A North-South divide over the prescription of high dose opioids and other painkillers has been revealed by Sky News research.
The findings are being described as a “time bomb” of potential addiction problems.
In the North East, the amounts prescribed are three times more per head than in London, according to data collated from Open Prescribing.
For example, a practice in Durham with 18,000 patients prescribes over 1.2 million milligrams of opioids a month, (the rough equivalent of 42,000 strong tablets).
An average UK practice of the same size would prescribe about 480,000 milligrams per month (about 16,000 strong tablets).
The region’s lead pharmacist told Sky News: “We’ve all got to re-educate ourselves” about the potential harms of over-prescription.
Opioids are also prescribed to people in the most deprived parts of the country almost twice as much as those in the most well-off areas.
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Social workers and other professionals say that GPs are creating the clientele for a growing black market in prescription drugs, and there is a lack of services to help people with their addictions.
While opioid use has fallen slightly in recent years – prescriptions of other painkillers such as pregabalin are on the increase.
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‘I don’t know how I’m alive’
Image: Justine Grant beat an additcion to heroin and was clean for 12 years, but says the drug her doctor later prescribed for pain relief was an even greater challenge
Patients have told Sky News that they struggled to beat their addiction and often turned to illegal dealers to top up their medication.
Justine Grant, from Sacriston, near Durham beat an addiction to heroin and was clean for 12 years, but says the drug her doctor later prescribed for pain relief was an even greater challenge.
She said, “I said I need something like ibuprofen but maybe a bit stronger, and that’s when they prescribed us the pregabalin. It’s very, very addictive. More addictive than anything I’ve taken in my lifetime.”
“I immediately got addicted to one of those a day, and then two and then three and then four. Up until I was taking ten a day. I don’t know how I’m alive.”
Justine was topping up her prescriptions using drug dealers, taking 3,000 mg of the drug a day, costing her £25.
What is pregabalin?
Pregabalin works on nerve pain by affecting messages travelling through the brain and down the spine.
The drugs information site Frank says it produces feelings of euphoria, relaxation and calmness; and can heighten the effects of other drugs.
Pregabalin and opioids taken together can cause people to stop breathing.
The NHS recommends it is not stopped suddenly as withdrawal could cause anxiety, insomnia, nausea, pain and sweating.
Officials who draw up prescribing guidelines at NICE have made it a class C drug and warn GPs to look out for signs of dependency and abuse.
She added: “Everybody’s getting them. The doctors think they’re the new wonder drug and they can’t see the problems they’re causing.”
Advice published by NHS England eight years ago warns doctors that this this type of drug “can lead to dependence and may be misused or diverted”.
It also says that the drug is used as a “commodity for trade” in prisons.
‘What will my little girl do if I don’t wake up?’
Image: When Cheryl Parker was addicted to codeine she was being prescribed 100 tablets every three days, and was in constant fear of overdose
Cheryl Parker, also from the Durham area, became addicted to codeine after complications giving birth. Soon she was being prescribed 100 tablets every three days. She was in constant fear of overdose, but was sick if she tried to withdraw.
She said: “God I used to be ill. Spewing, couldn’t walk, constantly on the toilet, mentally just totally drained. I used to have an inhaler down the side of my bed every night. I used to just be panicking. What would I do if I don’t wake up? My little girl’s there, what’s she going to do?'”
Justine and Cheryl are both housed by Positive Directions, which helps accommodate vulnerable people.
Beverly Crooks, one of its support workers, says there’s little help available for those with mental health and addiction problems.
She said: “For the last year there’s been a lot of suicides through drugs and people not getting help. People really depressed, can’t get any help from anywhere, getting told there’s no one that can come out and see them because there’s not enough staff.”
The director of Positive Directions, Gary Crooks, told Sky News: “It’s an absolutely huge problem and a time bomb that’s been simmering under the surface for quite some time now.”
“Being on the frontline, what we’re encountering is an explosion in prescribed drugs from the GPs, and certainly on the black market.
“A lot of people have been accessing drugs from the dark web, and buying prescription drugs that way, at a real big discount, and selling them on the streets.
“They are extremely addictive and quite often the problem is they’re prescribed by medical professionals and so the people who are taking the prescriptions don’t realise how addictive these substances are.”
‘Primary care is overwhelmed’
Ewan Maule, lead pharmacist for the North East and North Cumbria, says there is a link between poverty, especially in declining industrial regions such as the North East, and chronic pain and this in turn leads to greater use of opioids in certain regions.
However, he says that medical understanding about the risk of opioids has evolved and NHS professionals need to take note.
He said: “The conversation is changing and we are starting to talk about non-drug treatments, non-medicines for treatment of chronic pain, because we know the harm that can be done by opioids certainly long-term, outweighs the benefits.
“We all need to re-educate ourselves. People like me, who were educated 20 years ago, need to change the way we think about things.”
Medical academics in the region agree and a programme is being launched in the North East to use GPs’ databases to contact people on high dose opioids offering help.
Professor Julia Newton, from the Newcastle Hospitals NHS Trust, said: “We need to take notice that we’re an outlier in this area and begin to look at why that might be.
“Primary care is overwhelmed at the moment, time is very precious in short GP consultations. And I think sometimes it might just be easier when a patient wants a tablet, for a GP to prescribe or to continue to prescribe a medication.”
Offered heroin at a rehab centre
While getting hooked is easy, finding help to get off is a struggle. Addicts told us that the main rehab centre in Durham, called County Durham Substance Misuse Service – Centre for Change, often has dealers outside and sometimes inside.
One recovering addict said it was a great place to “go for a hit” rather than rehab.
When Sky News paid a visit, a social worker with our team was offered heroin by a client coming out of the premises.
Humankind, which runs the centre, said that it takes any reports of drug use and dealing within its centres “extremely seriously” and it has “strong, well-communicated policies in place prohibiting these acts”.
It added: “Anyone found to be dealing, sharing or using drugs on a Humankind site will be challenged and reported to the police, and any claims of drug dealing are investigated thoroughly.”
When it comes to the government’s levelling-up agenda, clearly this is another area that needs attention. Communities that have seen industrial decline and rising poverty have also added addiction to their list of problems.
Former addict Justine says: “How are they going to break the cycle? There’s no jobs, no help, no future, no dreams.”
And it seems medication is no substitute for investment, jobs and services.
A care worker who reported the alleged abuse of an elderly care home resident, which triggered a criminal investigation, is facing destitution and potential removal from Britain after speaking up.
“Meera”, whose name we have changed to protect her identity, said she witnessed an elderly male resident being punched several times in the back by a carer at the home where she worked.
Sky News is unable to name the care home for legal reasons because of the ongoing police investigation.
“I was [a] whistleblower there,” said Meera, who came to the UK from India last year to work at the home.
“Instead of addressing things, they fired me… I told them everything and they made me feel like I am criminal. I am not criminal, I am saving lives,” she added.
Image: ‘Meera’ spoke up about abuse she said she witnessed in the care home where she worked
Like thousands of foreign care workers, Meera’s employer sponsored her visa. Unless she can find another sponsor, she now faces the prospect of removal from the country.
“I am in trouble right now and no one is trying to help me,” she said.
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Meera said she reported the alleged abuse to her bosses, but was called to a meeting with a manager and told to “change your statement, otherwise we will dismiss you”.
She refused. The following month, she was sacked.
The care home claimed she failed to perform to the required standard in the job.
She went to the police to report the alleged abuse and since then, a number of people from the care home have been arrested. They remain under investigation.
‘Migrants recruited because many are too afraid to speak out’
The home has capacity for over 60 residents. It is unclear if the care home residents or their relatives know about the police investigation or claim of physical abuse.
Since the arrests, the regulator, the Care Quality Commission (CQC), carried out an investigation at the home triggered by the concerns – but the home retained its ‘good’ rating.
Meera has had no reassurance from the authorities that she will be allowed to remain in Britain.
In order to stay, she’ll need to find another care home to sponsor her which she believes will be impossible without references from her previous employer.
She warned families: “I just want to know people in care homes like these… your person, your father, your parents, is not safe.”
She claimed some care homes have preferred to recruit migrants because many are too afraid to speak out.
“You hire local staff, they know the legal rights,” she said. “They can complain, they can work anywhere… they can raise [their] voice,” she said.
Image: Sky’s Becky Johnson spoke to ‘Meera’
Sky News has reported widespread exploitation of care visas and migrant care workers.
Currently migrants make up around a third of the adult social care workforce, with the majority here on visas that are sponsored by their employers.
As part of measures announced in April in the government’s immigration white paper, the care visa route will be closed, meaning care homes will no longer be able to recruit abroad.
‘Whole system is based on power imbalance’
But the chief executive of the Work Rights Centre, a charity that helps migrants with employment issues, is warning that little will change for the tens of thousands of foreign care workers already here.
“The whole system is based on power imbalance and the government announcement doesn’t change that,” Dr Dora-Olivia Vicol told Sky News.
She linked the conditions for workers to poor care for residents.
Image: Work Rights Centre CEO Dr Dora-Olivia Vicol
“I think the power that employers have over migrant workers’ visas really makes a terrible contribution to the quality of care,” she said.
Imran agrees. He came to the UK from Bangladesh, sponsored by a care company unrelated to the one Meera worked for. He says he frequently had to work 14-hour shifts with no break because there weren’t enough staff. He too believes vulnerable people are being put at risk by the working conditions of their carers.
Migrant workers ‘threatened’ over visas
“For four clients, there is [a] minimum requirement for two or three staff. I was doing [it] alone,” he said, in broken English.
“When I try to speak, they just directly threaten me about my visa,” he said.
“I knew two or three of my colleagues, they are facing the same issue like me. But they’re still afraid to speak up because of the visa.”
A government spokesperson called what happened to Imran and Meera “shocking”.
“No one should go to work in fear of their employer, and all employees have a right to speak up if they witness poor practice and care.”
James Bullion, from the CQC, told Sky News it acts on intelligence passed to it to ensure people stay safe in care settings.
Donald Trump may be denied the honour of addressing parliament on his state visit to the UK later this year, with no formal request yet submitted for him to be given that privilege.
Sky News has been told the Speaker of the House of Commons, Sir Lindsay Hoyle, hasn’t so far received a request to invite the US president to speak in parliament when he is expected to visit in September.
It was confirmed to MPs who have raised concerns about the US president being allowed to address both houses.
Kate Osborne, Labour MP for Jarrow and Gateshead East, wrote to the speaker in April asking him to stop Mr Trump from addressing parliament, and tabled an early-day motion outlining her concerns.
“I was happy to see Macron here but feel very differently about Trump,” she said.
“Trump has made some very uncomfortable and worrying comments around the UK government, democracy, the Middle East, particularly around equalities and, of course, Ukraine.
“So, I think there are many reasons why, when we’re looking at a state visit, we should be looking at why they’re being afforded that privilege. Because, of course, it is a privilege for somebody to come and address both of the houses.”
But the timing of the visit may mean that any diplomatic sensitivities, or perceptions of a snub, could be avoided.
Image: France’s President Emmanuel Macron addressed parliament during his state visit this month
Lord Ricketts, a former UK ambassador to France, pointed out that parliament isn’t sitting for much of September, and that could help resolve the issue.
In 2017, he wrote a public letter questioning the decision to give Donald Trump his first state visit, saying it put Queen Elizabeth II in a “very difficult position”.
Parliament rises from 16 September until 13 October due to party conferences.
The dates for the state visit haven’t yet been confirmed by Buckingham Palace or the government.
However, they have not denied that it will take place in September, after Mr Trump appeared to confirm they were planning to hold the state visit that month. The palace confirmed this week that the formal planning for his arrival had begun.
With the King likely to still be in Scotland in early September for events such as the Braemar Gathering, and the anniversary of his accession and the death of Queen Elizabeth on the 8th September, it may be expected that the visit would take place sometime from mid to the end of September, also taking into consideration the dates of the Labour Party conference starting on the 28th September and possibly the Lib Dem’s conference from the 20th-23rd.
Image: Mr Trump has said he believes the trip to the UK will take place in September. Pic: Reuters
When asked about parliamentary recess potentially solving the issue, Ms Osborne said: “It may be a way of dealing with it in a very diplomatic way… I don’t know how much control we have over Trump’s diary.
“But if we can manoeuvre it in a way that means that the House isn’t sitting, then that seems like a good solution, maybe not perfect, because I’d actually like him to know that he’s not welcome.”
A message from the speaker’s office, seen by Sky News, says: “Formal addresses to both Houses of Parliament are not automatically included in the itinerary of such a state visit.
“Whether a foreign head of state addresses parliament, during a state visit or otherwise, is part of the planning decisions.”
Image: Mr Trump made his first state visit to the UK in June 2019 during his first presidency. File pic: Reuters
It’s understood that if the government agrees to a joint address to parliament, the Lord Chamberlain’s office writes to the two speakers, on behalf of the King, to ask them to host this.
It will be Mr Trump’s second state visit.
During his first, in 2019, he didn’t address parliament, despite the fact that his predecessor, Barack Obama, was asked to do so.
It was unclear if this was due to the fact John Bercow, the speaker at the time, made it clear he wasn’t welcome to do so.
However, it didn’t appear to dampen Mr Trump’s excitement about his time with the Royal Family.
Speaking earlier this year, he described his state visit as “a fest” adding “it’s an honour… I’m a friend of Charles, I have great respect for King Charles and the family, William; we have really just a great respect for the family. And I think they’re setting a date for September.”
It is expected that, like Mr Macron, the pageantry for his trip this time will revolve around Windsor, with refurbishment taking place at Buckingham Palace.
Liverpool have retired the number 20 shirt in honour of Diogo Jota – the first time it has made such a gesture.
The club said it was a “unique tribute to a uniquely wonderful person” and the decision was made in consultation with his wife and family.
The number 20 will be retired at all levels, including the men’s and women’s first teams and academy squads.
A statement said: “It was the number he wore with pride and distinction, leading us to countless victories in the process – and Diogo Jota will forever be Liverpool Football Club’s number 20.”
The club called it a “recognition of not only the immeasurable contribution our lad from Portugal made to the Reds’ on-pitch successes over the last five years, but also the profound personal impact he had on his teammates, colleagues and supporters and the everlasting connections he built with them”.
Image: Jota’s wife joined Liverpool players to view tributes at Anfield on Friday. Pic: Liverpool FC
Image: Pic: Liverpool FC
Newly-married Jota died alongside his brother when his Lamborghini crashed in northern Spain on 3 July.