People who use illegal drugs are sharing prescription-only medication if they can’t access treatment for a legitimate health problem.
This is one of the findings of a new study by a group of criminologists from the Centre for Criminology at the University of South Wales (USW).
They found that people who use drugs reported sharing their medication with others who have genuine health concerns, or opioid withdrawal symptoms.
Interviewees described an arrangement through which they would help each other, depending on need and availability. This was particularly evident in prison settings, where medication for legitimate medical needs was reportedly often hard to come by.
Prescription medication was also traded in prisons for commodities such as toothpaste, shower gel, and mouthwash.
The researchers spoke with both previous and current heroin users who had recent experience of prescription drug misuse. This included prisoners and people seeking help from drug treatment organisations in the community.
The most commonly used prescription drugs were opioid substitutes such as methadone and buprenorphine, mirtazapine – an anti-depressant with sedative properties, gabapentin and pregabalin – which are medicines used for neuropathic pain that produce euphoria, relaxation and calmness; and diazepam – a sedative that helps with sleep, tension, and anxiety.
Some of the interviewees reported difficulties in obtaining this medication through official routes. Barriers they reported included waiting lists for Opioid Substitution Treatment and tight prescribing protocols, which resulted in a reluctance among doctors to prescribe certain medications to people who use drugs even when they had genuine mental and physical health problems. This included pregablin, gabapentin, and diazepam.
While some involved in the study were able to obtain medications legitimately, limited access to these particular medications – both in community and prison settings – often meant they had to seek prescription medication through alternative routes.
Interviewees also reported that these medications helped to protect opiate users from experiencing harmful withdrawal symptoms. They often procured and stockpiled excess doses of methadone – either from their own or a peer’s weekend take-home supply - to assist in these situations.
The research was part-funded by Welsh Government and it will support the key priority in its’ recently published Substance Misuse delivery plan 2019-2022 which will look at dependency with prescription only medicines and over the counter medicines.
One of the USW Criminologists conducting the research, Dr Tom May, said: “Our study found that drug users reported three main reasons for sharing prescription-only medication.
“Firstly, to help overcome any barriers that they may experience when trying to seek medication legitimately for mental or physical health concerns.
“Secondly, as a practical tool for alleviating a number of concerns experienced by opioid users, including withdrawal, poor-quality heroin, and the harmful side-effects associated with certain drug types, such as crack cocaine.
“And, finally, medications played an important role in maintaining and establishing important social relationships and networks among opiate users. Entering into a co-operative relationship with another opiate user who would be willing to share or trade their prescription medications was a precautionary tactic against withdrawal or illness. This was particularly evident within prison settings.
“To reduce the harm caused by the misuse of prescription-only medication, it is important that no one should have to wait for a script when they have the courage to present for treatment. Getting individuals into treatment quickly would prevent the need to use harmful alternatives.”
Professor of Criminology at USW, Katy Holloway, added: “By understanding the motivations and issues facing people who use illegal drugs, we can begin to consider possible solutions that address their need to misuse prescription medication. This includes improving access to substance misuse treatment that is of optimal dosage and optimal duration.
“We also need to acknowledge the therapeutic motives that drug users have, and understand more how this can be addressed.
“The empathic sharing of medication within this vulnerable and marginalized group demonstrates their willingness to help one another in times of need.
“This social support system has enormous potential for helping reduce the increasing rate of drug-related deaths in Wales. Let’s use them to distribute naloxone kits to one another and disseminate overdose prevention advice more widely. This could help create safer peer-supervised consumption spaces, where the risk of harm is minimised.
“We hope this research can go some way to reducing stigma toward people who use drugs, particularly in healthcare settings where they may be restricted from obtaining the medication, support and treatment they need.
“If this stigma can be reduced, it may open up legitimate routes for treatment.”