appalachia — in the rural towns, the poverty

and the cascade of lives torn apart by pills that promised to take away the pain but in the end

created more.

But the agony eventually returned, so the doctor upped the dosage. The side effects were hell —

depression, anxiety, panic attacks. And her pain got worse.

Ten years ago, while working as a dairy farmer, Casey jumped off a truck and felt her knees give

way. An operation provided temporary relief, but the pain came back. She was told she had

osteoarthritis.

This is Australia’s poorest state, and like Appalachia, it is the country’s epicenter for opioids.

Tasmania has the nation’s highest rate of opioid packs sold per person — 2.7 each. One region

has the highest number of government-subsidized opioid prescriptions in Australia: more than

110,000 for every 100,000 people.

A doctor prescribed her opioids to ease her pa gy continuing to use our site, you agree to our Terms of Servic r 1, 1 and Privacy Policy. You can learn more about how vye use cocfelt like heaven.


Carmall Casey in her yard in Black River, Australia. (David Goldman / Associated Press)

Casey couldn’t afford private health insurance, so finding a surgeon who would treat the cause

of her pain was a struggle. She drove lo hours round trip to meet a surgeon in the capital,

Hobart, only to be told the wait list for the operation was two years.

Dr. Tim Andrewartha, a general practitioner in northwest Tasmania, says giving a patient with

chronic pain a drug for quick comfort can be tempting, when the alternative may be a years-

long wait to see a specialist.

Desperate, she saw other doctors. They sent her away with more prescriptions for more opioids:

fentanyl, codeine, oxycodone, tramadol, buprenorphine, tapentadol. Targin.

While taking a truck driving course, she injured her shoulder and began the same carousel of

fruitless doctors’ appointments.

She tried to quit the painkillers. She returned them to the pharmacy and dumped them down

the drain. She suffered through the nightmares and shakes of withdrawal. But eventually, the

pain would grow unbearable, so she’d take the drugs again.

An estimated 20% of Australians suffer chronic pain. But in poor, rural areas, access to pain

specialists can be logistically and financially difficult. Wait lists are long, and a few sessions with

a physiotherapist can cost hundreds of dollars. Under the government-subsidized prescription

benefit plan, a pack of opioids costs as little as $4.50.



“As a medical practice, we’re just falling short in terms of acknowledging the lack of evidence

that these drugs have for chronic, long-term use,” he says.

She lost her farm. Even worse, she says, she lost her daughter.

She made bad choices on the drugs, she admits now. She was living with a volatile man who

began to bully Sarah, so she sent her daughter, then 14, to live with her father. It’s a decision

that tore them apart, and still tears Casey apart today.



One day, she scrawled her anguish on a tattered envelope. “Imagine having a toothache for

weeks, months 1 year, 2 years, 3,4, and it’s still aching now... the pain eats away at you, the

drugs send you crazy,” she wrote.

Cartnail Casey washes pills from an old pack of tapentadol down the drain while going through her box of medicine. (David Goldman / Associated Press)

In June, she told herself: Enough. She returned the remaining pills to her pharmacist.

WORLD & NATION

She found a surgeon who took her seriously. And she got an appointment with a physiotherapist

who is teaching her exercises to manage her pain.

On a recent afternoon, she rifles through a box of medicine in her kitchen. Suddenly, she

freezes. Tucked inside is an old pack of tapentadol that she thought she’d thrown away. She

washes the pills down the kitchen sink.

She doesn’t know what she’ll do when the pain returns. But she says she will never return to

opioids.



eo4 sc.

“I’m not going back,” she says and begins to weep. “I’m not.”

Carmall Casey reads a note she wrote while sitting at her home in Black River, Australia. (David Goldman / Associated Press)

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Australian mother fights to save addicted son from opioids - New Delhi Times - India's Only International Newspaper

Edition: International Friday 06 September, 2019

NEW DELHI TIMES

httDs://www.newdelhitimes.com/australian-mother-fiahts-to-save-addicted-son-from-ODioids/ 1/19

And yet despite all her efforts to rescue her son from an addiction funded largely by her

iMbi1 tnus

This was hardly Sam Ware’s first dance with death in the years since his addiction to pharmaceutical opioids began with a simple wisdom tooth extraction; in just the past 12 months, he overdosed more than 60 times.

Deb Ware stared in numb horror at her son, a frail, 22-year-bld man in diapers who looked like he’d had a stroke.

For three years, she had battled to save his life, a lonely war against a system that made pharmaceutical opioids cheap and easy to get, in a country that has quietly endured what was once thought to be a uniquely American crisis of skyrocketing opioid addiction and deaths.

But on this day in June, inside this hospital in Australia, his mother wondered if it would be his last.

9/16/2019

Latest Stories, Pacific, World

Australian mother fights to save addicted son from opioidsBy New Delhi Times Bureau on September 6,2019

https://www.newdelhitimes.com/australian-mother-fiahts-to-save-addicted-son-from-opioids/ 2/19

On the opposite end of the earth fromAmerica, where the opioid epidemic has left 400,000 dead, Australia is facing its own crisis of soaring opioid use and fatal overdoses . It has all unfolded despite the glaring warnings from the U.S., and despite more than a decade of warnings from Australian health professionals about a looming disaster.

And then, unable to bear the fear on his face for a moment longer, she turned and walked out of the room.

So she simply kissed him and told him that she loved him. She told him he’d get through this, though she wasn’t sure he would.

Sam was 19 when it all began, a good kid with a good job as a factory machine operator. He loved photography and walking in the woods and doting on his dog. Holly, and cockatiel, Yazoo. He was close to his

On the Central Coast, around two hours north of Sydney, the Ware family is one of thousands across Australia locked in a life- or-death fight against opioid addiction. In months of interviews with The Associated Press, years of diary entries, videos, photos and medical records. Deb has shared her own family’s fight in the hopes it can alert the world to Australia’s plight.

Was this goodbye for now, or goodbye for good? How do you say goodbye to your only child?

I

9/16/2019 Australian mother fights to save addicted son from opioids - New Delhi Times - India's Only International Newspaper

government, here she was: Standing by,helpless, as doctors prepared to place herchild in a coma.

“Say goodbye to your son,” she heard a doctor say.

He wanted more.

https://www.newdelhitimes.com/australian-mother-fights-to-save-addicted-son-from-opioids/ 3/19

At first, though, he mistakenly believed that he’d need a prescription to get codeine. It took him a few months and a tip from a colleague before he discovered that Australian pharmacies sold it over the counter. Two more years would pass before Australia — facing a surge of pharmaceutical opioid-related deaths — made all codeine products prescription-only.

Deb had worked for years as a nursing assistant. She’d seen plenty of kids prescribed opioids after wisdom tooth extractions. And so there was nothing that initially worried her about Sam’s pills, medication that combined paracetamol (also known as acetaminophen) and codeine.

Disturbed, Deb took the remaining pillsaway. But Sam loved the buzz they’d given him. The codeine had made him feel safe and warm, like being tucked into a cozy bed on a cold winter’s night.

In Oct. 2015, his dentist recommended he have his wisdom teeth pulled. He was sent home afterward with a prescription for an opioid painkiller.

But in those days, all Sam needed to do was go to a pharmacy, hand over a few dollars, and walk out with an opioid.

The instructions stated that Sam should take two for his pain that night. The next morning, he told his mother he’d taken four.

I


mother, who had raised him on her ownsince he was a toddler, and who shared hisfondness for music and the beach. He hadlittle interest in drinking and none in drugs.

https://www.newdelhitimes.com/australian-mother-fiqhts-to-save-addicted-son-from-ODioids/ 4/19

After he got a CT scan that showed a bulging disc in his spine, his quest for opioids became even easier. The CT scan was his golden ticket, proof that he had legitimate pain. He began carrying the scan’s results with him everywhere in a plastic shopping bag, along with his pill crusher. Around 70 percent of the time, he could convince a doctor to write him a prescription for whatever he wanted. He also sought out benzodiazepines, used to treat anxiety, and — after a doctor handed him a sample pack

It was so easy. He started going from doctor to doctor, collecting prescriptions for a smorgasbord of opioids: OxyContin, Endone, Targin.

When the codeine stopped working, Sam knew he needed something stronger — which meant he needed a prescription. He went to a general practitioner and complained of lower back pain and nerve pain in his leg. The doctor scribbled out a prescription for an opioid called tramadol and sent Sam on his way.

Deb watched the kind-hearted, funny boy she loved rapidly disappear, and be replaced by a deceptive, desperate stranger. Lookingback, she marvels at how fast it all happened.

t


Initially, the codeine was an occasional treat.Soon he realized he felt lousy when hewasn’t taking it. He took more, movingquickly from a few pills a week to 40 a day.Then 80. Then 110. His abdomen began toache, which he feared was a result of all theparacetamol in the drugs. So he went onlineand learned how to extract the codeine fromthe pills.

“You become the drug,” she said.

https://www.newdelhitimes.com/australian-mother-fiahts-to-save-addicted-son-from-oDioids/ 5/19

She chronicled his swift downfall in a diary that catalogued all the drugs, the hospitalizations, the broken promises:

Deb called and wrote letters to the doctors whose names she found on Sam’s prescriptions, warning them that he was addicted to the medications.

But Sam just went to other doctors, riding the train up and down the coast and stopping in clinic after clinic. Deb found his pills in the bathroom ceiling, under the mattress, under the computer keyboard. Whenever he came home, she patted him down. It was futile.

The drugs were cheap. Most medications in Australia are government subsidized. For people like Sam who have concession cards — those who are older, or on low incomes, or have a disability — the out-of-pocket cost is just 6.50 Australian dollars (US$4.50) per prescription.

Sept. 13: “Sam — tested positive to valium. Suspended from work until Tuesday next week.”

I

9/16/2019

Dec. 27: “Sam slept in his car — unable to contact him by phone. I contacted police.”


— Lyrica, a brand of pregabalin that istypically used for nerve pain.

Dec. 25: “Sam evicted from Adam’s due to continuing drug abuse.”

Sept. 8, 2016: “Said he wants to get off codeine. Withdrawal symptoms: nausea headache stomach cramps. Called paramedics.”

Sept. 29: “Sam sacked.”

But he did.

https;//www,newdelhitimes.com/australian-mother-fights-to-save-addicted-son-from-opioids/ 6/19

His life became an endless pursuit of pills. He lost friends and family and most of his

He woke up in an ambulance, in a panic. The paramedics told him he’d had a massive seizure. They called Deb, and she rushed to meet them at the emergency department.

Deb fetched him a bag, into which he ejected a stream of bright pink vomit. He had mixed codeine pills with a codeine-based, pink cough syrup. Deb called the paramedics.

She begged him to go to rehab. He refused. One day, he told her he just wanted to take pills until he didn’t wake up. She called the police and they took him to the mental hospital. He stayed there for a week. The day he got out, he overdosed again, and ended up back in the emergency department.

The first time Deb truly began to fear that Sam might die was on Feb. 16, 2017.

He had taken a cocktail of opioids andLyrica, then walked to a restaurant to pick up a falafel wrap for dinner. His limbs began to jerk. He blacked out.

At the hospital. Deb was furious. Why would he do this to himself?

She found Sam there, lying on a bed, twitching.


His first overdose came around four monthsinto his addiction. “I don’t feel well,” he toldDeb, heart hammering, face pale.

“I know it’s really bad for me,” he told her. “I won’t do this again.”

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Soon after, he jumped the fence and fled.

https://www.newdelhitimes.com/australian-mother-fiahts-to-save-addicted-son-from-oDioids/ 7/19

On the nights he slept at home, she checked to make sure he was still breathing. On the nights he was gone, she would awaken to the sound of the train going by and wonder whether Sam was on board, dead in his seat.

She kept fighting. She contacted politicians, working her way up to federal HealthMinister Greg Hunt. In an email, she begged him to implement a national prescription monitoring system. “This is an URGENT situation which must be addressed as soon as possible,” she wrote.

An assistant secretary in the health department replied, assuring Deb that the minister took Australia’s opioid problem seriously, that a prescription monitoring

Each time the police called, she braced for the worst. She started asking Sam what music he wanted at his funeral.

Inside, always, was his precious CT scan, his fast pass to opioids.


belongings. His phones, laptop and clotheswere left behind or stolen while overdosingon trains, in shopping centers, in a library.Eventually, all he owned would fit into hisplastic shopping bag.

Deb tried to get him committed to the state’s involuntary drug and alcohol treatment program, but there are only 12 beds available for New South Wales’ population of 8 million. It took her two years to get him a spot. While he was there, she brought him a Bible, in which she had inscribed this verse: “For I know the plans I have for you, says the Lord. Plans to give you hope and a future.”

9/16/2019

The patient stared at her strangely.

8/19https://www.newdelhitimes.com/australian-mother-fights-to-save-addicted-son-from-opioids/

One day, she was tending to a patient Sam’s age who had just had his wisdom teeth removed. She handed him his discharge papers, along with the prescription a doctor had written for the same opioid Sam was prescribed after his own teeth were pulled.

She refused to bring him home and tried to drop him off at a shopping center. He

It had been another horrible morning at the emergency department. A bed in detox was available. Sam agreed to take it. And then, at the last minute, he changed his mind.

Deb stared at the young man holding ice to his swollen cheek. She saw Sam.

The day that Sam refused to go to detox was the day Deb hit her limit.


system was in the works, but that therollout’s timing was left to each state.

She paused. “Actually, probably try not to take it.”

“I wish you and your son all the best for the challenges you are both facing,” the bureaucrat wrote, infuriatingly, in closing.

“Get out of the car,” she told him.

“Please. Don’t take it.”

“Only take it if you really need to,” she said of the prescription. “Get your mum to hang onto it.”

“No, really,” she urged, tearing up. “It’s really addictive. Just be really careful.”

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Except fear.

9/19

Deb jerked the wheel left and right. Sam wailed, pressing his flip-flop clad feet against the dashboard so hard they left scuff marks.

As he sat in the passenger’s seat and sobbed, her rage and desperation grew. She had tried almost everything to save him.

Then she heard the beep-beep-beep of the seat belt alarm. Saw Sam unbuckling himself. Watched him yank the emergency brake and open the door.

She steered toward the freeway and jammed her foot on the accelerator. Sam clutched his seatbelt. “Let me out of the car!” he screamed.

“Why?” he replied.

“I’M GOING TO KILL US BOTH!” she roared.

“THIS IS IT!”


refused to get out of her car.

Her response was matter-of-fact: “I’m going to go as fast as this car can go. And I’m going to swerve off the road into a tree or a barrier. Because you’re going to die if you keep doing what you’re doing. And if you die, I might as well die, too. Let’s just get it over with now.”

“NO, NO, NO!” he shrieked.

“You got your seatbelt on?” she asked, a plan hatching in her head, as she threw the car into gear.

She pulled over just as Sam commando- rolled out of the car, shredding his knees on

https://www.newdelhitimes.com/australian-mother-fights-to-save-addicted-son-from-opioids/

9/16/2019

From falling down on you again

I can’t stop the rain

10/19https://www.newdelhitimes.com/australian-mother-fights-to-save-addicted-son-from-opioids/

She never really intended to hurt either of them that day. But there had been that little voice inside her urging her to do it, just do it, just end the misery now.

The end felt near that day in June, when the doctors told Deb to say goodbye and placed Sam into a coma.

Her son was on life support. Even if he survived, he could spend the rest of his life in a vegetative state.

Family and friends gathered. Her sister flew down from Queensland.

Day after day, she sat by his bed and prayed. She held up her phone to his pale face and played a song they both loved, “When the Rain Comes” by Third Day.

“Don’t come near me!” he shouted.

The doctors tried repeatedly to bring him out of the sedation, but his body went rigid every time.

She went from manic to calm in two seconds. Sam stumbled along the street, blood pouring down his legs, frantically trying to wave down passing cars. She went after him.


the pavement.

“I’m not going to hurt you, Sam,” she said. “But this is my desperation.”

“I can’t stop the rain

11/19https://www.newdelhitimes.com/australian-mother-flghts-to-save-addicted-son-from-opioids/

The day he was discharged, Deb welcomed him back into her home. The next morning^ he went to a shopping center to buy a box of chocolates and a thank you card for the hospital staff who had saved his life.

She began recording the moment on her phone. In the video^ dated June 20, a bleary but smiling Sam flashes a triumphant thumbs-up. “Praise the lord ” he says.

Sam agreed. No more drugs, he told her. He’d seen the light.

He is staring vacantly at the camera, eyes flickering, then closing.

And then he popped into a doctor’s office and got himself a prescription for an opioid and a benzodiazepine.

After 10 days, the doctors successfully awakened him. He looked terrible. Deb went home that night with low expectations.

She returned in the morning to find him sitting in a chair, eating breakfast.

Deb warned him he couldn’t do this again, and that if he did, their relationship was over.

She saw tears leaking from his eyes. She cried, too. Maybe Sam was still in there, somewhere.

“Sam the super man!” she declares.

“You’re alive!” she cried.


But I will hold you ’til it goes away”

« k

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“Open your eyes, Sam.”

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She is done.


The video was shot on June 29, five days after Sam was released from the hospital. He is slumped on Deb’s couch, overdosing on opioids, benzodiazepines and Lyrica.

The ambulance arrives. Deb is too fed up to follow. She calls the hospital later and learns that Sam was briefly put back on life support, but that it’s not as bad as last time.

On July 19, three weeks later, he steps off the bus, carrying his shopping bag. His sweatshirt and sweatpants hang loosely on

Deb has called the paramedics. She just has to keep Sam alive until they turn up.

When she gets to the hospital the next day, a nurse delivers another blow: Sam has withdrawn his consent for Deb to be updated on his medical care.

And yet, she’s not. She is his mother. He is her son.

Deb goes home, gathers Sam’s few belongings, and dumps them at the hospital.


“Open your eyes, Sam,” Deb orders again,voice tight with rage. “OPEN.”

“So you can see what you’re like,” she replies. “I thought seeing yourself on life support would help you not do this anymore, but clearly not.”

“Do you have any Lyrica left?” he mumbles.

“Why are you doing this?” he asks. “Why are you filming me?”

https;//www.newdelhitimes.com/australian-mother-fights-to-save-addicted-son-from-opioids/ 13/19

That was the moment he decided^ “Enough’s enough/’ he says. That’s why he agreed to go into detox for a few days. He says he hasn’t touched a drug since. He says he’s been staying in a hostel, but has no money left, no place to go. He says he can stay clean, if only he had a roof over his head.

And then he went to another doctor and got another prescription and had another overdose. He ended up back in the emergency department.

Back at her house, he sits on the porch and stares out at the surrounding gum trees. He ignores the sandwich his mother places in front of him, and begins to talk.

Deb is waiting for him. She wraps him in a hug and rustles his messy hair.

A couple weeks ago, he says, he was trying to sleep on the train but couldn’t stop crying, thinking about how badly he had hurt his mother. In his bed at the men’s shelter in Sydney, he lay awake all night, thinking of her pain.

He tries to explain why he withdrew his consent. He was worried she’d say something to the doctors that would get him committed to the mental health ward. He regrets it now.


his skeletal frame. It is clear from the smell that he hasn’t showered.

* «

9/16/2019

“For me to say that after everything mum’s done for me... especially bringing me up by herself, providing for me. And then with the OD in ICU when I was in the coma, coming to visit me every day, the toll that would have taken — I can’t begin to imagine,” he says, eyes darting toward his mother, who stares back in silence. “I felt terrible.”

And there’s something else.

https://www.newdelhitimes.com/australian-mother-fights-to-save-acldicted-son-from-opioids/ 14/19

She tells herself that coddling him is enabling him. That if she lets him get one foot in the door, he will force his way back into her life until the inevitable, awful end of his own.

But he doesn’t like rehab, he says. He doesn’t like the people who go there. He doesn’t like the rules.

It is dark now, and they are freezing. Deb lets Sam into the warmth of the living room. He sits on the couch where he overdosed three weeks earlier and wolfs down a sandwich, and toast, and cereal, and cookies. Deb sinks into her armchair, looking broken.

The argument goes on in a relentless loop.And in the end, there’s the desperate request she knew was coming.

' 9/16/2019 Australian mother fights to save addicted son from opioids - New Delhi Times - India's Only International Newspaper

“It doesn’t have to be like that, Sam,” Debinterjects. “You’ve been advised what thebest thing to do is to get your life back ontrack, and that’s to go to rehab.”

“I don’t want you staying here, Sam.”

“What if it doesn’t work?” he asks.

“I don’t know. Sleep on the footpath or walk to the train station or something.”

“Can I at least have dinner here?”

“You haven’t tried!” she snaps.

“And then what?”

“Can I please stay here tonight?”

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' ‘9/16/2019

But she cannot send him into the darkness. And so she keeps him home for one last night, for one last chance.

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Credit: Associated Press (AP) | Photo Credit: (AP)


She tells herself to stay strong, not to give in.

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