North-South divide in opioid and painkiller prescribing with high use in England’s most deprived areas
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.
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.
‘I don’t know how I’m alive’
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.
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?’
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.
WARNING: This article contains language and content some readers may find distressing
As a single mum, Lucy* looked forward to her rare nights out. A few years ago, during after-work drinks at a local pub, she started feeling unwell. When she collapsed and passed out, a bouncer called an ambulance. Lucy’s drink had been spiked.
The ambulance was crewed by two paramedics, a man and a woman. Still unconscious, Lucy was placed on a stretcher, strapped on to the bed, and driven towards the hospital.
After a scary episode, Lucy’s friends must have breathed a sigh of relief. She was safe, and being looked after. But, as the female ambulance driver looked in her rear-view mirror to check on Lucy, she says she saw the unimaginable – her male colleague sexually assaulting his patient.
Lucy still doesn’t remember what happened, but she has the police report and crime scene pictures of the inside of the ambulance.
Pointing to a photo of where she was strapped down, she says almost matter-of-factly: “He put my legs up, so my knees were up, and put his hand inside my groin area – possibly touching my vagina.”
When she regained consciousness, she was told what had happened to her. Years later, she is still struggling to process it.
The paramedic denied the charges and was found not guilty at trial, but later struck off by the paramedics’ regulator, the Health and Care Professions Council (HCPC).
They have a lower standard of proof than the criminal courts, and found against him, calling him a “serious threat to patient safety”.
Lucy still wouldn’t feel safe getting into an ambulance today. “It’s awful, you feel so violated and vulnerable,” she says.
“It’s a shock to think someone in that position would do that, when they’re supposed to be there to look after you.”
Her story is horrific, but Lucy is not alone. It forms part of a year-long Sky News investigation into sexual misconduct in the ambulance service, which has revealed a culture where abuse and harassment among staff are rife and patients are sexualised.
A senior ambulance boss admits the service has “let victims down”, while stressing that perpetrators are the “minority”.
Jason Killens, head of the Welsh Ambulance Service and the Association of Ambulance Chief Executives, says he expects “a steady increase” in the number of cases, with more paramedics being sacked for sexually inappropriate behaviour over the coming years, because of the work his organisation is doing to change the culture.
Data shared with Sky News shows one in five of the sexual misconduct complaints made against paramedics to their regulator, the Health and Care Professions Council, in 2023 were for acts against patients or members of the public.
While fewer than 1% of all HCPC members had concerns raised against them last year, in sexual misconduct cases, paramedics were hugely over-represented.
They make up just 11% of the HCPC register, but account for 64% of all investigations into sexual harassment against colleagues. The regulator’s chair, Christine Elliot, thinks the sexual misconduct cases are “just the tip of the iceberg”.
“This is all about patient safety,” she says. “Patients need to know when they see a practitioner, they can rely on them giving the best care possible with the best behaviour possible.”
‘Totally unnecessary breast examinations’
Cases like Lucy’s are rare but several whistleblowers across multiple trusts have spoken up about a culture in which “banter” or jokes about groping patients are commonplace.
Current and former paramedics claim to have heard patients, particularly young women, being sexualised by the men who had helped to treat or even save them.
One former paramedic revealed the phrase “totally unnecessary breast examinations” (or TUBEs), and said she had heard paramedics talking about “TUBEing” young, drunk women. She also claims to have seen a colleague grope another colleague’s breasts, telling her: “I just TUBEed you.”
A second woman said the same phenomenon was called “jazz hands” in her trust. Both said these were widely understood phrases which referred to colleagues accidentally, or deliberately, touching a woman’s breast during treatment.
A third paramedic told us she’d heard colleagues talk about patients in an explicitly sexual manner, saying things like: “She had nice tits” or “those were silicone”, while bragging about getting a patient’s number and having a “good feel”.
“That is assault. That is sexual assault,” she says.
‘It will be fun. Your career will progress’
“One of my biggest fears was that I wouldn’t be believed because of where I worked. It was the ambulance service and he was the man in charge,” says Ellie*, whose first job was as a call handler in an ambulance control room.
She loved the camaraderie and the idea that she was making a difference. Until one day, the manager called her into his office and invited her to a conference with him. At first, she was flattered and a little confused.
“He explained that he’d taken a liking to me and then he reached out and touched my leg.” Shocked, Ellie froze. “I was in my early 20s and didn’t know what his intention was. I was a bit naive, probably.” As he carried on talking, her boss slid his hand “as far up my thigh as it could go”.
Horrified, she shot back in her chair and asked him what he was doing.
“If you come, we’ll share a room. It will be fun. Your career will progress,” her boss replied.
“No,” she exclaimed, rushing out the room in a panic. Back at her desk, she carried on taking 999 calls while he watched over her.
Then she claims the messages started: “They were photos of his private parts, as well as messages suggesting meeting in the car park for sex and saying he wanted to kiss me. A whole manner of very descriptive sexual actions that he said he wanted to do with me.”
The messages carried on “for months”, she says, despite her pleading with him to stop. She was left dreading going to work for fear of seeing him, and avoided going to the toilet in case she ran into him in the corridor.
Eventually she showed the messages to HR, she says, but claims they suggested moving her to a different office. He wouldn’t be punished.
“It was sexual harassment,” Ellie says, caught between anger and despair. “They didn’t do anything. There was no investigation. No meeting with him that I’m aware of. No statement from me. Nothing. I was the problem.”
She eventually quit the service, but alleges he still works there to this day, an injustice that “makes me feel sick” she says.
An NHS England spokesperson said new national guidance and training has been recently introduced “to stamp out this awful behaviour”.
“Any abuse or violence directed at NHS staff is totally unacceptable and will not be tolerated, and the NHS is committed to tackling unwanted, inappropriate or harmful sexual behaviour in the workplace. We have recently introduced new national guidance and training that will help staff recognise, report and act on sexual misconduct at work to stamp out this awful behaviour,” they said.
‘We failed those individuals… I’m sorry’
Ellie’s story is simply “not right”, says ambulance boss Mr Killens.
“We failed those individuals,” he admits, saying “I’m sorry” to both staff and patients who have “been subject to poor behaviour from our people”.
Work is being done, he says, to tackle this kind of behaviour, citing it as his, and his organisation’s, top priority.
That will involve rooting out the perpetrators, but also playing the “long game” to change the culture “so that we can begin to tackle low level misconduct or inappropriate behaviour early, rather than let it fester and get worse,” he says.
According to the HCPC’s chair, cultural change is needed from leadership down. Sexual harassment, Elliot says, needs to be treated as high a priority as “waiting times and crumbling hospitals”.
Read more from this investigation:
Life as a female paramedic
‘Toxic’ culture of harassment revealed
But many of the victims we have spoken to say the HCPC takes too long (an average of three years) to investigate misconduct allegations.
Elliot agrees that isn’t good enough, but says they are running initiatives to speed things up, and wants to see legislative change to give her organisation more power to speed up investigations.
They have also created a sexual safety hub for both victims and witnesses of inappropriate behaviour.
It can be hard to hear allegations like Lucy and Ellie’s, contrasting their stories with a service in which the majority of people are dedicated to saving lives.
But it’s also clear that for far too long, abusers and those who commit sexually inappropriate behaviour have operated with impunity in the ambulance service. Some were perhaps protected by allegiances or cover-ups, many others simply hid behind the veneer of “banter”.
Ambulance and NHS bosses have made it clear to Sky News they are determined to root out not just the perpetrators of serious sexual violence, but also to stamp out the culture that breeds this behaviour.
But in the meantime women like Lucy, Ellie and countless others won’t hear an ambulance siren and feel safe, telling us they would even struggle to dial 999 in the case of a medical emergency.
*names have been changed
Illustrations by Rebecca Hendin
Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK
Consumer rights group Which? is suing Apple for £3bn over the way it deploys the iCloud.
If the lawsuit succeeds, around 40 million Apple customers in the UK could be entitled to a payout.
The lawsuit claims Apple, which controls iOS operating systems, has breached UK competition law by giving its iCloud storage preferential treatment, effectively “trapping” customers with Apple devices into using it.
It also claims the company overcharged those customers by stifling competition.
The rights group alleges Apple encouraged users to sign up to iCloud for storage of photos, videos and other data while simultaneously making it difficult to use alternative providers.
Which? says Apple doesn’t allow customers to store or back-up all of their phone’s data with a third-party provider, arguing this violates competition law.
The consumer rights group says once iOS users have signed up to iCloud, they then have to pay for the service once their photos, notes, messages and other data go over the free 5GB limit.
“By bringing this claim, Which? is showing big corporations like Apple that they cannot rip off UK consumers without facing repercussions,” said Which?’s chief executive Anabel Hoult.
“Taking this legal action means we can help consumers to get the redress that they are owed, deter similar behaviour in the future and create a better, more competitive market.”
Apple ‘rejects’ claims and will defend itself
Apple “rejects” the idea its customers are tied to using iCloud and told Sky News it would “vigorously” defend itself.
“Apple believes in providing our customers with choices,” a spokesperson said.
“Our users are not required to use iCloud, and many rely on a wide range of third-party alternatives for data storage. In addition, we work hard to make data transfer as easy as possible – whether it’s to iCloud or another service.
“We reject any suggestion that our iCloud practices are anti-competitive and will vigorously defend against any legal claim otherwise.”
It also said nearly half of its customers don’t use iCloud and its pricing is inline with other cloud storage providers.
Keep up with all the latest news from the UK and around the world by following Sky News
How much could UK Apple customers receive if lawsuit succeeds?
The lawsuit will represent all UK Apple customers that have used iCloud services since 1 October 2015 – any that don’t want to be included will need to opt out.
However, if consumers live abroad but are otherwise eligible – for example because they lived in UK and used the iCloud but then moved away – they can also opt in.
The consumer rights group estimates that individual consumers could be owed an average of £70, depending on how long they have been paying for the services during that period.
Apple is facing a similar lawsuit in the US, where the US Department of Justice is accusing the company of locking down its iPhone ecosystem to build a monopoly.
Apple said the lawsuit is “wrong on the facts and the law” and that it will vigorously defend against it.
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Oil state Azerbaijan is ‘perfectly suited’ to hosting a climate summit, says Azerbaijan
Big tech’s battles
This is the latest in a line of challenges big tech companies like Apple, Google and Samsung have faced around anti-competitive practices.
Most notably, a landmark case in the US earlier this year saw a judge rule that Google holds an illegal monopoly over the internet search market.
The company is now facing a second antitrust lawsuit, and may be forced to break up parts of its business.
Read more: Google faces threat of being broken up
File pic: Reuters
And in December last year, a judge declared Google’s Android app store a monopoly in a case brought by a private gaming company.
“Now that five companies control the whole of the internet economy, there’s a real need for people to fight back and to really put pressure on the government,” William Fitzgerald, from tech campaigning organisation The Worker Agency, told Sky News.
William Fitzgerald at Lisbon’s Web Summit, where he spoke to Sky News
“That’s why we have governments; to hold corporations accountable, to actually enforce laws.”
UK
Referees’ body taking ‘very seriously’ video that appears to show David Coote snorting white powder
A video appearing to show a Premier League referee snorting white powder is being taken “very seriously” by the referees’ body.
Professional Game Match Officials Ltd (PGMOL) suspended David Coote on Monday over derogatory comments he allegedly made about ex-Liverpool manager Jurgen Klopp and the club in previous footage.
PGMOL and the Football Association are investigating Coote who, it is alleged, used an expletive to describe Klopp and called Liverpool FC “shit”.
Now it has emerged the UEFA Referees Committee also suspended Coote until further notice on Monday, ahead of the upcoming round of UEFA matches “when it became aware of his inappropriate behaviour”, it said.
On Wednesday evening, another video appeared on The Sun’s website which it said showed Coote snorting white powder during this summer’s Euros in Germany, where he was officiating.
A PGMOL spokesperson said: “We are aware of the allegations and are taking them very seriously. David Coote remains suspended pending a full investigation.
“David’s welfare continues to be of utmost importance to us and we are committed to providing him with the ongoing necessary support he needs through this period. We are not in a position to comment further at this stage.”
The Sun said the video was filmed on 6 July, the day after the Euro 2024 quarter-final clash between Portugal and France, for which Coote was an assistant VAR.
A statement from UEFA said: “The UEFA Referees Committee immediately suspended David Coote until further notice on 11 November – in advance of the upcoming round of UEFA matches – when it became aware of his inappropriate behaviour.”
David Coote. File pic: PA
The previous video footage, appearing to show Coote making derogatory remarks about Klopp and the Anfield club, began circulating online on Monday.
He was subsequently suspended by PGMOL pending a full investigation, and the FA then said it was also investigating the matter.
Coote officiated Liverpool’s most recent Premier League game – a 2-0 win over Aston Villa on Saturday night.
Keep up with all the latest news from the UK and around the world by following Sky News
He was criticised by some fans after Liverpool forward Mohamed Salah was brought down by Aston Villa player Leon Bailey.
Liverpool forward Darwin Nunez went on to score after play wasn’t stopped – but a replay showed Coote had chosen not to stop the game because he believed the challenge on Salah wasn’t a foul rather than because he wanted the Reds to keep their advantage.
The PA news agency has approached the FA for comment regarding the Sun’s story.
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