Dealers in White Coats

The opioid crisis in the United States, a public health nightmare that is still unfolding, resulted from a toxic combination of intent, access, oversight, and socioeconomic factors. The late-1990s surge in prescriptions for opioid-based painkillers like oxycodone and hydrocodone was a major driving force behind this epidemic. At the time, pharmaceutical behemoths had managed to persuade the medical community that these potent painkillers posed little risk of addiction, resulting in a dramatic increase in their prescription rates.

Because of their widespread availability and legal status, these substances have lost their stigma, making it easier for people to fall into the trap of abuse. Even when regulations were in place, they were frequently not followed or were completely ignored. The opioid crisis took root and quickly spread across the country in the absence of strict prescription drug monitoring programs.

The epidemic was not limited to medical professionals. Socioeconomic factors played a significant role in igniting the fire. Opioid abuse increased disproportionately in areas with high unemployment rates, low-income populations, and an inadequate support system. Stress and a lack of viable alternatives drove many people to self-medicate, kicking off a destructive cycle of addiction.

As people became addicted to prescription opioids, they began to use illegal drugs like heroin or fentanyl, deepening the crisis. These substances, which were less expensive and more potent than prescription opioids, provided a lethal escape and accelerated the epidemic.

South Africa, on the other side of the Atlantic, is on the verge of a similar crisis with prescription medication. The problem isn’t limited to opioids in this case; it also includes benzodiazepine sedatives and codeine-based painkillers.

Similar to the early stages of the US crisis, a general lack of awareness about the addictive nature of these drugs sets the stage for potential misuse.

Over-prescription of powerful drugs is a problem in South Africa, as it is in the United States. In addition, the insufficient prescription tracking system, with insufficient focus on who is prescribing, dispensing, and receiving these drugs, allows for potential illicit acquisition or overuse. These prescription drugs, like their counterparts in the United States, are easily accessible and affordable, making them prime candidates for abuse.

The socioeconomic landscape of South Africa is also taken into account. High unemployment and poverty, combined with social and economic inequality, create an environment conducive to drug abuse and addiction. If addicts do not have access to effective treatment, a small spark can quickly turn into a raging public health fire.

Battling rehab and succumbing to relapse, she found herself entangled with cocaine. “The feeling of it being prescribed, legal, gives you an edge over junkies and seemingly makes it alright,” she shared.

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In hindsight, however, she came to realize she was no different from other addicts. “On prescription drugs, my life was just as out of control as it was on cocaine,” lamented McKenzie.

Gareth Carter, a licensed therapist and director at Changes rehab centre in Johannesburg, pointed out that it’s usually more challenging to convince individuals who rely on prescription drugs—legal, affordable, and readily available—that they’re struggling with addiction.

“People struggle to acknowledge their issue when the person supplying them has a degree and a white coat,” he expressed.

Despite the guidelines implemented by the Medicine Controls Council, prescription drugs are not difficult to obtain.

“I secured 100 vials of pethidine from a drug dealer, not a pharmacist. He claimed to be an employee at the drug factory in Port Elizabeth,” McKenzie revealed.

“It was surprisingly affordable. It cost R900 for everything. Cocaine was R450 a gram.” When you have the right prescription, you’re not even required to cover the cost yourself. “When street drugs are scarce, your medical insurance will sponsor your addiction,” she added.

Prescription drug abuse often goes unnoticed, but recent tragedies involving renowned celebrities like Heath Ledger and Michael Jackson have thrown the issue into public view.

The International Narcotics Control Board in its most recent report, called for immediate action to address the escalating problem of prescription drug misuse.

In the United States, prescription drugs rank second only to cannabis as the most abused drugs, with more individuals misusing prescription drugs in 2008 than cocaine, heroin, hallucinogens, ecstasy, and inhalants combined.

Robert Berghoff, a senior scientist at the Medical Research Council’s Alcohol and Drug Abuse Research Unit, expressed that prescription drug abuse is a neglected and underrated problem in South Africa.

Much of the research on the matter comes from treatment centers, failing to reach rural areas or those prescription drug addicts who turn to their GP for help in overcoming the issue.

Berghoff noted that those who succumb to prescription drug addiction are typically older, between 35 and 40, with over 60% being women.

The most commonly abused drugs are sedatives like benzodiazepine and pain relievers like codeine, but a significant number of people also misuse weight-loss pills, which contain amphetamines, and over-the-counter painkillers.

Derek Leung, deputy chair of the Central Drug Authority, indicated that it’s easier for those addicted to prescription drugs to evade notice. As these drugs are pure and their production is controlled, it’s easier for users to gauge their tolerance and regulate their dosage.

However, despite their purity, prescription drugs can be just as perilous as illicit drugs. “They can trigger kidney damage, inhibit breathing, and lead to unconsciousness. Users’ sense of normality is dependent on the drug, and without it, they experience withdrawal symptoms,” he cautioned.

Leung found it disturbing that the International Narcotics Control Board’s report highlights an increasing trend of prescription drug abuse among younger individuals aged 15 to 18. “They either demand these drugs from doctors or share with their parents. I suspect the same is happening here,” he commented.

Young Noah Steinberg found himself ensnared by prescription drugs. “I started as a kid, at 12, suffering from severe migraines. They used to inject me with morphine and pethidine,” he confessed. Initially, everything was legitimate.

Tired of the invasive procedures, Steinberg asked his doctor for an oral alternative. The doctor prescribed Stopain.

“We were all ignorant about the perils of drug abuse in South Africa.”