A grandfather today describes how he became hooked on powerful painkillers as GPs try to fight back against addictive opioid prescriptions.
It was 3am and a Lowestoft grandfather was alone, in a hotel far from home, experiencing the terrifying impact of withdrawal from opioid painkillers.
Sweating and shaking Steve Beamish, 64, had taken just one tablet less than his usual dosage to control his chronic pain.
It was then he knew he was an addict.
Mr Beamish, of Windward Way, started using fentanyl patches around eight years ago.
After suffering with polio as a child he battled with severe leg and back pain.
But the drug dramatically changed his personality and he did not notice the impact - or how dependent he was on the medication - until he decided to try to stop.
In 2018 Great Yarmouth and Waveney was the third highest area in the country for opioid prescriptions per 1,000 patients, although the number is falling.
Norwich, meanwhile, has the highest rate of deaths from heroin, an opiate, in the east of England.
Experts say four in five people who try heroin begin with prescription painkillers.
The most prescribed opioid drugs include tramadol, codeine and fentanyl.
Areas with higher rates of deprivation and more older people tend to have higher prescribing rates.
At Great Yarmouth and Waveney Clinical Commissioning Group (CCG), Michael Dennis is leading a campaign to cut the number of opioids prescribed.
'Some patients are reluctant,' he said. 'They know if they miss it for a day they feel rubbish. But you get to the stage where you're taking the dose to feed the addiction rather than to treat the pain.'
Mr Dennis said there was also a risk of death when taking opioids long term.
'It's not that uncommon,' he said. 'And there are some people out there who try to get hold of more and more.'
For Mr Beamish, it was his GP who stepped in to get him off opiods.
'She said 'it's got to stop' and I thought 'what the hell am I going to do?'.'
Mr Beamish did not believe her when she told him he was addicted but he agreed to try to come off the drugs.
That was when the reality of his addiction hit home.
'The doctor changed the prescription from patches to lots of little pills to wean me off,' he said.
The doctor told him to not cut his dose too quickly, but while on a trip away for work Mr Beamish decided to drop one of the 10 tablets he was taking.
'I laid in bed that night and shook like a leaf,' he said. 'It was just like when you see drug addicts on the TV. I knew then she (the doctor) was right.
'It was 3am, you are in a hotel, on your own. I was so frightened I had to take another one to top myself back up.'
Eventually Mr Beamish did manage to free himself from the drug, but it took six months.
'I was determined as soon as I realised,' he said.
Now, he can see how the opioids changed him. 'My mood changed over the years,' he recalled. 'I was not sleeping at night. I've been married 40 years and I was not the man my wife married.'
Mr Beamish said he had become withdrawn and after work as an internal auditor he would come home, put pyjamas on, and sleep.
His wife Lorraine said: 'It became normal. I just thought he's taking these pills, or he's old. But when I look back it did pull me down as well, without me realising it.'
Mr Beamish recalled meals with colleagues where he would not take part in conversations, and he would not play with his grandchildren.
His boss even suggested he retired.
'I put it down to the pain,' he said. 'But I'm in the same amount of pain now as I was then; the difference is I'm not on opioids.
'I'm quite outgoing, but I just withdrew into myself, I couldn't be bothered to talk to anybody.'
Mr Beamish said although he still struggled, it was a case of making adjustments rather than relying on opioids.
'Now, I've come back to life, I smile again,' he said.
Mr Dennis from Yarmouth CCG said there used to be a belief that opioids were useful in managing chronic pain, but in recent years that had been debunked.
He said: 'They're really good in acute pain, so when you've say had a heart attack, but when you start to use it for a pain that's been there for around 12 weeks, it becomes less effective over a few days.'
He said patients then found themselves taking higher dosages to compensate and became addicted.
Dr Tim Morton, who is based at Beccles Medical Centre, is the chairman of Norfolk and Waveney Local Medical Committee (LMC).
He said: 'It's [about] recognising the problems they've had in the States. They've had a decade of rising opiate prescriptions and rising deaths.'
Dr Morton said one of the issues was although opioids were not an effective long term pain killer, there was sometimes little alternative.
'GPs will be slated as being the bad guys for prescribing these, but they are not handed out like Smarties,' he said. 'These are dangerous drugs, but they're not terribly good painkillers anyway, for long term pain control, but there's a lack of alternatives.'
Vicki Markiewicz, director of charity Change, Grow, Live (CGL), which provides drug and alcohol treatment in Norfolk, said: 'It's a really difficult one because if someone is in chronic pain they do need some kind of pain killer.
'It's the long term solution which is difficult.'
Although CGL had not yet carried out research in Norfolk on opioids, Ms Markiewicz said their studies had found people abusing fentanyl in Peterborough, so it was likely Norfolk addicts were also using the powerful drug.
It is fentanyl which has triggered the deadliest drug epidemic in American history. It is 50 to 100 times more powerful than morphine.
In Norfolk, CGL handed out more than 4,000 opioid overdose reversal kits between April 2018 and the end of the year.
Each kit contains five doses of naloxone – an opioid antagonist which can temporarily remove opioid receptors from the body – and 2,600 were returned used.
Last year chief inspector Sonia Humphreys, from Norfolk police, warned a grain of fentanyl in a heroin sample could be toxic enough to kill people.
The deaths seen by Norfolk Coroner's court in the last year also include both those abusing opioids, and those prescribed them.
Among those deaths were:
• Vincent Culyer, 50, who was dependent on opioids and was a known heroin user. He died on March 8 last year in Norwich and the inquest heard from his GP that from 2013 he had accidentally overdosed six times every year until his death.
• Candida Davis, 44, from Norwich died on November 8, 2018. Mrs Davis, who suffered with anorexia, had fractured her left femur and overdosed on meptazinol - an opioid used as a painkiller.
• Jean Killigrew, 77, was found dead at her home address in Rye Close, North Walsham by a carer on September 25, 2018. The primary cause of death was given as toxicity from meptazinol.
• Piers Wilski-Jaloszynski, a live-in doctor at the Queen Elizabeth Hospital (QEH) in King's Lynn, was found dead in his room by a colleague on February 20 last year. He suffered with chronic hip pain and died from an overdose of morphine he was taking to cope.
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