Africa-Press – Uganda. The recent surge in the loss of young medical doctors in Uganda has illuminated the issue of opioid abuse in the country’s healthcare industry.
Opioids are prescription drugs used to treat moderate to severe pain. They have recently emerged as a silent killer, stealthily infiltrating the ranks of medical officers, claiming lives, and leaving behind a trail of grief and unanswered questions. Their latest victim is a general practitioner and public health specialist whose life was tragically cut short by the very drugs meant to alleviate suffering.
The doctor’s demise on December 8 adds to a grim tally, with three other medical doctors succumbing to opioid abuse in November alone. This development serves as a stark reminder that the opioid epidemic is not confined to the streets, but has permeated the very institutions dedicated to healing.
Opioids belong to a class of drugs that derive from, or mimic, natural substances found in the opium poppy plant. They work in the brain to produce a variety of effects, including pain relief, and their addictive nature is termed opioid use disorder. While their efficacy in managing pain is undeniable, the increasing abuse among medical professionals raises disturbing questions about the safeguards in place and the mental wellbeing of those entrusted with the care of others.
An April investigation by this newspaper revealed that on average, five out of 15 individuals checking into Butabika National Referral Mental Hospital’s alcohol and drug unit each month grapple with some form of opioid addiction. The investigation further unveiled that a staggering 90 percent of the average five individuals per week battling opioid addiction are health workers.
Dr Byamah Mutamba, a senior consultant psychiatrist who heads the alcohol and drug unit at Butabika, termed the trend an emerging crisis that necessitates immediate and appropriate intervention.
Roots of the crisis
As the medical fraternity grapples with this internal crisis, experts point to several factors contributing to the opioid epidemic within their ranks.
Dr Herbert Luswata, the president of the Uganda Medical Association (UMA), says the demanding nature of the profession, long hours, high stress, and the constant exposure to human suffering can create an environment ripe for substance abuse, opioids inclusive.
Several factors could place healthcare workers at an increased risk of drug overdose and death. Those who prescribe or administer medications have ready access to opioids and other controlled prescription drugs. They also frequently experience job stress and occupational burnout, all of which have been associated with an increased risk for opioid use disorder.
Many healthcare workers also routinely perform physically strenuous tasks that can lead to injuries, resulting in opioid prescriptions to manage pain and attendant risks.
Enter Pethidine
Dr Luswata notes that recent opioid-related deaths within their fraternity can be traced to Pethidine – a synthetic opioid that belongs to the phenylpiperidine class. It has a less potent and shorter-acting analgesic effect, usually lasting for two to four hours.
He notes that since opioids are medically prescribed to patients with severe pain, some medical workers battling addiction or those who have succumbed to its cruel hand previously underwent conditions like major surgeries and fatal accidents, making them prone to opioid usage.
“Since these drugs are used on them during their severe pain times, they resort to continuing with them in their palliative care times when they are weaned off these drugs, and in the long run, they get addicted to them,” Dr Luswata notes, adding that some choose to use them for a better feeling with the intention of returning to their work errands early enough before the stipulated time of rest.
Opioids can make your brain and body believe the drug is necessary for survival. As you learn to tolerate the dose you’ve been prescribed, you may find that you need even more medication to relieve the pain or achieve well-being. This can lead to dependency. Addiction takes hold of our brains in several ways, and is far more complex if less forgiving than many people realise.
Easy access
Although prescription pain relief drugs, where opioids belong, are not supposed to be accessed over the counter with absurd ease, they are readily accessible by either drug dealers on the black market or unsupervised medical outlets without the right professionals.
Per Dr Luswata, these opioids are under a lock and key surveillance system in authentic medical facilities, making it hard for colleagues to easily access them from their medical facilities. He adds that health professionals, given their knowledge in the field, tend to look the other way in issues like drug use even when professionally they are not supposed to treat themselves or prescribe medicine for themselves.
In incidents like those of opioid usage, Dr Luswata notes that they do it in hiding, and before they know it, they are overprescribing or getting addicted to the drugs.
Additionally, junior medics, per Luswata, have also been prone to this abuse of opioids. He explains that unlike medics who abuse opioids with a background of severe pains due to surgeries and accidents, the junior colleagues resort to opioids for euphoria sense of heightened wellbeing.
This, he notes, has been a result of stress that usually results from overworking, tight schedules, and time spent during advanced training far away from home as they further their studies. Dr Luswata adds that during this period of their career, the upstarts literally have no time for social life, and some end up missing their families, among other things stress throws at them.
Call to action
A call for a comprehensive approach to tackle opioid and other drug-related abuse within the medical community is growing louder. The need for enhanced education on recognising the signs of addiction, implementing support systems, and prioritising mental health has become paramount.
“The pressure to excel, the emotional burden of dealing with life-and-death situations, and the relentless demands can lead individuals to seek solace in substances, unwittingly spiralling into addiction,” says Dr Rebecca Mwanda, a psychiatrist specialising in addiction medicine.
One prevailing issue exacerbating the crisis is the stigma associated with mental health and substance abuse within the medical community. The expectation for doctors to be resilient and impervious to the struggles that plague ordinary individuals often results in the suppression of personal challenges.
“We need to recognise that doctors are human too, susceptible to the same challenges as anyone else. Creating a supportive environment where seeking help is encouraged can be a crucial step in preventing further tragedies,” Dr Mwanda says of the need to de-stigmatise seeking help within the medical profession.
UMA has put together a health subcommittee that offers a variety of services to medical officers. The issue, per Dr Luswata, casts a sombre light on a broader issue—the need for systemic change within the healthcare system. A re-examination of prescribing practices, stringent monitoring of medication distribution, and the cultivation of a compassionate and understanding work environment are integral components of a multi-faceted solution.
“Let the welfare of medics be taken care of to the dot. Issues like allowances, leave, being listened to, among many others, should be given priority by authorities and superiors to ensure the wellbeing of the medics,” he said.
Medical institutions are being urged to re-evaluate the pressures placed on their staff, fostering a culture that promotes wellbeing over relentless productivity. The implementation of counselling services, confidential support networks, and proactive mental health check-ins are seen as crucial steps in preventing future tragedies. The healing profession must now turn its gaze inward, acknowledging the vulnerability of its members and forging a path towards a healthier, more compassionate future.
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