'More drug-related deaths in Northern Ireland involve prescription pills than illicit drugs ... that frightens me'
Last week it was revealed that TV presenter Anthony McPartlin had entered rehab to deal with prescription drug and alcohol problems. Ahead of his hard-hitting documentary screened on BBC 3 iPlayer today, Belfast photojournalist Adam Patterson writes about the menace of prescription drug abuse here at home.
There's a dark cloud sweeping across Northern Ireland. Five months ago I'd never heard of pregabalin, a prescribed medication used to treat epilepsy, nerve pain and anxiety. Nor did I know much about prescription medication addiction, or why Northern Ireland has the highest prescription rates in the UK.
Pregabalin, also known by the brand name Lyrica or the street name 'buds' because of reported effects similar to drunkenness, is the single most prescribed drug in Northern Ireland. Prescriptions have increased by 27% in the last six years. Only when beginning to make a BBC Three documentary back in February, did I realise the severity of Northern Ireland's dependence on prescribed medication. A dark secret no one is talking about.
I've built my career focusing on tough global stories. From covering trapped Chilean miners, to being tear-gassed in Israel, I've always believed in asking the tough questions about the world we live in. I now find it sadly ironic that the biggest surprise of all came from making a film about the place I call home.
Unlike the rest of the UK, more drug-related deaths in Northern Ireland involve prescription drugs than illicit drugs. When I read that sentence aloud, it frightens me. Another one has the same effect. More people are dying here from using medication like pregabalin and tramadol - an opioid-based painkiller - than on our roads.
How has this happened?
Prescribed medication is legal. It's developed, trialled and distributed under immense medical scrutiny. It's prescribed to the public after consultation with medical professionals. It's designed to help, and often does. So why is it appearing, with increasing frequency, on the death certificates of people from across Northern Ireland?
This film started when I visited Kenneth. I met him years before when he participated in a photographic project I made about north Belfast. Last February he had just been released from a prison sentence he was serving for GBH. I quickly learned he was taking a range of prescription drugs, including pregabalin. I knew little about the drug. Kenneth told me it made him feel normal, helping him to socialise by reducing his anxiety. I was alarmed when he confessed that he couldn't go outside without taking pregabalin.
I wondered how that had become his normality - a complete reliance on a particular medication. But as I soon learned, Kenneth is just one of many locked into a similar cycle of dependency.
Kenneth was raised in a loyalist estate deeply affected by sectarian violence. He was only seven years old when the Good Friday Agreement was signed. His story is representative of the legacy of the Troubles in Northern Ireland. Drugs were widely prescribed to people affected by the mental and physical trauma of the conflict. This helped spawn a culture of dependency on and abuse of prescription drugs, which is rife today, nearly two decades after the signing of a peace agreement.
This hangover from the conflict, and a continued paramilitary presence in some areas, has left a generation of youth, like Kenneth, with severe anxiety and other psychological complications. Alternative talking and behavioural therapies are available, but with pressure on the NHS, waiting times are often months. Prescription medication therefore remains the primary immediate response.
Kenneth called me on Easter Tuesday, when he had run out of his pregabalin prescription. The chemist, where he collects his weekly script, was closed. He was more anxious than usual. I arrived at his home and saw someone in real pain, a state of panic and desperation. He was grabbing his chest, explaining how he felt it was closing in, that the pain was also physical.
This was difficult to observe and, like many other moments while making the film, convinced me further of the severity of the issue. How have we, as a culture, come to accept prescription medication as part of our lives?
Kenneth managed to call an out of hours doctor and get an emergency prescription. I saw an immediate change in his behaviour the moment he realised he would get his pregabalin. And then the anxiety crept in again as he waited three hours for the doctor to call back and issue his dose. I considered for a moment if Kenneth - at just 27 years old - could live like this for ever.
I joined Kenneth as he collected his medication. I watched as he got into the car and snorted 200mg pregabalin in front of me. He explained that by snorting, the drug takes control more quickly. When he can taste it, he explained, his mind begins to relax, knowing the drug is already in his system.
Pregabalin is directed for oral use, but the snorting seems to be a by-product of addiction, and highlights the level of dependence in people like Kenneth. Through the film Kenneth is seen to battle how he takes his pregabalin, knowing he shouldn't take it through his nose, but finding this pattern of administration almost impossible to adjust.
To quickly understand the scale of prescription medication addiction, I spoke with many experts and drugs counsellors. This is common practice when making a documentary. When entering a world you don't know, consult with those that do. Everyone I spoke with knew about pregabalin.
I pressed further to understand why prescription drugs are so culturally accepted here. Unlike illegal drugs like heroin, some experts told me prescription meds are accepted as "necessary". The justification continues because young people are growing up with these drugs in their homes. Parents use them, and so children think, 'Well, if that's normal for others, it might be normal for me'. This normalisation has contributed to another disturbing trend. Young people are buying pregabalin illegally, on the streets and online. It's cheaper than cocaine or ecstasy and, in some places, easier to obtain.
A drugs outreach worker introduced me to Podraig and Brandon, two young men from a small town north of Belfast. They aren't prescribed pregabalin, but buy it on streets to mix with other drugs and alcohol. This rising trend of 'polydrugging' use has seen a surge of fatalities in recent years. I spent time trying to understand why young people are taking these drugs, and what they are trying to escape from.
Podraig has been taking Valium from the age of 12. In the film we see him having a bad experience from 600mg of pregabalin he has bought from a dealer.
Both Podraig and Brandon express regret at their drug taking. They understand the dangers and the consequences of addiction, but this still doesn't prevent them from repeating the cycle.
Addiction is a difficult thing to comprehend. During filming I would return home, trying to find answers. I often found myself in a dark place with no real understanding. The only conclusive thoughts I could find were that Podraig and Brandon, and to a degree Kenneth, are trying to escape. There's something about our society that makes them feel weak and exposed, and pregabalin seems to offer an alternative.
When it was first released, pregabalin was cited as a non-addictive drug without consequence. The drug has some real and important uses, assisting thousands of people here with chronic physical and physiological pain. Many are able to control their dose and use the medication to assist and improve their quality of life. Others are less in control of their consumption. However, some experts liken its addictive nature to that of heroin, and those trying to come off it suffer sleeplessness, sweating and other physical complications.
I met with the Hillman family from west Belfast. Their son, Daniel, took his own life in 2016, a few hours after buying pregabalin on the street. When the toxicology report came back, it showed that what Daniel thought was pregabalin was actually phenazapam, a powerful psychiatric painkiller.
His family says he was prescribed pregabalin, but his addiction led to him buying more illegally to feed his habit. They, like myself, struggle to understand why young people would gamble with buying tablets on the black market when they have no idea what's inside.
The Hillmans are remarkably strong. To let me into their home and to talk about such tragedy takes great courage, and films like this one can only work when people speak out in this way. They tried everything for Daniel, but in the end, they couldn't beat his addiction.
During the film-making process it transpired that prescription drug misuse was a nationwide issue. Not just in working-class inner city estates - often synonymous with addiction - but something that was striking right across society.
I travelled to Banbridge to speak with a custody sergeant working on the front line. Sharon told me that in the past four years she's seen a rise of roughly 80-90% of detained people, who are using prescribed medication at the time of their arrest.
She explained how this increase is placing a heavy burden on resources. When people are arrested having taken a cocktail of different drugs, they need to be kept on observation. This is to monitor their health, until a time when they can be interviewed by police. More police officers monitoring people in custody means fewer officers on the streets fighting crime. Sharon explained how staff are often abused and even spat at. When people are high on prescription drugs, she says, they often have little or no control over their actions.
After spending months making films about tough, emotional subjects, people often ask how I deal with it. The truth is I don't. I engage with raw testimony about things I never really understand. I then return home and try to process the things I've seen. Often this doesn't go well, and I lean heavily on close friends who offer support. Often my frustration comes from failing to comprehend what is going wrong with society.
Film-making is a strange job. The best I can hope for with this film is a better understanding of a very complex and difficult issue. I hope viewers take something away and that it encourages discussion and debate. For myself, I'm still looking for some kind of closure, but I'm more accepting now that we don't have to have all the answers when asking the important questions.
Adam Patterson's film Drugs Map of Britain: Belfast Buds launches today on BBC 3 iPlayer. Adam is a producer, director and photographer who has produced documentaries on drug addiction and teen gangs, the trapped Chilean miners in 2010, a BBC Panorama special following Syrian refugees 1,500 miles from Greece to Austria, and a film on Iran for Channel 4's Unreported World