CHENNAI: To choose over-the-counter medication in India is not an uncommon affair, thanks to the easy accessibility. And while this availability may seem like a boon to many, it is also a curse. A 2020 review article ‘Over-the-counter medicines: Global perspective and Indian scenario’ in the Journal of Postgraduate Medicine shares that 52 per cent Indians were estimated to self-medicate according to a survey across 10 cities. While the statistic in itself is alarming, it is also disheartening when one considers the rising cases in painkiller addiction. Having worked in de-addiction for 24 years, Sheeba Williams, senior counsellor, TTK Hospital, TT Ranganathan Clinic, talks about the causes, danger, and treatment of painkiller addiction.
What causes painkiller addiction and how often do you see it?
Initially, there were only alcohol patients coming in. Now we have a lot of patients who are using an opioid or narcotic. People usually use pain-relieving medicines over the counter for some kind of physical ailment, but these painkillers activate the pleasure centre in the brain and cause euphoria. People get addicted to it, and they want to do it more and more to feel a sense of well-being, which is extremely temporary. The pain centre in the brain gets nullified initially and it becomes addictive because of the endorphins neurotransmitter secreted in the brain. The withdrawal is just the opposite of the effect when they take the painkillers. So when we are not on it, they feel pain. And to handle it, they take it again and again.
Could you talk a little bit more about the withdrawal?
When people take painkillers, they feel it has a tranquilising effect — they feel as if they have to go to sleep and they feel the body is in the air and the withdrawal is just the opposite. It’s so painful. They feel restless, they are not able to sleep. Sometimes, some patients even complain of nausea, and lack of appetite.
When does taking over-the-counter medicine start becoming a problem?
All the medications that are prescribed by the doctor, there is a particular time frame for them. So if a doctor prescribed medicine, for sleep or for pain for a particular period of time, say, 10 days, it is called drug use. If I take the same prescription, and increase the dosage, for example, 10 medicines per day, and I’m doing this for six months, it becomes drug abuse. There’s a difference between drug use and drug abuse — if it goes according to the prescription, according to the quantity and duration that the doctor prescribed, it is drug use.
How do you recognise it? When should one go to a doctor/de-addiction centre?
According to the definition of addiction, a person’s drug abuse or substance use is becoming a problem when it starts affecting one or more areas in his life — a person’s life or family, finances, occupation, social status or health. If they are not able to fulfil their responsibilities with family or continue despite their financial position or social status suffering, it’s high time that they think about taking treatment. It’s very difficult to just abstain and continue with a lifestyle because of the withdrawal. Physical and psychological withdrawals exist, sometimes they can feel depressed, or anxious or even have a seizure. It’s always better to get into a treatment centre or clinic where there is a safe administration of medicines for their withdrawals and symptoms.
What are the statistics regarding this? Has the number increased?
I think it’s increasing nowadays. Initially, as I told you, it was only alcohol. But now a lot of youngsters have started using these painkillers because it’s cost-effective and easily available. For example, if they want to sleep off after an exam, they can just take a painkiller and sleep. The age of initiation has considerably come down. When I started my career 24 years ago, the client would say they started using drugs when they were 25. But now some say in school, in class 8 or 10. They say a friend said it’s going to be helpful to handle your pain. This means the damage to the still developing brain is greater because the brain keeps developing from age five to age 20. When drug use is initiated, when the brain is still developing, brain deterioration or functioning can be affected, which is very, very alarming for our younger generation, and society at large.
Is there any way or need for intervention?
The government has a drug policy where these medicines cannot be given over the counter without prescription. The doctor’s prescription and the prescription date are very important. Few medical centres do follow these procedures, but we always have a back door for everything. So maybe more stringent procedures from the government and the narcotic people to ensure that it’s not easily available (would be helpful). People who are taking more money to give drugs without any prescription should be punished severely. It’s also very important to create awareness. Peer pressure is part of life and the parents and teachers have to definitely play a better role in guiding children. I think families have to be more responsible now with social media; the right kind of information should be communicated to the children and the right amount of money should be given to them.
What does de-addiction from painkillers look like?
All addiction treatments should be an in-patient programme, we can’t treat them outpatient because once we go back to their old environment, there are a lot of chances for them to have this craving again. Whenever a person comes in for a treatment programme, the first thing that needs to be done is detoxification. The painkillers have definitely done a lot of damage to the system. After the detoxification process, the person is physically fit but not mentally. Which means this craving still persists. The next step will be psychological intervention in the form of counselling and therapy, and other interventions.