In light of this week’s International Day Against Drug Abuse and Illicit Trafficking on 26 June, Mopani Pharmacy paid a visit to SANCA – a drug and alcohol dependence centre in Nelspruit. The general manager, Marina Erasmus, and Sr Debbie Capazorio shared their expertise on the ins and outs of the problem, ever prevalent, in the area.
Drug of choice
According to the latest statistics, the addictions are ranked as follows:
- Alcohol / Nyope (heroin mixed with marijuana, antidepressants and other ingredients)
- Benzodiazepine-based drugs (tranquilisers / sleeping tablets /calming tablets)
- OTC pain killers – codeine based, known as the “yellow tablets”
Other commonly used items: Grandpa’s (some snort it for the caffeine boost or use it as a mixer) / paracetamol / ibuprofen / cough syrups mixed with cold drinks.
- It is important to note that evidence-based findings admit that most who are addicted to hard drugs are likely also using alcohol, marijuana and pills, to take the edge off, when they can’t get their drug of choice.
- However, there are people that will only drink alcohol, only use marijuana, or only use pills.
As we are a pharmacy, this article will focus on pharmaceutical abuse.
Who’s at risk for substance addiction?
“Addiction knows no age, gender, race or class. It does not discriminate on how educated you are or your chosen religion. Absolutely anyone, is at risk”, says Marina.
In pill-popping, it appears that women are pulling rank. “Many women don’t drink at all. But they use pills all the time. More than 85% of pill addicts are women.”
Unfortunately, the habits can start young. Tween and teen girls who go through menstruation are often handed pain tablets to help them deal with the cramps.
It can also start with something as simple as an injury. People tend to take more than they need to or more often than they should, so they can remain mobile. They end up re-injuring themselves because they are over-doing it, and therefore keep using the pain tablets, which then becomes a cycle.
The appeal of codeine- and benzo-based drugs, are that they also numb emotional pain. People who experience anxiety or emotional pain may use these drugs as a crutch to get through a tough day. Once done, it’s easy to keep using these drugs, because it is much easier than dealing with the issues at hand or to learn healthy coping mechanisms.
The catch 22
Drug addicts often buy from multiple pharmacies, as all pharmacies are not linked. This creates a perfect loophole in which addicts can fudge the system.
They can walk into a Mopani Pharmacy, and buy pain medication. They then go to another pharmacy from another chain, and buy the same medication there as well. The process is repeated at every possible pharmacy chain in town. The same process is repeated at local independent pharmacies, or they buy under someone else’s name, like a spouse or a parent or a child, claiming it is for them.
Schedule 0 medication is available off the shelf, making it easy to take a few bottles and pills.
“Luckily we can confirm that Mopani Pharmacy is excellent at picking up on these things and have discreetly checked in with us whenever they have suspected addiction,” says Marina.
How addiction works
Sr Debbie explained that the brain has many receptors. When we take in a substance, it binds to those receptors, and gives it a nice high. If we misuse substances when there is no pain or we use too much, the receptors multiply. There is no way to measure how many or to what level the receptors have multiplied, which makes it difficult to manage. This effectively creates an actual disease within the mind. The receptors will want to get that high again. The body then fabricates pain, so you will want to take more medicine or drugs or alcohol, to numb that pain.
People who are detoxing and getting clean, can become violently ill. Those on codeine, benzo-based pills, or harder drugs may need medical intervention because their bodies can go into shock. Or they will use again to feel better and end up overdosing.
Overdosing happens when your dosage is too high for the number of receptors in the brain. Unfortunately, drug dealers are not always honest.
“Your drug dealer might have told you that he has sold you one or two grams in a packet, meanwhile, it was only half that amount. After a while you build up a tolerance to that. So, you think you need two and a half grams, even though you are only used to half a gram. Now you get to a new dealer and he gives you two and a half grams. You take it all and you risk a fatal overdose because you are taking twice the amount your body can handle”, says Sr Debbie.
In other cases, it is just a matter of wearing your body down over time and one day, it will just be too much.
How big is the problem?
“We are not a live-in facility, we have about 600 clients annually. There are around 50 new clients every month, and around the same number that stop coming or finish their programmes”, says Marina.
According to Marina, some cases are not as serious, and can be dealt with in a period of a few weeks.
However, there are some cases where an addict is in utter denial, or has a serious problem. “I’ve had a client come here, and tell me he could kick his habit at any time. That it is ‘not that bad’. He did not even realise that he had his addiction for longer than he was sober”. These types of cases can take around 6 months to a year before the person manages to develop a healthy drug-free life style.
“Sometimes there are fall backs. We build relationships with our clients and they are honest with us, and then we just keep going. We don’t always have success, but every success is worth it,” says Marina.
Complications of addiction
Sr Debbie explained, that in the cases where codeine is used, an addict may take between 20 and 40 pills a day. This may cause constipation and prolapse of the intestinal organs, often resulting in portions of the intestines being removed.
“Kidney failure is prevalent, and unfortunately, the tolerance build-up is so severe that they are constantly experiencing pain, for which a paracetamol or ibuprofen tablet does nothing.”
Benzo-based medicine can have a huge effect on your mental health. Building up a tolerance to this, results in using a drug meant to help you sleep, just to numb your mind. Some experience vivid hallucinations – your mind is “asleep” while you are awake. They experience life as a dream, and have no recollection of what happened, after the effects have worn off.
This can be detrimental to people who experience mood or mental disorders. “A person can have an underlying condition that is manageable and mild. However, continued substance abuse just sends them over the edge.”
How does SANCA help?
SANCA runs on two important components – Counselling / social work, and the medical.
Clients can come in once or twice a week. If the substance abuse is severe enough, Substance Replacement Therapy may be done. This means that methadone is prescribed and administered in small doses to keep withdrawal to a minimum, and then tapered off until a person can stop altogether.
This type of treatment is only feasible to those who have a support structure at home, who will monitor the addict and give them the right dose.
It is no better than drugs, but it is considered safer as it is available in liquid form, and can be administered, orally.
Unfortunately, there is no way of knowing whether or not the number of receptors aching for the substance of choice will ever subside, that is why sobriety is considered a lifestyle choice and not just a programme for a few weeks.
How to get help
Call 013 725 4376 for an appointment at SANCA Lowveld. They can be found at 8 Hope Street, Nelspruit, and often have clients coming in from all over Mpumalanga.
If you are worried about the dosage of your medications, refer to our knowledgeable pharmacists. More often than not, medications prescribed are available in lower doses. If you are using medication to treat pain, do not use it for more than 10 days, or longer than prescribed.
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