Issue link: https://maltatoday.uberflip.com/i/602004
maltatoday, SUNDAY, 15 NOVEMBER 2015 13 advises. "Illicit drugs will always be more dangerous to human health, and they are illicit precisely because they are addictive and offer very few benefits to human health," Zahra said. "However," he added, "Some medications may have abuse potential, in particular those kinds of medications which have an effect on our emotional state, or which relieve par- ticularly unpleasant states, such as persistent pain." Zahra explained that in and of themselves, prescribed medications are not intentionally addictive but that some of them may cause an effect in the person that would be desir- able (such as the resolution of pain), or in some cases, inadequate control of the symp- toms might bring about a higher use of the medication, or difficulties when attempting to reduce the dose of medication. "Addiction to these medications happens when there is no further therapeutic indica- tion for taking the medication, yet the per- son experiences the compelling need to continue, to the point that it may interfere with usual everyday functioning," Zahra explains. Some of the most commonly misused prescription meds fall into three main cat- egories: Opioid painkillers such as mor- phine and methadone among others, Cen- tral Nervous system depressants (locally referred to as kalmanti or tranquillisers) such as benzodiazepines, as well as stimu- lants which have both legal forms such as caffeine and nicotine, and illegal forms like methamphetamines and cocaine. Zahra sais that some opioid pain relief medicines might sometimes function be- yond their role as pain relievers, and cause a state of emotional well being. "This positive emotional state is medica- tion induced, and thus may lead a person to have more and more of the medication to artificially induce this chemical high once again." The American Society of Addiction Medicine says a shocking 46 Americans die everyday day from prescription opi- oid overdoses. Clinical director of Agen- zija Sedqa, George Grech confirmed that painkillers can be very addictive if taken for long periods of time, or when they are taken for the wrong reasons. Grech said that the misuse of painkillers has become a major problem in terms of morbidity and mortality. "The problem is compounded further by the fact that people who misuse these pain killers usually abuse alcohol and other psy- chotropic medication besides." Indeed sedatives and tranquillisers, or CNS depressants, are the main types of drugs abused in Malta. Anthony Zahra explained that tranquil- lisers are often used as anxiety medication, known scientifically as benzodiazepines such as diazepam (Valium) and alprazolam (Xanax) and lorazepam (Ativan) among oth- ers. Although 2014 data reveals that a mere 0.26% of the population had sought assist- ance from public entities for benzodiazepine addictions, the true extent of the addiction might not be visible from these figures given that they do not include private facilities. Asked about the potential hazards of ben- zodiazepine misuse Zahra explained that any medication that is taken unnecessarily can have poten- tial consequenc- es, and that this particular class was no excep- tion. "In the short term, a person will experience sedation, lack of concern for everyday activi- ties and respon- sibilities, slowed reflexes and mental activities, with possible un- predictable emo- tional states," Za- hra said. "In the longer term, there appears to be a link to cognitive impairment, such as mem- ory problems and difficulties in other areas of mental functioning," he said, adding that over the past years, researchers found an as- sociation between benzodiazepine use and the risk of developing dementia five or six years down the line. "Taking the medication for more than six months was associated with an 84% in- creased risk of having an Alzheimer's type dementia," he said, adding however that the findings showed an association, but not a definite causation. He explained that the early signs of dementia may include problems with sleep and anxie- ty, and thus the benzodiazepines possibly would have been used to address these symptoms. Zahra added that further re- search into the matter is war- ranted but that long term pre- scription in older persons was not considered best practice anyway, in view of other com- plications, such as the risk of falls, fractures and clouded thinking. He said that these medications are meant to be closely monitored, with regular pre- scriptions being recorded on a sheet the patient has to present to the pharmacist to help them monitor patterns of possible es- calating dose or frequency of use. "They are typically prescribed in situa- tions where the person is suffering from an acute stress or anxiety reaction, and current guidelines recommend use for a few weeks," he said, adding that the medications are not inherently harmful. "However, in my work with adults and older persons, I often come across instances where a person would have been having the medication for several years." Substance abuse psychologist and 'Dwar- na' presenter Mariella Dimech added that very often patients stand to benefit from these medications, but only if they are taken in line with therapy. "Medication would be much more effec- tive if people use the time they are feeling better to learn how to think on a more posi- tive level and perceive things differently in order to change the way they feel," she said, stressing the need for psychiatrists and doc- tors to refer people to therapy more readily. Dimech added that medication was ab- solutely necessary for people who suffered from conditions known as 'psychoses', that is where people are not aware that they are hallucinating, but that people who suffer from conditions classified as 'neuroses', like anxiety, depression, obsessive compulsive disorders or even post traumatic stress dis- orders, would not necessarily require medi- cations depending on the severity of their condition. "A number of patients become addicted or dependent on medication and it may be very traumatic to stop or change medication," she added. "This process really needs to be monitored carefully as the patient may relapse into the same problems prior to receiving the neces- sary treatment." Asked why the medications could lead to dependence, Zahra said that this could stem from a combination of factors, including the direct effect of the medication, which re- solves anxiety symptoms. "An anxious person experiences multiple unpleasant symptoms, ranging from dry mouth to palpitations to shallow breathing, to a sense of impending doom and panic, so the rapid and effective reduction of these symptoms is naturally very tempting." He added however, that the medications tend to be effective at symptom control but not so effective at preventing further episodes from recurring. Asked whether some people were more susceptible to prescription pill addictions than others, Zahra said that well-recognised risk factors include a family history of addic- tion, male gender, and the easy availability of addictive substances among others. "However," he added "the development of an addiction is ultimately a very personal story, with genetic, developmental, social and psychological factors weaving to form different coping strategies." Psychotherapist and 'Dwarna' presenter Mariella Dimech Psychiatrist Anthony Zahra prescription meds fall into three main cat- egories: Opioid painkillers such as mor- phine and methadone among others, Cen- tral Nervous system depressants (locally referred to as kalmanti or tranquillisers) such as benzodiazepines, as well as stimu- lants which have both legal forms such as caffeine and nicotine, and illegal forms like methamphetamines and cocaine. medicines might sometimes function be- yond their role as pain relievers, and cause a state of emotional well being. tion induced, and thus may lead a person to have more and more of the medication to artificially induce this chemical high once again." Medicine says a shocking 46 Americans die everyday day from prescription opi- oid overdoses. Clinical director of Agen- zija Sedqa, George Grech confirmed that painkillers can be very addictive if taken for long periods of time, or when they are taken for the wrong reasons. has become a major problem in terms of Atavin Non-Fatal Overdoses Prescription Drugs Illicit Drugs by year Male Female Total Male Female Total 2011 54 73 127 33 9 42 2012 46 58 104 26 4 30 2013 34 48 82 18 2 20 2014 44 30 74 15 6 21