10 Mar 2014

Not part of the script: Prescription drug abuse in NZ

10:22 am on 10 March 2014

Aaron stares at the sea as he talks. “There are two types of waves, man.” It’s summer, and we’re sitting in a car at Lyall Bay on one of the warmest days Wellington is likely to have all year. Small black blobs jostle and bob in the swells. “There’s the ones out there,” he says, his eyes still, “and there’s the ones at parties.” Through the windshield a man catches a wave and cuts a line into the water.

Aaron* doesn’t surf as often as he did, and he tries not to frequent the same parties he used to. He doesn’t do pills anymore, either – “I stopped after a bad experience,” he says, and doesn’t elaborate. His words hang, as a trail of white foam covers the place where a surfer had stacked his wave and disappeared underwater seconds ago.

The surfer resurfaces, and makes his way back out to sea to rejoin the cluster. There’s a lull as the group awaits the next set, sitting on their boards, looking out to sea. The first type of waves tend to come in sets of seven, rolling in with a calming regularity untroubled by the mechanics of supply and demand, or by the people riding them.

The second type of wave is different. It’s prescribed, controlled, regulated, used, abused. Its supply and demand – a function of humans’ decisions, mistakes, desires and capital – is chaos in comparison. It comes not in sets but in trays, boxes, small bottles; not from the horizon but from a medical professional.

The pills which Aaron refers to are, of course, prescription drugs. These come in three types: opioids, like codeine, which are generally used for pain relief; benzodiazepines, like Valium, prized for their psychoactive and sedative qualities, and stimulants, like Ritalin, which increase alertness. Prescription drugs are governed by the Misuse of Drugs Act 1975, the same law that covers substances like cannabis, MDMA and LSD. While prescription drugs are obtained legally for medical use, like the aforementioned substances prescription drugs are used illegally for recreational purposes.

Recreational users require higher, more immediate doses than are available over the counter. As such, the recreational market is built on prescriptions commonly obtained by deception, forgery, and sometimes, actual medical need

Given that it is legal to possess and import such drugs with a legitimate prescription, doctors are targeted as a key part of the supply chain – recreational users require higher, more immediate doses than are available over the counter, and as such, the recreational market is built on prescriptions commonly obtained by deception, forgery, and sometimes, actual medical need.

2012 research paper by the University of Auckland’s School of Pharmacy surveyed 300 GPs from around the country, and found that two-thirds of respondents had felt pressured into prescribing a drug – of these, 16 per cent had been verbally threatened, and four per cent had been threatened physically. Half the doctors reported benzodiazepines were a major problem in their practice, and a third reported this was also the case for codeine.

Of course, the patients abusing prescription drugs are not solely occasional recreational users and dealers - addiciton has also been a growing issue. A report in the New Zealand Medical Journal said the number of people on opiod subsitition for dependancy increased from 650 in 1990 to more than 4000 in 2011, when it was published. The study of 31 new patients at three provincial drug clinics showed each one spent an average of $367 per week on prescription drugs - mostly methadone and morphine - bought on the street.

Aaron was never a hardcore user, just the odd weekend when it was offered. His forays into recreational use of prescription medication were brief jaunts, exclamation points on friendships spent in the water over summers and on the snow during winters. Supply, he says, was facilitated simply by the regularity at which his mates sustained injuries for which medications were prescribed.

For a person with a fresh cast and a new script, the allure of dealing prescription medication is built on a series of rational decisions. Let’s say you’re prescribed a painkiller like codeine after a sports injury, or you’ve been diagnosed with ADHD but don’t need to use Ritalin. If the drugs are prescribed to you, it’s not illegal to have them in your possession. Selling small volumes of drugs to friends is highly unlikely to attract the attention of the police, especially if these drugs are just the surplus to your own medical requirements – say, if symptoms have disappeared before the full course of medication is finished. Repeat prescriptions are relatively easy to obtain, and scripts are cheap – if subsidised by the Government, a course of tablets can cost as low as $5, but have a street value of hundreds. For some medications, like Ritalin, it’s possible to get three months’ supply in one prescription. There’s no shortage of people who are willing to pay $5 or $10 dollars to reconfigure how their bodies understand themselves, even if only for a few hours.

No caption

Photo: Photo NZ

The nature of the supply chain dictates that most dealers of prescription medication run low-level, low-volume operations. Unlike selling marijuana, it's incredibly difficult to obtain and sell the volumes of pills necessary to sustain yourself as a full-time prescription drug dealer. Even dealers with a reasonable supply do not make serious money. In January last year, the Otago Daily Timesreported on a police raid of Otago University student-cum-Ritalin dealer Druvi Rodrigo yielded just 17 pills, street value: $170. He would buy 40 pills at a time for $5 each and sell them at $10 a pop – a modest profit considering Ritalin is a class B drug, the supply of which can earn you a maximum of 14 years in prison.

In June, the ODT reported a second Dunedin man’s involvement in another Ritalin ring. 25-year-old Ronald Topi was more financially successful than Rodrigo: a fraudulent prescription allowed him to collect and sell 582 tablets over a three month period – street value around $5000. In the end, both Rodrigo and Topi paid for their efforts: Rodrigo was sentenced to 10 months home detention, 200 hours of community work; Topi was sentenced to two years and three months' in prison.

Although addiction starts with recreational use, young recreational users are more likely to be found at parties than in drug programmes. The 2007/8 New Zealand Alcohol and Drug Use Survey found the average user is a white male in his thirties, though the average age of first use is 19. Amongst young people, women are just as likely as men to use sedatives (2.8 per cent), and about two-thirds as likely to use stimulants (4 per cent for men compared to 2.6 per cent for women). Men use prescription drugs recreationally about twice as frequently as women.

If I’m complicit in abusing them, the upshot is that people who really need them are restricted access because I want to have a good night

Unlike alcohol, it’s difficult to predict which communities will abuse prescription drugs. The same survey that found two-thirds of doctors had been pressured for prescriptions also found that patients in rural areas were just as likely to demand prescription drugs as those in cities, and that North Island patients pressure doctors with the same frequency as South Island patients. Whether the doctors were male or female, experienced or inexperienced did not matter – patients targeted each with similar frequency.

Doctors, of course, are not employed to deal drugs to party goers, and this is not lost on some of the users I speak to. “If I’m complicit in abusing them, the upshot is that people who really need them are restricted access because I want to have a good night,” one person tells me. The struggle to reconcile one’s hedonic pleasures with the resultant difficulties others have in alleviating their own maladies is unique to prescription medication, but does not affect all users. “They’re so overprescribed,” another user tells me. “I’ve never really thought about it like that.”

In winter, there will be fewer surfers at Lyall Bay. Anecdotally, in ski resort towns like Ohakune, it’s a great time for supply, as the substance-inclined turn torn achilles and broken bones into happy accidents for themselves and their friends. (Ohakune Pharmacy dispute this, telling me illicit prescription drugs are most likely brought in from out of town.)

“Like, obviously a lot of young people are doing drugs,” Aaron admits. “You’ll never stop them. But these dudes are getting pills real easy, on the cheap, and everyone knows about it. Even the doctor’s gotta know.” I tell Aaron about the University of Auckland School of Pharmacy study, where 95 per cent of the doctors reported they were confident with their ability to spot prescription drug misuse. Through the windscreen, the waves keep rolling in.

* Name has been changed

This content is brought to you with funding assistance from New Zealand On Air.