Colin's Blog

NHS compensation costs rise to £807m
Legal costs soar from £613m to £807m over three years as complaints of medical negligence against the service rise sharply

Owen Bowcott
The Guardian, Wednesday 19 August 2009

http://www.guardian.co.uk/society/2009/aug/19/nhs-legal-costs-compensation

The NHS spent more than £800m settling legal claims last year as complaints of medical negligence against the service rose sharply.
The surge in payouts is revealed in the NHS Litigation Authority's annual accounts which show that maternity services attract the highest legal costs. Clinical errors in delivering babies can result in lifelong damage and payments accordingly reflect the intensive medical care often needed for decades to come.

Among the contested claims highlighted in the report are the case of six male cancer patients who had banked semen samples with the North Bristol NHS Trust for possible future use. The samples thawed and became unviable.

Five claimants allegedly sustained psychiatric trauma as a result, believing that possibly their last chance to become a father had been lost. The sixth suffered mental distress. "In fact, the fertility of three claimants subsequently returned," the report notes.

The case, which has already been to the court of appeal, will return to the county court to assess damages payable. "This is a very novel ruling and has arguably increased NHS liabilities," the authority comments.

In one case a child born with congenital rubella syndrome, "due to admitted NHS negligence", is receiving care costing £130,000 a year. Legal costs for the NHS have risen significantly over the past three years, from £613 million three years ago, to £807 million in the last financial year. The latest figure alone represents a 22% increase over the previous year.

The liabilities show no sign of easing off. After five years of relatively consistent levels of claims for compensation due to errors by NHS staff, numbers leap last year by 11%. "We have not been able to identify any single factor that might have precipitated the rise," the authority commented in its report.
Most cases are settled out of court. Of the 8,885 clinical and non-clinical claims made in 2008/09, fewer than 4% are expected to end in a court hearing. There were almost 6,000 claims received last year under the clinical negligence scheme for NHS trusts. The sums include both damages paid to claimants (including patients, staff and members of the public) and the legal costs incurred on both sides where they are paid for by the NHS.

The popularity of Conditional Fee Agreements (CFAs) - where lawyers take on cases for a proportion of the final settlement rather than for up front fees – is one factor in the growth in litigation. Claimants' costs are often significantly disproportionate to the amount of damages paid, particularly in low-value claims," the report observes."This was not a vintage year for corporate defendants generally, nor for the NHS in particular, in most areas of litigation managed by the authority," the report says.

The NHSLA fears that several landmark judgments will stimulate future claims. It has warned that "no win, no fee" solicitors are damaging NHS patient care and that compensation payouts and lawyer fees can only come from the NHS's budget.

The Conservatives seized on the figures. The shadow health minister, Mark Simmonds, said: "We need a robust and fair way for patients who have received negligent treatment in an NHS hospital to get the compensation they deserve.

"Instead, we have an inefficient system which incurs vast legal costs for NHS Trusts involved in legal battles.The government could have saved a lot of money if they had listened to our proposals during the passage of the NHS Redress Bill three years ago.

"Our proposals would have required an initial 'fact-finding' phase, which would then allow more cases to be resolved without costly litigation.But the government missed this opportunity and as a result hospitals will now have less money to spend on patient care."

Stephen Walker, the NHSLA's chief executive, explained that there had been an increase in the number of claims settling in the £100-£500,000 range and delayed resolution of more than 100 catastrophic injury cases that had been awaiting the outcome of a test case.

A Department of Health spokesperson said: "Patients deserve high quality healthcare from their NHS. The vast majority of the millions of people treated by the NHS every year experience good quality, safe and effective care and we are one of the world leaders in the international drive to improve the safety of healthcare.

"However, on the rare occasions that patients do not receive the treatment they should, and mistakes are made, it is right that they receive an apology and explanation and, if appropriate, receive financial compensation.

"The amount spent on clinical negligence in 2008/09 does not necessarily reflect the number of new claims being made in that year, but could indicate that more claims were settled and compensation paid. However, disproportionate litigation costs are a concern across government and beyond, not just in the NHS. This is why Lord Justice Jackson is currently reviewing civil litigation costs to ensure that fees are proportionate and the results of this review are due to be published later this year."

Patients in England are being forced to fight lengthy and costly legal battles to receive an apology and an explanation of what went wrong

By Nina Lakhani
Sunday, 30 August 2009

http://www.independent.co.uk/life-style/health-and-families/health-news/plan-to-help-victims-of-nhs-negligence-is-left-to-languish-on-statute-book-1779386.html

Ministers have been condemned for failing to implement a law designed to help victims of NHS negligence and improve patient safety.
The 2006 NHS Redress Act was intended to offer patients a quicker and fairer alternative to expensive and lengthy legal battles, which have caused the cost of NHS negligence to spiral dramatically in recent years. But the Department of Health has failed to produce the necessary secondary legislation to make it operational, leaving the Act totally unworkable in England.

In contrast, the Welsh and Scottish governments are accelerating their own plans to set up similar schemes.
Lawyers, medical professionals and patient safety campaigners have severely criticised the failure. The Parliamentary Health Select Committee described it as "appalling", while Peter Walsh, chief executive of the patient safety charity Action Against Medical Accidents, said his organisation was "dismayed" by the Government's failure to act.

Mr Walsh said England was now lagging behind the rest of the world. The Welsh Assembly government had "shown a refreshing willingness" to act and its scheme will be up and running by next year, while the Scottish governmen is considering the more radical step of introducing a "no-fault compensation" scheme. A similar system is well established in New Zealand but has been rejected for England.

He added: "Given that Andy Burnham was a key supporter of the legislation at the time and has now returned to health as the Secretary of State, we hope there may be a renewed enthusiasm to move forward. It is completely unacceptable for the Government to sit on its hands and do nothing."

The NHS Litigation Authority this month revealed a 22 per cent year-on-year rise in compensation payouts in England. Nearly half of the £807m paid out by the authority in 2008-09 was spent on lawyers. There has been a four-fold increase in clinical negligence costs incurred by the NHS over the past decade. Official figures from 2002 show that legal fees exceed the sums paid out to patients in two thirds of cases where compensation is under £50,000. Though the time taken to settle a claim has been reduced, it still takes on average 1.4 years.

The proposed NHS Redress Scheme was intended to offer a swift resolution for patients when things go wrong by providing investigation, remedial treatment, rehabilitation and care where needed, as well as explanations and apologies, and financial compensation in certain circumstances. It would largely eradicate the need for lawyers for claims under £20,000, saving an estimated £7.6m in legal costs in the first year. Its contents are based largely on recommendations made by the Chief Medical Officer in his 2003 report Making Amends, which criticised the current system as "slow, complex, unfair and expensive".

The Government claims it will consider implementing the new scheme after recent reforms to the complaints system have been fully assessed. But critics say this is disingenuous.

Peter Gooderham, lecturer in law and bioethics at Manchester University Law School, said: "While the Act did not offer the radical reforms some people hoped for, the Redress Scheme it provided for did offer an alternative to the clinical negligence system for lower-value cases.
"I suspect it has not been implemented because the Government thinks it can better keep the lid on the costs by sticking with the current system, however unsatisfactory."

The scheme was also intended to build trust between NHS staff and patients by discouraging blame and encouraging openness. According to the British Medical Association, the current clinical negligence system is focused on finger-pointing rather than improving services.
The select committee said: "By dragging its heels over implementing the scheme, the Department of Health is... obliging the NHS to spend considerable sums on legal costs and... hindering the development of a safety culture in the NHS."

When two-year-old Chloe Coyle became unwell in September 2002, her parents, Kate and Chris, took her to an accident and emergency department, but were sent home. It took three more visits for Chloe to be admitted to hospital, by which time she was suffering from an excruciating headache. Blood tests were taken, but the results were not seen; antibiotics were prescribed, but not given. By the time meningitis was finally diagnosed, it was too late.

Kate Coyle said: "We just wanted to know why things had gone so wrong and have some reassurance that it would never happen again. We had no choice but to see a lawyer because the [NHS] trust kept fobbing us off. It took three years of battling to get a three-line apology from the trust and just over £20,000 compensation.

"We had absolutely no interest in the money but it was the only way they would accept responsibility – take it or leave it. We spent so much energy writing letters, while trying to grieve, just to get an apology.
"I cannot understand why the new scheme has not started – we would never have gone to lawyers if there had been another option."

Doped and duped
Adverse effects of widely-prescribed drugs are often overlooked because there is so little truly independent academic evidence
David Healy
guardian.co.uk, Saturday 8 August 2009 09.30 BST

http://www.guardian.co.uk/commentisfree/2009/aug/08/seroxat-pharmaceutical-birth-defect

Since 2005, the SSRI paroxetine, first marketed by GlaxoSmithKline as Seroxat, has carried warnings of risk of birth defects. In the US litigation in which I have been asked to give evidence, the plaintives will argue that, even before they were launched, there was good laboratory evidence that the SSRIs might cause problems, and, following their initial marketing, evidence emerged over a decade ago from clinical use that the drugs actually do cause problems. Yet these drugs have been actively promoted, de facto primarily to women of child-bearing years. How could this happen?

Part of the problem is that having gone to their GP with a nervous problem, many women become dependent on a prescribed SSRI and find it impossible to stop using it whether they wish to get pregnant or if they find they are pregnant while on treatment. But few, if any, of these women will have been informed of either the risk of birth defects or the risk of becoming addicted. Why not?

What we are seeing here is the astonishing marketing power of pharmaceutical companies, which can now effect huge changes in medical culture within months. In this case, a great part of the scientific literature (the primary marketing tool of companies) on the use of antidepressants in pregnancy and on dependence on antidepressants is ghostwritten – just as virtually all literature on giving antidepressants to children was, at one point, company-written. Firms of medical writers are contracted to pharmaceutical companies to place in academic journals articles attributed to, but not actually authored by, university researchers.

Because of this, guideline makers like Nice, which can only go by the published literature, are trapped. Regulators, like the FDA and MHRA, which reflect a professional consensus rather than lead on issues like this, are likewise stuck. Doctors who believe their role is to follow Nice, the MHRA and the scientific evidence are in the same bind.

The process of manufacturing clinical consensus has become so slick that it is now almost impossible to find independent articles from academic physicians with no links to industry that will sound a note of caution about prescribing antidepressants to women of child-bearing years. This is a problem that increasingly applies across all of medicine – from the use of HRT, to drugs for osteoporosis, respiratory or gut problems, pain-relief, as well as all psychotropic drugs.

Where once drugs were seen as poisons to be used judiciously and with caution, they are now treated as fertilisers whose more or less indiscriminate use can only do good. Where once farmers knew to keep their cattle out of fields growing the serotonin reuptake inhibiting weed, St John's Wort, as it caused miscarriages, under industry influence women have been herded by doctors in exactly the opposite direction.

Comments

• Getting off Seroxat can take years and cause a much greater problems that the unhappiness it was prescribed to solve.

• We now have this new (and fatal) disease called "evidence-based medicine" . Only Big Pharma has the means to perform randomised controlled trials (the "best" evidence).

• There is a solution - this is to abolish copyright for medicines. Pharmacutical companies then become manufacturing companies only. The cost of research and testing would be carried out by an international body, complemented with national and NGO bodies, all using standard accepted protocols, and financing would depend on human need, not future profit. Private innovation could be encouraged through major cash prizes for companies or individuals who make major breakthroughs.

• What a slick and successful business model these pharmaceutical companies have adopted! They've managed to manufacture their lucrative products yet quash all criticism of them.

• This is a huge issue, with almost all drugs. If there are severe and catastrophic side effects, like death, the medical profession reacts quite quickly, usually. However, for heavily prescribed drugs, the only side effects the doctors act on are those on the patient information leaflets that come with the drugs. Any thing not on the list can't be a side effect, must be another cause. Even if half the patients report the same adverse effect. A good example is that of statins, the cholestorol wonder drug. A US survey found that half of all patients had side effects such as confusion, loss of memory, reduced intellectual abilities, excessive sensitivity to touch, muscle pains, joint pains, sexual dysfunction, and a whole host of other effects which diminished the quality of life of those people. Half of those reported the symptoms to their doctors, all of them were told it was their age, some other factor, or imaginary, because these were not listed adverse effects.

• It takes years for non-catastrophic side effects to get accepted by the medical profession, even where the evidence is overwhelming. And to expect patients to understand the risks when qualified medical personnel don't is absurd, especially for depressed people. One of the key symptoms of depression is inability to focus on anything, or to make decisions at all.

• Let's face it, the big pharmaceutical companies have behaved like your stereotypical drug pushers when it came to marketing all of the new re-uptake inhibiting drugs like Seroxat and Prozac.

Antidepressants once seen as miracle drugs: now risks are becoming evident
US courts to hear claims that insufficient attention was paid to dangers to foetus
•    Sarah Boseley
•    guardian.co.uk, Friday 7 August 2009 22.10 BST

http://www.guardian.co.uk/society/2009/aug/07/antidepressants-drugs-health-risk

Since the horror of the Thalidomide scandal in the 1960s, pharmaceutical companies and medicines regulators have been acutely aware of the dangers drugs may pose to the unborn child.

Establishing what the effect of a drug may be on a foetus, however, is no simple task. Companies must rely on animal studies in the early stages of research and hope that the drug will behave in humans in the same way. Trials on pregnant women are rarely carried out, for obvious reasons.

Depression and anxiety became big business for the pharmaceutical industry in the 1990s as doctors became better at diagnosing the problems, exposing a population of over-achieving, highly-stressed, worried-well.

Women, always more willing to see a doctor than men, were a large proportion of those diagnosed and put on SSRIs (selective serotonin reuptake inhibitors) such as Prozac and the British drug Seroxat, known as Paxil in the US. For a while, these seemed to be the new miracle drugs. They were safer than older antidepressants because the severely depressed could not overdose on them.

But in court cases about to begin in the US, it will be argued that insufficient attention was paid to the possible dangers for young women who were pregnant or might become pregnant and more particularly, for their babies.

Twenty years ago, when serotonin, a chemical which sends messages to the brain, was under investigation, it was recognised that it was likely to have an effect on the developing foetus, according to David Healy, professor of psychiatry in Bangor, Wales, and an expert witness in the legal action against GlaxoSmithKline. It was not just a neurotransmitter, but played a role in organ development in the embryo.

Animal tests appear not to have been reassuring, he says. By 1991, a study by Shuey and Lauder had shown that all SSRIs were potentially teratogenic – could cause birth defects – in animals, albeit in small numbers. GSK denies this. "The animal and human studies did not show teratogenicity, and were made available to regulatory agencies as part of the approvals," said a spokesman. But based on Lauder's work, Pfizer which made a rival drug, Zoloft, recommended that women on their drug "should employ an adequate method of contraception".

Datasheets

GSK launched Seroxat in 1992. It was recognised that insufficient work had been done to establish the safety of any of the SSRIs during pregnancy, and as a result, throughout the 1990s, the standard statement on the drug datasheets which go to doctors was that they "should not be used during pregnancy or by nursing mothers unless the potential benefit outweighs the potential risk".

But pregnant women become depressed too. "I think depression is generally underestimated in pregnancy," said Dr Tim Kendall, joint director of the National Collaborating Centre for Mental Health in the UK. "It is much more common than people think. It used to be thought you gave birth and you are suddenly depressed – the withdrawal of all those oestrogens. But in fact people who have postnatal depression are quite commonly depressed before the birth."

GSK began to market Seroxat as the SSRI of choice for women who were depressed and pregnant, or might become pregnant, says Healy. GSK says marketing to women of childbearing age was valid, as women make up a high proportion of those diagnosed with depression and anxiety and most would be of childbearing age.

Seroxat was positioned as the best SSRI in cases where the benefits of treating depression outweighed any risk. It was found in only low concentrations in breast milk, the company said, which meant that breastfeeding would not be a problem. It pointed to studies which showed children born to mothers on Seroxat had no mental or behavioural problems.

GSK also argued that depression itself could harm the baby because an untreated mother is more likely to smoke, drink and take drugs and maybe even to harm herself. Healy says there is no evidence relating to women with depression during pregnancy – only to those who were diagnosed with postnatal depression.

From 2000, GSK in the US was running a targeted promotional campaign to increase sales of Paxil to pregnant women and women of reproductive age. The Mother Knows Best Campaign had three main objectives: to raise awareness of its greater claims for safety than other antidepressants, such as the low Paxil levels in breastmilk, to educate doctors and consumers generally on the benefits of the drug for women of childbearing age and to encourage women with depression to ask specifically for Paxil.

Influential psychiatrists, called in the business "key opinion leaders" were recruited to give talks and author articles on Paxil's safety for mothers to be.

But in February 2005, the Lancet published an analysis of almost 100 cases from the World Health Organisation's adverse drug effects monitoring centre in Sweden of babies who suffered from convulsions and other withdrawal symptoms after birth because their mother had been taking an SSRI for depression during her pregnancy.

The effects were most marked on Seroxat, it said, and recommended that all SSRIs "should be cautiously managed in the treatment of pregnant women with a psychiatric disorder".

Malformations

In 2003, the Food and Drug Administration (FDA) which regulates medicines in the United States had asked GSK to look at the incidence of birth defects on Seroxat, or Paxil. In 2005, the company handed over a retrospective epidemiological study which found an increased risk of major congenital malformations in the babies of women who took it in the first three months of pregnancy.

GSK pointed out that data from other places did not show up a problem. Nonetheless, the FDA changed the pregnancy warning from category C, meaning not enough research has been done to be sure of safety, to category D, meaning there are signs it may not be safe.

"FDA is advising patients that this drug should usually not be taken during pregnancy, but for some women who have already been taking Paxil, the benefits of continuing may be greater than the potential risk to the foetus," it said.

A later advisory notice from the FDA drew attention to a raised risk of a life-threatening lung condition called persistent pulmonary hypertension in babies whose mothers took Paxil later in pregnancy – up sixfold from the usual level of one or two per 1,000 babies born in the US. But at the same time it pointed to a study in the Journal of the American Medical Association showing women who stopped taking antidepressants while pregnant were five times more likely to relapse.

GSK insists that their drug has only ever been promoted for those who need it – in the case of pregnant women, those in whom the dangers of depression are greater than any possible risk from the drug. "GSK appropriately marketed paroxetine for use by the patients for whom it was indicated and who could benefit from it," said the company in a statement.


Women given antidepressant that can cause birth defects
Revealed: GPs still prescribing pill, despite evidence of risk in pregnancy

•    Sarah Boseley, health editor
•    guardian.co.uk, Friday 7 August 2009 22.22 BST


http://www.guardian.co.uk/society/2009/aug/07/women-antidepressant-birth-defects

Seroxat has been marketed to women to relieve depression but GPs have now been given stricter guidelines.

Thousands of women in the UK may be taking antidepressants prescribed by their GPs without knowing that the pills, which are hard to stop taking, could cause birth defects in unborn children.

The problems relate to a class of drug known as SSRIs (selective serotonin reuptake inhibitors), which includes Prozac and, in particular, the British-made Seroxat. Several studies have shown a link to birth defects, particularly malformed hearts, in a small proportion of the babies born to women who were taking the drug in the early weeks of pregnancy.

Most GPs in the UK believe that these drugs are safer than older antidepressants. Seroxat has been marketed to women as a drug to relieve anxiety and depression.

In the US, the Food and Drug Administration, which licences medicines, issued a warning in 2005 and changed the status of Seroxat, which is sold there under the brand name Paxil. The FDA warns doctors "not to prescribe Paxil in women who are in the first three months of pregnancy or are planning pregnancy, unless other treatment options are not appropriate".

The UK regulator, the Medicines and Healthcare products Regulatory Authority (MHRA) wrote to doctors telling them to prescribe Seroxat for pregnant women only when the benefits outweigh the risks. The National Institute for Health and Clinical Excellence (Nice) also urged caution.

But experts including Dr Tim Kendall, joint director of the National Collaborating Centre for Mental Health which wrote the Nice guidelines on depression, say GPs are still giving SSRIs to pregnant women and other women of childbearing age without warning of the potential dangers.

Most psychiatrists he knew would no longer prescribe Seroxat, said Dr Kendall. "But in primary care it is still quite widely prescribed. GPs are quite flooded with advice. It is unlikely they will have picked up a specialist piece of advice from Nice about mental health."

In the US, a series of legal actions is about to begin. Lawyers representing women suing the manufacturer of Seroxat, GlaxoSmithKline, say the British company knew or should have known about the birth defects more than 10 years ago. GSK denies it, saying it told the authorities as soon as it was aware of the issue.

All the SSRIs are implicated. According to David Healy, professor of psychiatry in Bangor, Wales, who has been asked to give evidence in the US cases, the rate of birth defects is doubled from 2% in the general population to 4% of those on the drugs. The rate of major defects rises from 1% to 2%. The general rate of miscarriages is 8%, but 16% of women on Seroxat miscarry.

Concern about depression in pregnancy has grown in recent years. Midwives at antenatal clinics are increasingly encouraged to ask pregnant women about their mood and feelings, to pick up any signs of depression which could cause them to harm themselves or fail to bond with the baby when it is born. Talking therapies should be an option but are often in short supply.

Kendall believes the issue of the SSRIs in pregnancy needs to be addressed. "They are addictive," he said. "The question is should we warn young people before they take them that if they think they might be wanting to get pregnant, these drugs are quite hard to get off?"

"From the late 1980s there was work which very clearly showed that the SSRI group of drugs ought to be regarded as posing a high risk of birth defects to women in the early stages of pregnancy or when they didn't even know they were pregnant," said Healy.

One of the SSRI manufacturers, Pfizer which made Zoloft, indicated in the prescribers' bible, the British National Formulary, that their drug was not recommended for women who might become pregnant. This warning, said Healy, "probably did very little to deter women from taking the drug or doctors from prescribing it, but GSK went further and actually promoted the drug to women of childbearing age".

All SSRIs pose a risk, said Healy. The danger with recent warnings from the FDA and MHRA about Seroxat is that GPs will switch women to another drug of the same class. Emily Jackson, professor of law at the London School of Economics, believes there may be a case for legal action in the UK. Cases could potentially be brought against either the GP or the manufacturer for a failure to warn of potential risks.

"The group of patients who often receive an inadequate warning are women who are not currently pregnant or trying to become so, but who are not warned that there is a danger that they will become addicted to paroxetine [Seroxat] while they are not pregnant, and will find themselves unable to stop taking it once they become pregnant, perhaps many years later," she said.

She raises the possibility of an action under the Congenital Disabilities Act of 1976 on behalf of a child injured by antidepressants prescribed for the mother.

She compares the "no alcohol" message put out by the department of health to pregnant women to the "more equivocal advice" on Seroxat and pregnancy. In both cases, she says, "it seems that women are not to be trusted with making choices for themselves".

GlaxoSmithKline argues there is still insufficient scientific evidence to prove that the drugs directly cause defects. A spokesman said: "Tragically, birth defects can occur whether or not the mother was taking medication during pregnancy. We have monitored reports of foetal exposure to paroxetine since the first studies of the drug and there was no indication of increased risk from studies, adverse event reports or any other source until the summer of 2005.
 
"As soon as we became aware of a potential increased risk, we promptly notified regulatory authorities and physicians.  We strongly believe that doctors should be advised of the potential risk of medicines before prescribing them, and the potential risk of paroxetine use during pregnancy is detailed in the information provided with the medicine."

Comments

1. The tragedy is that the majority of the doctors instead of questioning the results of the clinical trials simply behave as they are part of the medical industry and use their own patients as customers "selling" them a product which is nothing more but a fake.

2. For me this is probably the story that made me decide not to take the rushed out flu vaccine that we're all supposed to take.

3. It is interesting that American psychiatrists now classify shyness as a mental illness although everyone knows that there are millions of people who live and work normally and probably never think about shyness as a problem. And suddenly pharmaceutical companies come up with new drugs telling people that these drugs cure their "illness." If a person feels depressed it is not because of chemical substances in his brain as the pharmaceutical companies like to show but there must be much deeper causes.

 4. Nowadays many scientists believe they are more intelligent than nature. And of course they like to experiment without knowing the consequences. And we all know that even the greatest scientists have suffered from vanity...

Dear Colin
 
I agree with your many points.  The Benzo issue is political.  It needs a political solution.
The injustice is immense, and was summed up perfectly by Phil Woolas's Westminster Speech.  We have no choice but to fight on, for those who cannot.
 
Have you received a reply from Nina L?
 
Best wishes,
Barry Haslam


Dear Colin
Thanks for your email.
I'm sorry that you are so angry and disappointed at the article. I however would like to say this: I never promised to include large chunks about you or the excellent political work you have done around benzos. Nor did I say that i would be writing the piece as you wanted it - I'm sorry but I am a journalist and therefore make my own decisions about what the story should include. Whilst I valued talking to you and reading (some, but you're right not all) of the material you sent me, at no point was I ever going to only include your findings.
I disagree with you on the point about personal stories, and more to the point, the article would never have got in the magazine without them because it is an issue many people would otherwise find difficult to engage with. I also think I made several points throughout the piece which refer readers to the political inaction, or worse, and the role of doctors.
If I have included any inaccuracies about your personal story then I unreservedly apologise. And I am also truly sorry if I have put you off journalists, but I do think you have to understand that my job isn't to represent one side, no matter how strong the evidence or what I personally believe.
Very best wishes

Nina Lakhani
Independent on Sunday
News Desk
020 7005 2498
 

Tranquillisers - what the DoH is avoiding answers to and the meaning of

The drugs are addictive. What does this addiction mean? Drug withdrawal experts including Professor Malcolm Lader have said in the past that withdrawal is far worse than withdrawal from heroin but there are no dedicated government- provided withdrawal centres for those addicted to tranquilliser prescriptions in the UK. There are roughly 400,000 self-addicted heroin addicts in the UK and government action and help is focused on them. Yet there are certainly a million and perhaps two million who are addicted to prescribed benzodiazepines and Z drugs who receive little help and who government certainly does not focus on.

Mike Shooter, the former President of the Royal College of Psychiatrists acknowledged over 200 side-effects related to benzodiazepine use (and Z drugs are similar) – far more than heroin provides. You will not find this reality acknowledged by the Department of Health, by Pharmaceutical companies or in your local doctor’s surgery. Ask yourself the question that the DoH does not – why is this? Some of these side-effects are extremely serious (including death) and for an unfortunate 15% (Professor Heather Ashton’s estimate) could be permanent. In other words coming off the drugs may not save you from the benzo legacy.
 
The addiction happens as has always been the case because prescribers do not appreciate the potential impact on an officially unquantified number of patients and because they have traditionally ignored attempts to get them to prescribe safely. Even those doctors who do now prescribe benzodiazepines safely have little idea of withdrawal protocols for those already addicted and, it seems, little idea of the full range of symptoms long-term prescribing can produce. The main reason why prescribing doctors have little idea of the seriousness of benzodiazepine addiction is because the information available to them is limited due to a system of regulation that does not protect patients, the role of pharmaceutical companies, the ignorance of politicians, the partiality of advisers and an almost complete absence of any research into patient experiences. As an Independent Article on 2 August 2009 (A pill for every ill: Two million Brits have become addicted to prescription drugs) said:

“Curiously, she [Professor Heather Ashton] has repeatedly been denied funding to study these effects [long term health problems cause by benzodiazepines] more rigorously by The Wellcome Foundation, the Medical Research Council and the other main supporters of medical research.”

The victims of the last 50 years of benzodiazepine over-prescribing are yesterday’s men and women – the show has moved on. Today the DoH prefers to call all tranquilliser addicts drug abusers, whether they addicted themselves by ordering drugs from the internet, bought them on the street, or were given the drugs by doctors – without warnings. Internet use is a recent phenomenon but it has given medicine providers an excellent cover for their past profligate activities as it impacted on the forgotten men and women of the 60s through to the 80s when the bulk of the over-prescribing took place. What happened to many of these forgotten people – health destroyed, relationships harmed and economic life blasted, is not an issue today, they were all drug abusers/misusers. Any present day commentator in articles or programmes which appear in the media on benzodiazepines has no understanding of what happened to the historical victims. Their ignorance provides acceptance and misunderstanding of a practice that ruined health for many and made them un-persons thereafter.

To summarise, politicians have avoided engaging with the results of the addiction and they have avoided this for so long that we have now moved into the era of ‘choice’ where people do choose to use benzodiazepines and Z drugs illegally (and other drugs). The world has moved on, and although there have been many deaths in the past 50 years, there are still many alive today who have been addicted for decades or who are no longer addicted but whose lives, choices and opportunities have been taken completely away from them. These people did not use the internet because it did not exist, trusted doctors, received no warnings and have never received help or recognition. We all have dreams when we are young and the future seems full of possibilities but for many of the addicts created by doctors, the end of a positive and meaningful life came early and for a significant percentage there was no rising from the ashes even when the drugs were stopped.

But surely there is some cure for the health problems created by tranquillisers? I can say categorically that no agonist for benzodiazepine damage exists. There are other drugs but they are inadequate sticking plasters for an unrecognised cause and as all defenders of prescription  drug use are fond of telling us – all drugs have side-effects. Why after the experience of benzodiazepines would you want to run the risk of further side-effects from further drugs? The answer to that is most of those affected. Most people are completely unaware of the reality of benzodiazepines – who would tell them unless they feel able to investigate for themselves?

Not all people suffer a serious health impact from the drugs by any means but a sufficiently large number do (though the DoH is uninterested in finding out how many). Withdrawal symptoms whether permanent or not are usually not recognised or called something else – atypical pain or Fibromyalgia are favourite diagnoses. Symptoms can mimic early multiple sclerosis, ME, arthritis or thyroid problems and the cost of false investigations must be enormous.

In The Independent newspaper article, Professor Heather Ashton, emeritus professor of clinical psychopharmacology at the University of Newcastle upon Tyne said this:

“The inaction from government is incomprehensible. I have spoken to so many ministers and committees and each time you think you've made your point, then nothing happens. The right of doctors to prescribe as they see fit always takes preference – but it hasn't worked."

In the same article, Suzanne Atreides of the charity Addiction Dependency Solutions, who tries to help people dependent on painkillers as well as tranquillisers. As she says, "People dread coming in to me... They think I'm going to stop it straight away and can't imagine life without their tablets...There are so many people addicted out there; left on the drugs, as it's easier."

It becomes easier to do that in a culture which has allowed itself to avoid the impact of the addiction and where a few people such as Professor David Nutt, the Home Office chief adviser on drug misuse still maintain that the drugs have no serious downside. The Department of Health says it is reviewing its policy on legal drug addiction but significantly and completely foreseeable it does not intend to analyse the ‘problem’, preferring to maintain the age old message of referring all responsibility to prescribers and local health authorities. Remember it is the state that licences drugs such as benzodiazepines which go on to wreak havoc, it is the state that is in charge of drug regulation, it is the state which employs doctors (even if most are for historical reasons private contractors in the UK) and it is the state which receives the bulk of the evidence from patients and campaigners. Why would the state not want to gauge how bad the ‘problem’ is and why it happened? Why would the state refer the problem to the class of people who addicted patients in the first place? There is nothing ‘minor’ about benzodiazepine tranquillisers - they are as Phil Woolas (now a government minister) said in 2004, “responsible for more pain, damage and unhappiness than anything else in our society.” Even those who believe in medicine as it now is and in its institutions, must wonder why government has refused to control the prescribing of tranquillisers, has not instituted some form of recognition and help for those affected (beyond the lottery of DWP benefits) and still maintains that it has no responsibility for what happens and has happened in the past.
 

Dear Nina,

I have no idea if you have ever realised who I am, but to summarise, as far as I am aware I am the only person in this country who has analysed the history of benzodiazepines and Z drugs and the politics surrounding their use, and then written extensively about it. It is all there in my book and various other writings, backed up by authoratative evidence you presumably would accept if you had read it. But you seem not to have read it (including the pieces I sent you), presumably telling yourself that you did not have the time or perhaps the newspaper would not print it.

The article, whilst good on OTC drugs, made some promising points about benzodiazepines but they were almost completely unfocused and without conclusions. Incidentally, you might have mentioned that many people end up on painkillers because of the physical effects of benzodiazepines but perhaps you were not aware of that. As you know very well, I do not believe in the real effectiveness of personal stories (or government would have been forced into action by now) and I told you that I would only agree to talk to you if you stressed the political points. I said this to you in my email:

"I must stress that the important point in this is the political background and not my personal story...."

What do I find in the article? What I found was a somewhat inaccurate personal story (very shortened) and a cobbled together quote. What of this that I sent you is reflected in the piece?

Head of Department in a Primary school at 25.  ‘Mentioned in despatches’ by Her Majesty’s Inspectorate of Schools (which I was told was a rare thing). Overworked and went to doctor. Addicted after a few months. Ran out of pills one day which had dire mental effects. I was coming out of it after a couple of days but a new doctor I had seen at the surgery ‘kindly’ brought another bottle of Valium from the pharmacist when he came to see me at home and so the addiction continued. He obviously had no idea that what he had seen was withdrawal.

Things went from bad to worse and eventually I resigned. I was given antidepressants and applied to return to teaching after a few weeks. This was successful but I had lost my previous role and was sent to a new school as an ordinary teacher. I managed to carry on until 38 when I resigned on grounds of ill health and have not been able to work since.

During the whole of this time (25-38) I was given 17 mind altering drugs and a variety of other drugs for physical symptoms caused by tranquillisers. For roughly ten years afterwards I virtually existed in a bedroom and never went out.

I found out what the problem with my life and health was quite by accident. Somewhere around age 52 we changed our car insurance policy and I was asked the question of whether I was taking any medication. I gave chapter and verse and my driving licence was taken away by a drug misuse committee which appalled me. I went to the doctor’s and said I wanted to get my licence back. The only role the doctor had in this was to provide prescriptions for reducing amounts of Valium (diazepam) and Zopiclone. At the same time I stopped taking antidepressants. Getting off took about two years. Shortly afterwards withdrawal symptoms began to appear, most of which the medical profession as a whole does not recognise because Pharma hasn’t owned to them and they have never been researched. Many of these symptoms have remained with me including exhaustion, permanent insomnia, joint and muscle pain making walking difficult and a variety of sensory problems. The symptoms I now have are quite different to the ones I had when taking prescriptions but they remain unrecognised in spite of an absence of research that demonstrates no link. These symptoms are commonly reported by patients as are the common symptoms experienced when taking tranquilliser/hypnotics but make no waves in medicine.

I did not find any reference to what I have done since coming off the drugs nor to the fact that I have had no normal life since the age of 25 (and neither has my wife). There was no mention of benzo.org.uk where my writing is found alongside the biggest benzodiazepine library on the internet.

I have campaigned against a background of ill health and lack of money for seven long years and I have demonstrated beyond any doubt the cover-up that government, pharmaceutical companies and medicine has organised. Benzodiazepines are not ' a new drug problem' - this scandal has been taking place for 50 years. Use of the internet to buy drugs and OTC addiction may be a relatively new problem but iatrogenic addiction is not.

To give just one example of where you failed the victims of benzodiazepines by not making the political point, you referred to the CMO's 2004 reminder to doctors. You did not mention that Ray Nimmo, Heather Ashton (whom you quote elsewhere) and others, regard this reminder as disastrous for patients. Heather Ashton, who knows far more about benzodiazepines than the CMO offered to help with the wording of the reminder but was ignored. The reaction of many doctors was to abruptly stop patient's prescriptions leaving them to either source the drugs elsewhere if they could (including the internet) or failing that to be precipitated into abrupt and dangerous withdrawal. Note The reminder was only sent because of campaigner representation at the Department of Health.

Associating benzodiazepine prescribing with OTC medicines was never a good idea as I told Brian Iddon - the two problems are completely separate - one is a scandal and the other somewhat less than that involving personal responsibility. I imagined that having told you of that and my desire that you should examine the politics and failures behind the 50 years of benzodiazepines, that I was steering the article in the right direction. But I was wrong. What you have done in the end is ensure that I will never speak to a journalist again. This of course matters little in a country which seems not to want to face up to reality. Government Minister Phil Woolas once said:

"The scale of the [benzodiazepine] problem is so large...that it is beyond the grasp of many politicians and people in power to solve it...you have this huge problem with a huge number of people involved and yet we seem as a society to be incapable of acting on it. We can only cope with problems that are so big...we can't cope with this one."

It seems he was perfectly right.

All the Best

Colin Downes-Grainger

A pill for every ill: Two million Brits have become addicted to prescription drugs
http://www.independent.co.uk/life-style/health-and-families/features/a-pill-for-every-ill-two-million-brits-have-become-addicted-to-prescription-drugs-1764497.html

Britain has a new drug problem: two million of us are addicted to tranquillisers, while countless thousands abuse over-the-counter painkillers. How has this unchecked culture of legal drug addiction been allowed to flourish, asks Nina Lakhani?

Sunday, 2 August 2009

What do Michael Jackson, Heath Ledger, Marilyn Monroe and Elvis Presley have in common? They were all taking tranquillisers – prescription drugs for insomnia, depression, anxiety – at the time of their deaths. The results of toxicology tests undertaken after Jackson's death in June are expected to reveal the presence of drugs to alleviate pain, depression and anxiety, and will inevitably reignite the debate about the benefits and human costs of drugs that are prescribed by doctors or bought over the counter in vast quantities the world over.

All drugs can cause side effects, but two types of legal drug are habit-forming: benzodiazepines (tranquillisers) and opiate-based painkillers (such as morphine and codeine); both can have serious, even fatal, consequences for users. Yet addiction to legal drugs is a controversial and complicated issue. It typically involves an accidental or involuntary dependence to medication first taken, and given, in good faith for a genuine ailment or condition. Jackson, for instance, is believed to have become addicted to Demerol (known as Pethidine in Britain) after suffering from a serious burn during the filming of a Pepsi commercial in 1984.

But critics, including many former addicts, argue that these drugs are too readily available, and are taken for too long, with little regard for, or understanding of, the long-term physical and psychological consequences. The addictive qualities of the drugs in question are all too apparent: tranquillisers, as the name suggests, relax and calm the subject; by contrast, opiate-based painkillers induce a state of euphoria (though they can have a sedative effect in high dosages). Worse, the chemistry of both types of medication means taking them every day for just a few weeks can lead to dependence and, if stopped abruptly, nasty physical and psychological withdrawal symptoms – occasionally, fatal seizures. The rising numbers of people thought to be addicted to legal drugs in the UK is shocking: there are in this country around 400,000 heroin addicts, yet there are believed to be up to seven times as many in thrall to tranquillisers and opiates.

Benzodiazepines ("benzos") were touted as the world's first wonder drugs. Introduced in the 1960s to treat anxiety and insomnia, within a decade they became the UK's most commonly used medication, with more than 30 million prescriptions annually at their peak. Last year, more than 22 million prescriptions for these drugs, including diazepam (Valium), lorazepam and temazepam and the newer "Z" tranquillisers, such as zopiclone, were dispensed by chemists in Britain (this does not include drugs used in hospital). The figures confirm what support groups and helplines have long said: millions in Britain are still in the grip of "Mother's little helpers", which continue to be inappropriately prescribed to men and women, young and old, for everyday and normal pressures such as wedding-day nerves, bereavement, domestic violence and financial woes – and lead many to addiction.

The Government can claim some success in its war on illegal drugs: its strategy between 1998 and 2008 was primarily focused on heroin users, and it succeeded in getting record numbers of the country's estimated 400,000 addicts into contact with drug-treatment services and on to the legal substitute, methadone. In stark contrast, the policy of successive governments for prescription drugs has been simply to warn doctors about the potential of dependence on benzodiazepines to try to prevent addiction occurring. This has led to informed estimates that between 1.5 and two million people are addicted to tranquillisers in the UK; we have little idea of how many are addicted to prescription and over-the-counter (OTC) painkillers, but it is thought, conservatively, to be tens of thousands. And many of these "legal addicts" are fighting their drug battles alone. They are generally not welcome in government-funded drug services, nor do many want to seek help in centres frequented by street-drug users, as they do not perceive themselves as addicts and have quite different needs. Nor do most GPs understand enough about the drugs, their long-term effects or how to wean people off them. So, apart from a handful of services set up by pioneering individuals, charities and NHS organisations, the majority of these addicts have nowhere to turn.

The problem with these drugs (though they are very useful medications when used correctly) is not only their addictive nature, but also the manner in which, for decades, they have been prescribed. In 1988, the Committee on Safety of Medicines told doctors that tranquillising drugs should be prescribed only for severe anxiety or insomnia, and for a maximum of two to four weeks. A reminder of these guidelines was issued by the Government's chief medical officer, Sir Liam Donaldson, in 2004, but apart from that, there has been scant interest from a succession of governments. The figures suggest this "hands-off" strategy has failed. The Department of Health has finally agreed to review its policy, but has rejected calls to study the problem in greater depth, deflecting responsibility back on individual doctors and "abusers" – a label that angers many of those who lost years to these widely prescribed drugs, which are mistakenly viewed as benign.

Colin Downes-Grainger, 62, a former primary-school teacher, was given 17 different tranquillisers, sleeping tablets and anti-depressants from the age of 25 for work-induced stress. "To be labelled as a drug abuser feels dark, surreal and wrong," he says. "All I did was go to my GP with a problem and follow his advice. I spent the next 10 years in my bedroom, missed my children growing up in large parts, and had my life taken away needlessly. I can live with the fact that when these drugs were first introduced, no one really knew about all of the problems. But the fact that, decades later, people are still being made into addicts is indefensible."

Heather Ashton, emeritus professor of clinical psychopharmacology at the University of Newcastle upon Tyne, set up the first NHS withdrawal clinic in 1984; it was oversubscribed for 12 years, but none of her colleagues wanted to take over from her when she retired in 1996. "It just wasn't fashionable in the medical world – not enough people believed it was a problem, and although many have now come round, it still isn't widely understood. The inaction from government is incomprehensible. I have spoken to so many ministers and committees and each time you think you've made your point, then nothing happens. The right of doctors to prescribe as they see fit always takes preference – but it hasn't worked."
 
Ten years after coming off all the medication, Downes-Grainger still suffers from various sensory problems, joint and muscle pain, permanent insomnia and exhaustion. According to Professor Ashton, around 15 per cent of long-term benzo-diazepine users will have long-term, possibly permanent, physical problems (which can mimic symptoms of early multiple sclerosis) even after they stop. Curiously, she has repeatedly been denied funding to study these effects more rigorously by The Wellcome Foundation, the Medical Research Council and the other main supporters of medical research.

Since reporting of such incidents began, there have been 12,247 adverse reactions related to benzodiazepines (including 198 deaths) and opiate painkillers (403 deaths) reported to the Medicines and Healthcare products Regulatory Agency (MHRA). But reporting is itself problematic: research shows that only five to 10 per cent of adverse drug reactions are ever reported by health professionals, which means thousands of people may have suffered harm or died as a result of medications meant to help them – far more, it may be surmised, than have ever died from taking illegal drugs such as heroin or ecstasy. Yet the current head of the Government's Advisory Council on the Misuse of Drugs, Professor David Nutt, is on the record denying that there are any risks associated with long-term use of benzodiazepines.

The over-use of opiates as painkillers is equally alarming. Despite being the most common reason why any of us ' visits the doctor, pain is poorly understood and frequently treated with pills rather than investigated. Sir Liam has called for urgent action to address a gaping hole in medical training, which currently fails to teach students anything about chronic pain, saying: "Although we now have effective means of tackling both pain and the consequences of pain, services have not kept up with demand and too many people struggle to cope with their symptoms."
 
There were 15.96 million community prescriptions for opiates such as morphine and dihydrocodeine in England and Wales in 2008 – a rise of 55 per cent in five years. In the same year, 290 million packets of OTC painkillers such as paracetemaol, aspirin and Nurofen Plus were sold in Britain's chemists and supermarkets. Of these, 27.5 million packs were products containing codeine – similar to, but much milder than, morphine. As with all opiates, the most serious potential side effect is death due to respiratory depression – something linked to, but not yet confirmed in Michael Jackson's death. Withdrawal symptoms are similar to those experienced by a heroin user: stomach cramps, diarrhoea, vomiting, the sweats and hallucinations.

Brian Iddon, a chemist and Labour MP, chaired the All-Party Parliamentary Group on Drug Misuse for ten years. Under his watch (he stepped down in June), the group conducted an inquiry into OTC and prescription-medication addictions in 2008 and found too many doctors were still not following prescribing guidelines, and handing out repeat prescriptions for habit-forming drugs. The committee also criticised the MHRA for failing to reduce the pack size of OTC codeine painkillers from 32 to 18, and urged it, and the drugs firms, to do more to monitor the risks posed by these drugs.

Martin Johnson, a Barnsley GP and chairman of the Royal College of GPs' pain-management committee, first became interested in pain as a medical student after his grandfather's very sore sciatic shingles was badly treated. A quarter of all the patients in his surgery are on painkillers but he, like other GPs, has no idea how many are taking OTC medications as well, as there is no joined-up system for counting or monitoring patients who take habit-forming painkillers. "The problem is that pain has never been accepted as a true area of medicine and most doctors are still not that interested. So, for too many doctors, a prescription is a quick fix and quick consultation," says Dr Johnson. "This means that you, I, or anyone who has an acute problem can end up with a long-term untreated condition. For example, there are 650,000 whiplash injuries a year in UK and a high proportion are given a prescription and told to go away and rest, which is totally inappropriate advice and will lead to unnecessarily pain and more painkillers. Even fewer doctors can recognise a dependency or would know how to help someone withdraw safely. Medically speaking, addiction and pain are in different worlds."

Dr Beverly Collett, a consultant in pain management in Leicester, set up a monthly clinic for patients addicted to painkillers 10 years ago. She sees patients jointly with a psychiatrist – one of only a handful of such services in the UK. Together, they try to deal with the physical and psychological aspects of pain, drug dependence, withdrawal and the mental-health problems many of their patients have. "The people we see have different chronic-pain problems and have often been put on multiple medications and mixtures of drugs," she says. "The relationship with their GP has often broken down. These aren't people who set about trying to get high; these are people who are desperate to get their pain under control and the addiction creeps up on them. Back pain is common among these patients and we have one man who smashed his ankle during a suicide attempt. But at the heart of all these problems is that doctors do not understand how to treat chronic pain."

A recent survey of callers to the telephone helpline Over-Count (set up to help those addicted to OTC drugs) found the most common age range of those addicted is 18 to 36; two-thirds are women; users generally stick to one product, and 100 per cent say they have no inclination to progress to harder or illegal drugs. The vast majority ended up accidentally hooked, because the cause of their headache or backache had never been treated. Allowing people easier access to medication is something the Government is keen to promote in order to reduce the NHS medication bill – which hit £10bn in 2007 – and relieve some of the burden on GPs. But this could lead to more addiction – and expense.
 
Barry Haslam, 65, a former accountant from Oldham, persuaded his local NHS Trust to pay for a specialist withdrawal clinic – one of only a handful in the country – after he lost 10 years of his life to a cocktail of antidepressants and benzodiazepines. He was the first person to be awarded Disability Living Allowance because of the long-term damage caused by the medication. The Benzo Project, run by Suzanne Atreides for the charity Addiction Dependency Solutions, has started to see people dependent on painkillers as well. "People dread coming in to me," says Atreides. "They think I'm going to stop it straight away and can't imagine life without their tablets. But I work as slowly as they need me to, at their own pace – 92 weeks in one case. Many people feel embarrassed and keep it secret from their families for years, but the fear of getting caught just adds to their stress. There are so many people addicted out there; left on the drugs, as it's easier."

There is no doubt that drugs which alleviate pain, crippling anxiety and insomnia help millions of people across the world every year, but are they given out too easily when other options could be considered? The most effective pain clinics advocate the use of psychology and psychiatry alongside pharmacology, but patients can wait years for an appointment.

Michael Jackson's blood results are expected any day now. But for the millions of people living the nightmare of legal drug addiction – ashamed, unacknowledged and with nowhere to turn for help – pointing the finger of blame at Jackson's doctor or scrutinising the troubled star's addictive personality will change nothing. Instead, the millions who are believed to be caught up in legal addiction, the pharmaceutical industry, the medical profession, the Government, and all of us who are happy to take a pill for every ill, have a duty to acknowledge the truth – and do something about it.
 
Mark Lawton: addicted to morphine

"It was an ordinary Sunday night in 2002: we were getting the kids ready for school the next day – the eldest was in the bath – when the door bell rang. My partner Julie answered it and then, bang, everything changed. A man ran into the house and shot me twice in my right leg, in a case of mistaken identity.

The next thing I knew, I had woken up in hospital with doctors telling me they'd have to cut my leg off."
Mark Lawton, now 40, refused to accept this fate and, against medical advice, signed himself out. He spent the next few months at home in agony, taking just paracetamol while searching for a surgeon who would try to save his leg.

Finally, in August 2002, he was admitted to the nearby Hope Hospital, for the first of 15 operations.
His shin was removed and his foot was attached just below his knee with 19 pins. He was told in hospital to take as much morphine as he needed to stay on top of the pain, so he did.

"I was in agonising pain and I started eating the Sevredol tablets like toffees; I would clock-watch until it was time for the next one. I went home after 23 days with a spanner, so I could break the bone everyday to let the shin re-grow, and as many tablets as I needed. Looking back now I was already hooked – I was a junkie."

Around a year later, still in a wheelchair, still on regular morphine from his GP, he missed a dose.

"I was lying on the bed, curled up in a ball, sweating and shaking. The doctor came around, gave me an injection and I felt better. That was the first time I realised what I'd become: I was as bad as a heroin addict who needed his fix."

But over the next few years, try as he did to cut down, he couldn't do without the tablets completely. His weight dropped, his appetite got smaller, and he rarely left the house, having lost his job as a butcher.

"You know how a man should be able to eat a proper plate of meat pie and chips; well, I couldn't do it any more. All I could think about was making sure I didn't run out of medication. It was the first thing I thought about when I woke up and the last thing before I went to bed. It's wrecked my life; I hate it."

After begging his GP for help again, he was recently referred to see Suzanne Atreides, a counsellor with the charity Addiction Dependency Solutions, who runs a unique project in Oldham, where he lives. Lawton is now down to 15mg of morphine a day (from 40mg), his appetite is improving and for the first time in years, he has some hope.

"The doctors never once told me I could get hooked," he says. "It was always like, 'Take as many as you need, the nerve damage is really painful, so don't try to do without them.'

"I would just pick up the prescriptions, no questions asked, no advice. Now I've found someone to help me, I'm determined to get off them by Christmas. I have to get my life back."
 
Jane Hadi: addicted to Valium

Jane Hadi, 52, from Bristol, can't remember a life without pills. "I was going through a personal crisis, I was ill and stressed, so my mum took me to the doctor. He gave me Ativan [a form of lorazepam]; I was 12."

In 1969, Hadi wanted to be a lawyer. She loved school, liked playing outside with her friends and she remembers herself now as a happy child. The day she started taking lorazepam, all that changed."I can't really remember how I felt before. I was emotional and used to cry sometimes, and the tablet made me feel nice. My mum never questioned it – why would she? But if she knew then what we know now, she would never have let me take them."
 
Life went on. Hadi met her husband, Basem, a car mechanic, when she was 18. They got married and had four children. It was when she was pregnant with her eldest child, in 1977, that she first stopped taking the medication. "I remember feeling really emotional, having mood swings; I was a nightmare to live with. I thought it was the pregnancy but looking back now it was withdrawal symptoms." She stopped during each pregnancy, but after each birth, the doctor put her straight back on Valium.

"I would take them every time something went wrong with the kids; maybe one of them fell over, and I would take one to cope. This is how I'd been brought up: 'Take a pill if you're not coping.'"

Ten years ago, Hadi was admitted to a psychiatric hospital where she was diagnosed with bipolar affective disorder (manic depression), taken off the Valium

and instead prescribed a major tranquilliser. The next four years at home were hell. "I couldn't cope with the kids, the housework, with cooking; I couldn't do anything. My legs hurt, my back ached, I felt terrible. So I started to drink, heavily, from 10am to 11pm, just so I could cope with life." In 2005, as her son's wedding day approached, Hadi looked into the mirror and hated the overweight, puffy face in front of her. "I'd seen a programme on TV about people buying Valium online. I couldn't go to my GP – she's been so happy that I'd come off them and I didn't want to disappoint her – so I started buying them on the internet.

"It was easy, it only cost me £80 for 100 tablets and soon I was taking 30mg a day, more than ever before."

Three months ago, Hadi went back to her GP for help after she realised she couldn't pay the £2,000 credit-card bill for the pills. She now gets help from Battle Against Tranquillisers (www.bataid.org) and is reducing her dose by 1mg every three weeks. "I don't want to ever stop completely, I couldn't cope, but I'd like to get down to 10mg a day. It's like a love-hate relationship: I can't live without them but they rule my life. I do feel angry because I should never have been put on them, but it's all I know."

David Grieve: addicted to cough syrup

It was 1975; David Grieve (now 59 and living in Dumfriesshire) was working as a psychiatric nurse in Portsmouth, when he developed a bad cough, so he went to the chemist, and got some cough linctus. It contained codeine (a mild, but addictive opiate like morphine) and ephedrine (a stimulant and decongestant, also addictive). He took it for four days, then stopped. But his cough came back, so bought another bottle.

"I was taking it as directed on the bottle and I felt great; full of energy and alert. After the second bottle, my cough was gone, so I stopped. But a few weeks later I was having a bad weekend, so I bought a bottle to make the downer go away. Over the next year I did it a few times, but soon two teaspoons weren't enough, so I kept upping the dose, to get the same effect."

Over the next few years, Grieves moved to Merseyside, trained as a policeman and progressed on to a bottle a day, still trying to kid himself that he could stop at any time. By the time he moved his family to Scotland, he was close to taking 90 bottles – nine litres – every week.

"I would go 'trawling' three times a week: Monday I'd travel north to Edinburgh or Glasgow, Wednesday as far south as Stafford, and Friday I'd go east to Newcastle. Each time I'd buy 30 bottles from different pharmacies. My wife had found out by this point, but I loved the cough mixture more than my family." By 1990, it had become a huge burden. Grieve had given up work so he could trawl, and spent £20,000 in the last two years of his addiction. His doctors were at a loss as to how to treat such a serious addiction. It wasn't until 1992, 17 years after he had begun, when he became critically ill, having damaged his liver, kidneys and gall bladder, that he pleaded with his doctor and a chemist to help him withdraw. "If I had carried on, I'd have been dead in a year, so over the next nine-and-a-half months, I cut down from 10 bottles a day to none. It was 10.25am on 13 September 1992 that I drank my last 50ml; I haven't touched a drop since."

The following year he started up the Over-Count helpline to help those addicted to OTC drugs, after a magazine article about his life attracted interest. In the first year, the line took 1,000 calls; it has taken nearly 20,000 since. The addictions have moved on – very few people are dependent on OTC cough mixtures now that the ingredients have been changed. Instead, most people use codeine-based tablets such as Nurofen Plus, which the majority – 92.9 per cent – started taking for minor, but painful, physical ailments. "The Government's move towards more self-health means this is a 21st-century problem which is not going away. More and more people come to us each year and all are struggling to get help, yet stopping these medications abruptly can be fatal. "Joe Public has to take more responsibility, but he can only do that if the information is available in a form he understands. Most people still don't think something which is so easy to buy can be addictive, and many don't read the information leaflet after the first time; it's too small, too technical and people find it boring."

To contact Over-Count, call 01387 770 404 or visit myweb. tiscali.co.uk/overcount/index.htm. For Addiction Dependency Solutions, call 0161 834 9777 or visit www.adsolutions.org.uk