A mother who had beaten her family apart when she became addicted to opioids has begun her ongoing struggle with the prescribed medicine.
Carmall Casey, 51, was prescribed opioids for the first time 10 years ago after being injured in jumping a truck on a dairy farm in Tasmania.
As she stuck the first patch on her skin, it felt like heaven.
& # 39; I became addicted without knowing it & # 39 ;, she says.
The doctor had increased the dose when the pain from her injury returned, but the side effects were hell-depression, anxiety, panic attacks. And her pain got worse.
She saw other doctors desperately. They sent her away with more recipes for more opioids: fentanyl, codeine, oxycodone, tramadol, buprenorphine, tapentadol, Targin.
In the past decade she has tried to stop the painkillers. She would take them back to the pharmacy and dump them in the sink.
She suffered from the nightmares and the withdrawals. But in the end the pain would become unbearable, so she would take the medication again.
Carmall Casey, 51, (photo) first got prescribed opioids 10 years ago after being hurt by jumping a truck at a dairy farm in Tasmania
Carmall Casey (right) is comforted by friend, Jake Marshall, while visiting her home in Black River, Tasmania, Australia
Casey eventually lost her farm.
But worse, she says, she has lost her daughter.
She made poor drug choices, now admits them, and lives with a fleeting man who started bullying her daughter, then 14, so she sent her to live with her father.
It's a decision that tears them apart and Casey still tears apart today.
She is not alone in her struggle. Australia has failed to pay attention to the lessons of the United States and is now facing sky-high rates of opioid prescriptions and related deaths.
Coroner nationwide have long urged officials to tackle Australia's balloon-addictive opioid addiction and create a tracking system to prevent people from collecting multiple prescriptions from multiple doctors.
But while thousands died, the hearers' arguments were largely answered with silence.
& # 39; For what it's worth, I add my voice to the choir arguing for urgency & # 39 ;, wrote coroner Barry King from Western Australia in his report, which was delivered in May.
Pharmaceutical companies being watched for their aggressive marketing of opioids in America have turned their attention to overseas and bypassed marketing regulations to push painkillers in other countries.
And just like with the US, the Australian government is also slow to respond to years of warnings from concerned health experts.
In dozens of interviews, doctors, researchers, and Australians whose lives were suspended by opioids described a situation that now extends from coast to coast.
Australia's death rate from opioids has more than doubled in just over a decade.
And health experts are worried that without urgent action Australia is moving towards an even steeper peak in deaths such as those in America, where the epidemic has left 400,000 dead.
Carmall Casey finds an old suit of tapentadol while walking through her box of medicines in her kitchen in Black River, Tasmania
Carmall Casey is embraced by Maxine Piper, an old friend and a source of support by Casey's addiction to opioids and struggle with chronic pain, in her home in Black River, Tasmania
On an island off the coast of Tasmania, Dr. Bastian Seidel and his colleagues & # 39; s immersed in what he called a & # 39; nightmare scenario & # 39; calls.
Two years ago, when he was president of the Royal Australian College of General Practitioners, Seidel called Australia's opioid problem a & # 39; national emergency & # 39 ;.
Today he wonders if anyone was listening.
& # 39; It is sometimes depressing to see how we practitioners have literally confused our communities & # 39 ;, he says.
& # 39; It is our signature on the scripts. But the pressure exerted by the pharmaceutical companies, by certain health sectors – that is the situation that we are now facing. & # 39;
Australia knows the extent of the problem, he says. The country knows that addiction is destroying its communities. And yet, he says, nobody does anything.
& # 39; Unfortunately in Australia we have followed the bad US example & # 39 ;, he says. & # 39; And now we have the same problem. & # 39;
AUSTRALIA OPIOID ADDICTION
Opioids were once reserved for the treatment of pain that was short-lived, terminal or cancer-related. But in the 1990s, pharmaceutical companies began aggressively marketing them for chronic pain.
From 2000, Australia started approving and subsidizing certain opioids for use in chronic, non-cancer pain. Those approvals coincided with a peak in the use of opioids, which nearly quadrupled between 1990 and 2014, says researcher Emily Karanges of the University of Sydney.
Dr. Jennifer Stevens, a pain specialist, saw the rise with astonishing clarity while working at St. Vincent's Hospital in Sydney.
A few years ago a hospital pharmacist told her to hire an extra person just to handle all the prescriptions they handed out for Endone, a brand of oxycodone.
Stevens discovered that the Endone prescriptions from the hospital had risen 500 percent in eight years, without decreasing other opioids provided.
& # 39; Imagine that you have weeks, months, 1 year, 2 years, 3, 4 toothache and it still hurts … the pain disappears to you, the drugs drive you crazy, & # 39; she wrote
Casey tried to leave the painkillers. She brought them back to the pharmacy and threw them down the sink
Further research showed that 10 percent of patients were still using opioids three months after surgery, although the drugs are generally only recommended for short-term use.
& # 39; We just pumped this stuff into our local community and thought it had no consequences, & # 39 ;, says Stevens, an advocate for changing opioid prescribing methods.
& # 39; And now of course we realize that it has huge consequences. & # 39;
Just like in the US, when opioid prescriptions increased, fatal overdoses also increased. Opioid-related deaths have increased from 439 in 2006 to 1,119 in 2016 – an increase of 2.2 to 4.7 deaths per 100,000 people, according to the Australian Institute of Health and Wellbeing.
Most of those deaths were related to prescription opioids and not to illegal opioids such as heroin.
More than 3 million Australians – one eighth of the country's population – receive at least one opioid prescription per year, according to the latest data.
The numbers and warnings may have been partially obscured because of Australia's scraps system for data collection and reporting, says Dr. Christian Rowan, an addiction specialist in the state of Queensland.
Data are reported by different states, coroners and agencies and often only contain prescriptions that have been entered through the government-subsidized drug system and not private prescriptions.
Carmall Casey walks past photos of her children hanging in her house next to a clock in the shape of Tasmania. As she struggled with her addiction, Casey lost her farm. Even worse, she says, she has lost her daughter. She has made bad choices for the medication, she now admits. She lived with a fleeting man who started bullying Sarah, so she sent her daughter, then 14, to live with her father
Carmall Casey, left, is visited by Jake Marshall, a friend who herself has recovered from an opioid addiction, in her home in Black River, Tasmania
& # 39; Because it is fragmented, people have no idea of what is happening, & he says.
The Australian government maintains that it is now taking the problem seriously.
The opioid codeine, which was previously available without a prescription, was available only by prescription in 2018.
And last month, the country's drug regulator, the Therapeutic Goods Administration, announced stricter opioid prescriptions, including limiting the use of fentanyl patches to cancer patients, in palliative care, or under & # 39; exceptional circumstances & # 39 ;.
& # 39; I can't speak for the past & # 39 ;, says Greg Hunt, who became the federal health minister in 2017.
& # 39; I can speak for my watch and my time when this was one of my absolute priorities, and that is why we have taken such powerful steps. My focus has been to ensure that we do not have an American-style crisis. & # 39;
But for Sue Fisher, whose 21-year-old son Matthew died of an overdose in 2010, it is too little, too late. The crisis is here, along with what they call a & # 39; crisis of ignorance & # 39; calls.
& # 39; We live in a country that is not aware of what is going on & she says. & # 39; Why don't we learn from America's mistakes? Why don't we learn? & # 39;
HOW THE GOVERNMENT SHORTLY fell
Former Australian soldier Matthew Tonkin suffered from a post-traumatic stress disorder when he became addicted to the prescribed medication.
He transferred at least four times before his death in 2014.
His father David Tonkin blames his son's death on the system that enabled him to see 24 doctors and get 23 different medicines from 16 pharmacies – all in the six month period.
Between January and July 2014, Matthew Tonkin received 27 recipes for oxycodone alone. The addiction that eventually ended Matthew's life began in 2012 after being wounded by the Australian army in Afghanistan.
When the 22-year-old arrived on leave at his father's house in the Western Australian city of Perth, he held up a stack of OxyContin pill strips. The drugs were prescribed by American doctors in Afghanistan for his injured hip and ankle.
& # 39; Look porridge, & # 39; he said. & # 39; The Yanks really know how to take care of you. & # 39;
Matthew was 14 kilograms (30 pounds) lighter than the last time his father had seen him.
David Tonkin has a photo of his deceased son, Matthew, in his room at their home in Perth, Australia, Sunday, July 21, 2019. The addiction that eventually ended Matthew's life began in 2012 after being injured during a training session while serving with the Australian army in Afghanistan. The pills were prescribed to him by American doctors in Afghanistan
David Tonkin looks at the coroner's report about his son Matthew, as Matthew & # 39; s friend, Ivo Kinshela, attributes in Perth, Australia, Sunday, July 21, 2019. Kinshela regards David as a father figure. He has been around the Tonkin family for a long time and lived with David and Matthew for three years when he was younger
He suffered a post-traumatic stress disorder due to the horrors of Afghanistan, including the death of his best friend, a fellow soldier. He also suffered from a growing addiction to opioids.
The addiction escalated after the army sent him to recover in Queensland, where doctors put him on an opioid called tramadol.
Matthew soon discovered how easy it was to get the prescriptions prescribed. He forged the signature of his doctor. He told a doctor that he had put a bottle of pills in the toilet and needed more.
In August 2013, another doctor prescribed more oxycodone for him after Matthew said he was suffering from PTSD and hip pain.
A few weeks later Matthew received his first overdose of oxycodone. A few months later he was released from the army.
A doctor called a hotline for medical professionals to report Matthew's apparent abuse of prescription drugs.
But when Matthew moved back to Perth to live with David, doctors couldn't know that his drug use was marked in Queensland.
He jumped around in clinics and collected prescriptions for opioids.
The doctors were largely unaware of what he was doing because Australia does not have a national, real-time prescription tracking system.
Bracelets recalling Matthew Tonkin, left, and his friend and fellow soldier, Robert Poate, are sitting on a table in the Tonkin House in Perth, Australia, Sunday, July 21, 2019. Matthew suffered from a post-traumatic stress disorder, a consequence of the atrocities that he has experienced in Afghanistan, including the death of his best friend, Poate. He also suffered from a growing addiction to opioids
David Tonkin walks past a mural decorated with the map of Australia and the word "Hope" in his neighborhood in Perth, Australia, Sunday, July 21, 2019. His son, Matthew, who died of an overdose of drugs, jumped from clinic to clinic, the collecting prescriptions for opioids and benzodiazepines, used to treat anxiety. The doctors were largely unaware of what he was doing, because Australia does not have a national, real-time tracking system for prescriptions
David begged Matthew's doctors and pharmacists to stop giving him OxyContin. Matthew just went to other doctors.
During a solemn meeting in honor of military personnel on 25 April 2014, two friends of Matthew had to keep him upright.
Back home after the service, David told Matthew to hand over his pills.
Matthew pushed David through the kitchen into the cupboard. Then he pushed his father to the ground and began to choke him.
David thought he was going to die.
Matthew finally let go and both men went to the hospital for treatment. Two days later Matthew called his father.
& # 39; Do you still love me, Dad? & # 39; he asked. And of course he did. So David kept trying to save him until July 3, 2014, when he returned from a walk and realized that Matthew had not come out of his room all morning.
Matthew had been ill the night before.
David had cleaned the vomit of his son's floor and changed his sheets. Matthew took a shower, thanked his father, and climbed into bed.
David entered his son's room.
Ivo Kinshela wipes a tear as he talks about his childhood friend Matthew Tonkin at the Tonkin House in Perth, Australia, Sunday, July 21, 2019. & Matt left Perth and Australia to Afghanistan, a very healthy, fit young man, and he came back broken, & Kinshela said. "And he came back broken and addicted to opioids & # 39;
David Tonkin strokes Ned, the cat of his son Matthew, who now sleeps on David's bed on the sleeping bag that Matthew used on Sunday, July 21, 2019 in Afghanistan, Perth, Australia. After Matthew died, and for years to come, David would suddenly wake up at 10 o'clock – the same time that Matthew called from Afghanistan. Now, instead of Matthew's voice, there is only silence. Just like the silence of the officials who, according to him, did little to prevent the death of his son
& # 39; Time to get up, mate. & # 39; There was no answer.
David put a hand on Matthew. His body was warm. But he had no pulse. David called an ambulance and started CPR. While he was pumping his son's chest, the coordinator counted the counts.
A. Two. Three. Four.
Nothing. Nothing. Nothing. Nothing.
Five. Six. Seven. Eight.
The conclusion of King, the coroner, was blunt: if a prescription tracking system had been introduced, Matthew would not have received the oxycodone that killed him.
King's findings about Matthew's death were delivered for at least a dozen years after the first coroner's reports began to warn of a growing opioid problem.
Already in 2007 a coroner had suggested that someone investigate why the opioid recipe on the island of Tasmania was so high.
Two states – Tasmania and Victoria – developed their own recipe tracking systems, but they only monitor opioid recipes within their respective states, and neither is currently mandatory.
The development of a national system has led to bureaucratic delays.
In 2017, the government pledged 16 million Australian dollars (US $ 11 million) to create one, and Hunt, the health minister, later said it would be ready by the end of 2018. It has yet to be rolled out.
In an interview, Hunt blamed the states. The national framework is ready, he said, but the states must connect to it.
In March 2019, coroner Harriet Grahame in New South Wales warned that the opioid deaths in Australia could reach many thousands in the next five years.
& # 39; We seem to have few coordinated strategies to address this issue & # 39 ;, Grahame wrote in a report.
& # 39; Reducing the number of opioid overdoses is clearly achievable, but it will require a government that is willing to listen to health professionals and act decisively on their advice. & # 39;
After Matthew died, and for years to come, David suddenly woke up at 10:00 pm – the same time Matthew always called from Afghanistan. Now, instead of his son's voice, there is only silence.
ARMS PAY THE PRICE
From her home in northwestern Tasmania, the 51-year-old Carmall Casey sees a system that, according to her, has driven her and so many others into addiction. It is a system that has made opioids the cheap and easy alternative for Australians, especially the poor.
Here in Tasmania there are echoes of the American Appalachia – in the rural towns, the poverty and the cascade of lives torn apart by pills that promised to take away the pain but ultimately created more.
This is the poorest state in Australia and, like Appalachia, is the epicenter of the country for opioids.
Tasmania has the highest percentage of opioid packages sold per person – 2.7 each. One region has the highest number of government-subsidized opioid prescriptions in Australia: more than 110,000 for every 100,000 people.
Casey still has the torn envelope on which she unleashed her fear as she fought her addiction.
& # 39; Imagine having weeks of pain, toothache for weeks, months, a year, two years, three, four, and it still hurts … the pain eats you away, the drugs drive you crazy, & # 39; she wrote.
In June she said to herself: enough. She gave the remaining pills back to her pharmacist.
She found a surgeon who took her seriously. And she got an appointment with a physical therapist who teaches her exercises to control her pain.
One late afternoon while she ran through a box of medicines in her kitchen. Suddenly she freezes. Inside is an old pack of tapentadol that she thought she had thrown away. She washes the pills by the counter.
She does not know what she will do when the pain returns. But she says she will never return to opioids.
& # 39; I'm not going back & # 39 ;, she says and starts crying. & # 39; I am not. & # 39;
The AP's report on the global opioid crisis is supported by a grant from the Pulitzer Center on Crisis Reporting. The Global Opioids project can be seen here.
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