Horizon

Britain is in the grip of a drug crisis.

Wow.

Each year, more than five million of us are prescribed opioids.

Painkillers which can be as powerful as class A drugs.

You know that it is related to morphine and heroin?

No.

In America, a prescription opioid epidemic accounts for more deaths

than gun crime.

Now, a landmark report suggests we may also have a problem.

How many of these tablets were you consuming?

Erm, between 50 and 70... Wow.

...a day.

I ended up overdosing.

I'm Dr Michael Mosley.

I want to understand just how worried we should be,

because millions of us get stuck on these painkillers long term.

The tablets just destroyed her, really.

When a doctor prescribes them, you take them -

you take whatever, whatever you can take.

I want to find out how easy it is to get hold of these potent drugs.

Pain relief prescriptions, free UK express delivery.

That's for me.

And discover their potential risks.

We're really heading towards a very dangerous place

and we need to do something about it now.

I also want to explore the biology of pain...

I can feel it beginning to burn now.

...to find out why opioids work for some...

...but not for others.

They didn't sort the pain out.

What they actually did was turn my beautiful, lovely,

active wife into a zombie.

I think this is a major public health issue up there

with heart disease and cancer.

I want to find out what's gone wrong and whether science can help us

tackle Britain's opioid crisis.

I'm in Hastings, a town that's on the front line

of Britain's opioid problem.

You don't have to look far to find evidence that they are now part

of our everyday lives.

Thanks.

This contains codeine, which is a powerful and effective painkiller.

It is also an opioid which makes it part of the same family

as morphine and heroin.

And that means it can also cause addiction.

Now, this stuff absolutely pales in comparison

to what you can get from your GP.

Your GP can quite legally prescribe you something which

is 300 times more powerful than this.

Here in the Hastings area, around one in seven adults

were prescribed an opioid last year.

But do they know what they're taking?

So any of you on painkillers? I am.

What are you on? Dihydrocodeine.

You know that it is an opioid,

related to heroin and morphine? No.

Did you know that they are related to heroin and morphine?

Not really, no.

Would that put you off taking them? Of course it would, yeah.

What are you on? Oxycodone.

You know that it is an opioid, related... Yes, I do.

...to morphine and heroin? Yes, I do.

OK, and does that put you off, at all? No, not at all.

Doesn't turn me off, I still take my tablets.

It doesn't really, I don't touch drugs anyway.

They're a life-saver for me, they get me about.

And do they work?

Erm, they do, but I didn't like the feeling that I had.

What was that?

I just felt a bit, well, my partner call them my happy pills,

because I felt a bit spaced out.

So, plenty of familiarity with opioids in Hastings.

But what of the national picture?

Come on, I'm taking a pound to clear!

I've invited my new friends to my stall in the town market

to demonstrate the scale of our opioid consumption.

OK, ta-da.

Whoo-hoo!

Right, so, imagine this is the amount of opioids

the good old British public was consuming 20 years ago.

How much do you think they're consuming now?

More. More, a lot more?

OK, how much more do we reckon?

I reckon about here. OK.

I think about here.

About here? I reckon it'll be...

I'm asking people to guess how much the total amount

of prescription opioids has increased.

Shout when you think I'm getting close to it.

Whoa! Lots of lovely opioids going in, yeah.

More?

A bit more, keep going.

As the years have gone by, the population's been getting older.

But we certainly haven't been getting this much sicker.

Keep going, we're going, going, going, going, going, going, whoa!

Hurrah, that was 2017.

Wow!

So that is a good doubling in the amount of opioids

that people were consuming 20 years ago.

So that is pretty terrifying, isn't it?

That is terrifying, yes.

There's no doubt that opioids have a vital role to play

in cancer pain, end-of-life care,

or to relieve pain after an operation.

But that doesn't begin to explain the huge surge in prescribing

we've seen in recent years.

I do think it's important to point out that opioids in the right

patients can be absolutely life-changing.

However, a major new report by Public Health England

has revealed that 5.6 million adults in England and Wales

are currently on prescription opioids.

That is an astonishing one in eight of us.

So what are opioids?

Originally, they came from the sap of the poppy plant,

which has been used for thousands of years,

both recreationally and to treat pain.

It gave the world heroin.

They act on the opioid receptors in the brain,

blocking pain signals from the rest of the body.

In fact, they're probably the greatest tool doctors have

for numbing acute pain, like a broken bone,

or an infected tooth.

They're often promoted as a safe and effective way

to treat all manner of pain.

But unfortunately, many patients are discovering

that this simply isn't true.

Nice cup of coffee. Thank you.

I was weighing these books up.

And as I turned, sort of, like, bent slightly sideways to check

the reading, something in my back just went pop!

It was actually heard throughout the office.

It was.

My immediate boss was like, "What the hell was that?"

In 2014, Karen popped a disc in the middle of her spine.

Almost like having a having a red-hot poker

put between your vertebrae.

Painful, very painful.

Research suggests there could be as many as 28 million Brits

like Karen living in chronic pain.

Pain, which is constant or recurring

and has been there for more than 12 weeks.

Karen's doctor's solution? Opioids.

We got on these opiates,

which initially, I was very excited about

because I thought, "Yes, she's going to be pain free."

Sadly, it didn't work out like that.

You got this false sense of illusion that, "Well, actually,

"they must be doing something, even though I'm still in pain."

What, if I stopped them, my God, the pain's going to be horrendous.

Over the course of five years, Karen was put on increasingly

powerful opioids, starting on Tramadol and ending up on morphine.

But they didn't sort the pain out.

What they actually did was turn my beautiful, lovely,

active wife into a zombie.

The curtains were always shut.

The bed was always unmade,

because I was always in it, sleeping.

It was heartbreaking because the girls used to say,

"Where's our mum?

"She's not... she's not here any more."

Yeah, I felt like a drug addict.

Every day was the same.

And it was just sleep, wake, eat...

...toss and turn, get up.

Sleep, eat.

I felt like there was no hope.

You want it to help, do you know what I mean?

So you kind of...

...tell yourself it's working.

And it's only people around you say, "Nothing's changed, Karen,

"if anything, now you're mindless."

Long-term opioid use put people like Karen at risk of constipation,

memory loss, addiction, even accidental death by overdose.

And perhaps the most startling finding of the Public Health England

report is that over half a million people have been on opioids

continuously for more than three years.

Doctors have over 40 different opioid painkillers

at their disposal.

Most can be picked up from one of Britain's 11,000 pharmacies,

like this one in south London.

Akash, here?

Just round there? Lovely, thank you. Hi there.

Hi, Akash, Michael Mosley, hello.

Nice to meet you.

Akash Patel is a pharmacist who's agreed to show me

just how powerful opioids can get.

He says all of them are safe if used correctly,

but dangerous if misused.

That's the weakest, which is bog-standard co-codamol

that you can buy over the counter. OK.

The codeine in co-codamol is mixed with paracetamol.

It can be bought from a pharmacy without a prescription.

Even at this strength, codeine can be addictive.

But just how powerful do opioids get?

Akash has offered to demonstrate, using pills to show different

opioids' relative strengths.

OK, so that represents one pill. Yeah.

Yeah, OK, what's next?

Moving on to some codeine, 30 milligrams,

that you can only get on a prescription. OK.