By Jessica Jaganathan
News Reporter
jessicaj@sph.com.sg

 

POPPING a sleeping pill is usually a fairly innocuous thing done by many who are either stressed with their work or with their daily life. But for others, it becomes a nightmare when they need the pills to survive the day.

Patients recounted their tales of their desperate, and sometimes successful, attempts to get 30 tablets for their daily hit.

Some doctors have inadvertendly helped to fuel this demand.

At least for 18 doctors who were disciplined by the Singapore Medical Council for the past four years. This year alone, 19 cases are being investigated by the industry watchdog. Although current figures are not available, it was reported in 2005 that seven million sleeping pills are prescribed here every year.

This issue is not new. It came up in 2004 when eight doctors from the Grace Polyclinic chain were punished for indiscriminately prescribing addictive sleeping pills. In fact, it took some coaxing before doctors were even willing to talk to me on this topic.

Many general practitioners that I called from the phonebook said they did not want to comment before hurriedly putting down the phone. Some of the ones I knew said "this was a sensitive topic".

 So what is the appeal in these drugs, addictive when consumed for long term, that has caused some of these doctors to dish out them out so freely?

Profit margins can be quite substantial. A tablet of benzodiazepine - which is a class of drug used to treat insomnia and anxiety - costs a few cents but are sold for between 70 cents to $3 a tablet.

One patient told me that he managed to buy 30 erimin tablets at one go from a GP who did not ask him many questions. This would mean that the doctor could have gained $45 just for that one transaction.

 It could also be a question of experience. "Most experienced doctors will be able to tell when a patient is an addict when he walks in," said Dr Adrian Wang, a consultant psychiatrist in private practice. "When a patient comes in and straight away asks me for Dormicum or is not interested to work on his sleeping habits first, warning bells start going off as I know this could be an addict," said Dr Kenny Pang, a sleep specialist who preaches good sleep hygiene and habits for his patients.

The Health Ministry advocates physicians to spend time with patients asking for sleeping pills and assess and justify the need for these tablets.

But often, general practitioners are hard pressed for time to do so, said one GP who did not want to be named. "Quite frankly, doctors can be exploited by patients. Patients can give a good story on stress and insomnia and a doctor who is hard pressed for time will just issue the tablet and send them away," he said.

 The problem might not be as widespread in Western countries like United Kingdom, as patients would sue their doctors if they end up being addicted to the sleeping pills prescribed by their doctor, said Associate Professor Munidasa Winslow of the department of psychological medicine in the National University Health System (NUHS). "In Singapore, patients are incredibly compliant," he added.

 Of course, doctors are not to be blamed all the time. When there is a will there is a way for determined patients who want to get their hands on these pills. Often, they doctor-hop with some even having Excel spreadsheets of the different doctors they go to to get their pills, said Dr Winslow.

 It amazed me to hear one 50-year-old's story on the road to her addiction. Her son, playing truant from school during his "O" level period, caused her much anxiety and stress. The beautician started going to a psychiatrist who prescribed benzodiazepines to ease her distress. She slowly started getting addicted and "couldnt go without it", she said. She went to three different GPs in the same week telling one white lie after another and soon, she was taking up to ten tablets a day.

 Another 29-year-old Sales Executive told me that he would buy erimin-5 tablets whenever he was going clubbing to "get a high". When asked if he was an addict he replied without hesitation that he was not but in the same breadth said the most number of tablets he took at one go was 70!

 So can this problem be stamped before it gets out of control?

The Ministry of Health is reviewing guidelines on benzodiazepines and said it will be releasing them by end of the month.

When asking people in the profession on their suggestions to tackle this issue, the general consensus appeared to be self-regulation.

Many supported the idea of a central registry where doctors can key in patients' records which can be accessed by other physicians who will then be alerted if the patients are repeat customers.

 Medical Director of Raffles Medical Dr Chng Shih Kiat stressed on training of doctors in private practice, especially in the areas of behavioural therapy and psychotherapy to pick out the addicts.

Perhaps, the more plausible suggestion is patient education as Government Parliamentary Committee (GPC) for Health summed it up: "For insurance sales, for example, agents are required to explain basic information with clients before concluding the sale. Perhaps we should consider something similiar for certain prescriptions."

I, for one, am considering myself lucky to be one of the rare few who can sleep anywhere at anytime. So for now, I'm keeping the sleeping pill at bay.