Tag Archives: doctors’

Charlie Gard doctors can stop providing life support, court rules

A couple who want to stop doctors taking their baby son off life support so they can take him to the US for treatment could take their case to the supreme court.

Appeal court judges ruled on Thursday that doctors could stop providing treatment nine-month-old Charlie Gard, who is being kept on a ventilator at Great Ormond Street hospital in London.

Chris Gard and Connie Yates had sought to keep their son alive long enough to travel with him to the US for experimental treatment that may prolong his life.

Lawyers representing the couple told appeal court judges that they would like the supreme court to consider the case.

Connie Yates and Chris Gard.


Connie Yates and Chris Gard. Photograph: Gareth Fuller/PA

Charlie, who was born on 4 August last year, had a form of mitochondrial disease that causes progressive muscle weakness and brain damage. He can only breathe through a ventilator and has been fed through a tube.

Lord Justice McFarlane, Lady Justice King and Lord Justice Sales analysed evidence at a court of appeal hearing in London. A high court judge last month ruled against a trip to the US, and in favour of Great Ormond Street doctors who said they believed it was time to stop providing life support for Charlie.

Richard Gordon QC, who led Charlie’s parents’ legal team, told the appeal court judges that the case raised serious legal issues, including the possibility that Charlie might be being unlawfully detained and denied his right to liberty.

“They wish to exhaust all possible options,” Gordon said in a written outline of Charlie’s parents’ case. “They don’t want to look back and think ‘what if?’. This court should not stand in the way of their only remaining hope.”

Gordon said judges should not interfere with the exercising of parental rights and added: “What is really at stake in this case is the state, on a massive scale, intruding in your right to private and family life.”

But Katie Gollop QC, who led Great Ormond Street’s legal team, suggested further treatment would leave Charlie in a condition that gave him “no benefit”. The therapy proposed in the US was “experimental” and would not help Charlie, she said.

“There is significant harm if what the parents want for Charlie comes into effect,” she told the appeal judges. “The significant harm is a condition of existence which is offering the child no benefit.”

Gollop said nobody knew whether Charlie was in pain, “because it is so very difficult because of the ravages of Charlie’s condition. He cannot see, he cannot hear, he cannot make a noise, he cannot move.”

After the judges upheld the ruling, Lord Justice McFarlane praised Charlie’s parents for their composure and dignity, and said: “My heart goes out to them.”

Charlie Gard doctors can stop providing life support, court rules

A couple who want to stop doctors taking their baby son off life support so they can take him to the US for treatment could take their case to the supreme court.

Appeal court judges ruled on Thursday that doctors could stop providing treatment nine-month-old Charlie Gard, who is being kept on a ventilator at Great Ormond Street hospital in London.

Chris Gard and Connie Yates had sought to keep their son alive long enough to travel with him to the US for experimental treatment that may prolong his life.

Lawyers representing the couple told appeal court judges that they would like the supreme court to consider the case.

Connie Yates and Chris Gard.


Connie Yates and Chris Gard. Photograph: Gareth Fuller/PA

Charlie, who was born on 4 August last year, had a form of mitochondrial disease that causes progressive muscle weakness and brain damage. He can only breathe through a ventilator and has been fed through a tube.

Lord Justice McFarlane, Lady Justice King and Lord Justice Sales analysed evidence at a court of appeal hearing in London. A high court judge last month ruled against a trip to the US, and in favour of Great Ormond Street doctors who said they believed it was time to stop providing life support for Charlie.

Richard Gordon QC, who led Charlie’s parents’ legal team, told the appeal court judges that the case raised serious legal issues, including the possibility that Charlie might be being unlawfully detained and denied his right to liberty.

“They wish to exhaust all possible options,” Gordon said in a written outline of Charlie’s parents’ case. “They don’t want to look back and think ‘what if?’. This court should not stand in the way of their only remaining hope.”

Gordon said judges should not interfere with the exercising of parental rights and added: “What is really at stake in this case is the state, on a massive scale, intruding in your right to private and family life.”

But Katie Gollop QC, who led Great Ormond Street’s legal team, suggested further treatment would leave Charlie in a condition that gave him “no benefit”. The therapy proposed in the US was “experimental” and would not help Charlie, she said.

“There is significant harm if what the parents want for Charlie comes into effect,” she told the appeal judges. “The significant harm is a condition of existence which is offering the child no benefit.”

Gollop said nobody knew whether Charlie was in pain, “because it is so very difficult because of the ravages of Charlie’s condition. He cannot see, he cannot hear, he cannot make a noise, he cannot move.”

After the judges upheld the ruling, Lord Justice McFarlane praised Charlie’s parents for their composure and dignity, and said: “My heart goes out to them.”

Charlie Gard doctors can stop providing life support, court rules

Doctors can stop providing life-support treatment to a sick baby who is being kept on a ventilator at Great Ormond Street hospital, appeal court judges have ruled.

The decision comes after a legal battle by Chris Gard and Connie Yates, who had sought to keep their son, Charlie Gard, alive long enough to travel with him to the US for experimental treatment that may have prolonged his life.

Connie Yates and Chris Gard.


Connie Yates and Chris Gard. Photograph: Gareth Fuller/PA

Charlie, who was born on 4 August last year, had a form of mitochondrial disease that causes progressive muscle weakness and brain damage. He can only breathe through a ventilator and has been fed through a tube.

Lord Justice McFarlane, Lady Justice King and Lord Justice Sales analysed evidence at a court of appeal hearing in London. A high court judge last month ruled against a trip to the US, and in favour of Great Ormond Street doctors who said they believed it was time to stop providing life support for Charlie.

Richard Gordon QC, who led Charlie’s parents’ legal team, told the appeal court judges that the case raised serious legal issues, including the possibility that Charlie might be being unlawfully detained and denied his right to liberty.

“They wish to exhaust all possible options,” Gordon said in a written outline of Charlie’s parents’ case. “They don’t want to look back and think ‘what if?’. This court should not stand in the way of their only remaining hope.”

Gordon said judges should not interfere with the exercising of parental rights and added: “What is really at stake in this case is the state, on a massive scale, intruding in your right to private and family life.”

But Katie Gollop QC, who led Great Ormond Street’s legal team, suggested further treatment would leave Charlie in a condition that gave him “no benefit”. The therapy proposed in the US was “experimental” and would not help Charlie, she said.

“There is significant harm if what the parents want for Charlie comes into effect,” she told the appeal judges. “The significant harm is a condition of existence which is offering the child no benefit.”

Gollop said nobody knew whether Charlie was in pain, “because it is so very difficult because of the ravages of Charlie’s condition. He cannot see, he cannot hear, he cannot make a noise, he cannot move.”

Doctors’ leaders accuse ministers of ‘callous disregard’ for the NHS

Ministers are guilty of “callous disregard” of the NHS and have put its funding into “deep freeze”, doctors’ leaders claim in a sharply worded attack on the Conservatives’ stewardship of the health service. The government must plug “the enormous funding gap” in healthcare spending between Britain and other major European countries, the British Medical Association says.

Dr Chand Nagpaul, chair of the BMA’s GPs committee, is to tell a conference of family doctors on Thursday that the NHS “has been paralysed by the vote for the UK to leave the European Union”.

“Far from the pledged investment of an extra £350m per week, audaciously plastered on double decker buses, the reality is we’ve been cheated with the opposite: a deep-freeze in NHS spend, continued savage austerity cuts, and with politicians turning a blind eye to the spiralling pressures affecting the entire health and social care system, in which even the 18-week target, laid down in the NHS constitution, is being allowed to be breached,” Nagpaul will say.

In addition, GP services are under such pressure and beset by such serious understaffing that they are “on the brink of collapse”.

Norman Lamb, the Liberal Democrats’ health spokesman, said: “Instead of £350m a week for the NHS, under the Conservatives we’ve seen the health service being gradually run into the ground. The NHS cannot take five years of a Conservative landslide that would give Theresa May free rein to cut services further at your local hospital.”

Meanwhile, the Health Foundation thinktank has warned the prime minister that the operation and future of the NHS and the social care system are at risk because of serious and deepening staff shortages.

Urgent action is needed, the thinktank says, because 900 people a day are quitting as social care workers, too few new recruits are joining the sector, and the workforce is struggling, with 80,000 vacancies.

Popularity of sushi has brought rise in parasitic infections, warn doctors

From nigiri to temaki, sushi has boomed in popularity in the west, but now doctors are warning of a less appetising trend: a rise in parasitic infections.

A team of doctors from Portugal raised concerns after a 32-year old man was admitted to hospital complaining of pain in his abdomen just below his ribs, vomiting and had a slight fever, all of which had lasted for a week.

An endoscopy soon revealed the culprit: the larvae of a type of parasitic worm from the genus Anisakis. The doctors note that the condition, known as anisakiasis, is caused by eating undercooked or raw fish or seafood that has been contaminated: indeed, questioning of the patient revealed that he had recently eaten sushi.

After the larva was removed the man rapidly recovered, say the medics.

Two views of the parasite, seen here firmly attached to an area of the patient’s upper gastrointestinal tract.


Two views of the parasite, seen here firmly attached to an area of the patient’s upper gastrointestinal tract. Photograph: Carmo et al/BMJ case reports

Writing in the journal BMJ Case reports, the team warn that with sushi in vogue in the west, awareness of anisakiasis is growing.

“Most of the cases were described in Japan due to food habits; however, it has been increasingly recognised in western countries,” the authors write, pointing to a Spanish study that reported 25 cases of the condition over a three year period from 1999 to 2002, with all patients having eating raw anchovies, as well as Italian research which flagged both anchovies and sushi as routes by which individuals could become infected.

The Italian study added that medical professionals should suspect the condition should patients complain of severe abdominal pain after eating raw fish, pointing out that “no effective pharmacological treatment is able to kill the larvae once eaten”.

Indeed, as the US Center for Disease Control and Prevention notes, “The treatment for anisakiasis may require removal of the worm from the body by endoscopy or surgery.”

The authors of the latest report add that besides the symptoms shown in the Portuguese case, the condition can also trigger a host of other symptoms including severe allergic reaction, as well as complications such as digestive bleeding, bowel obstruction and peritonitis.

The Food Standards Agency noted that raw fish occasionally contain parasitic larvae, but said that under European food hygiene legislation fish that is to be eaten raw should be frozen before it is sold to consumers to ensure any parasites have been killed.

The FSA added that fish and meat should always be cooked properly according to the producer’s instructions, but offered a few tips to those planning to make their own sushi.

“If you do choose to make your own sushi from fish at home, ensure you follow a reputable recipe,” the FSA advised. “If wild fish are to be eaten raw or lightly cooked, ensure that all parts, especially the thickest part, have been frozen for at least four days in a domestic freezer at -15C or colder. This will ensure that any undetected Anisakis larvae are killed.”

Doctors owe it to patients to tell the truth: the NHS is in terminal decline | Rachel Clarke

Like church and state, medicine and politics are traditionally seen as a queasy mix. The last thing you want in your flimsy hospital gown is some zealot with a stethoscope trying to sway your vote. Doctors, at the bedside, should clearly stick to doctoring. But – in a world of ever more outlandishly spun health statistics – where, outside of clinical encounters, do the limits of doctors’ duty to act in our patients’ best interests lie?

I made the sobering discovery, in my first few weeks as a doctor, that serving patients in the modern NHS was at least as much to do with advocacy as medicine. It has to be, in a system that’s stretched beyond breaking point. With resources so scarce, speaking out counts.

Once, I actually stalked a professor, in sheer desperation to provide an inpatient with decent care. He did a double take at the steely-eyed junior doctor, sat perched outside his clinic, fired up to plead her patient’s case. With everyone run ragged, overwhelmed by patients, no one had believed me or cared enough to act when I’d insisted my patient was suffering from a rare diagnosis, adult-onset Stills disease, that had left her heart swamped in fluid, her temperature soaring, her circulation so fragile it might need intensive care. “Please,” I begged. “Just see her for yourself.” As the pre-eminent professor of rheumatology in my hospital, he was the one man I knew who might act. And he did. He confirmed the diagnosis and whisked my patient off to his specialist care, possibly saving her life.

When almost every statistic about today’s NHS depicts a system quietly imploding around us, advocacy writ large has never mattered more. Doctors, like nurses, bear daily witness to the facts behind the spin. Our testimony is a vital corrective to a government hell-bent on airbrushing away the truth about today’s underfunded NHS. We look the patients in the eye as they languish on trolleys in hospital corridors. We apologise, shamefaced, to the families whose loved ones are stranded in hospital, because no social care exists to support their safe discharge home. We turn away the elderly who sob in A&E because the pain in their hip is beyond endurance, yet who haven’t even made it on to a waiting list for surgery. If we turned a blind eye and kept our heads down, would Hippocrates nod his assent?


Having to break bad news to a patient is never easy. But unflinching conversations are a cornerstone of good medicine

The state of the NHS in 2017 demands that doctors speak out about the human cost of underfunding since it clear our political leaders will not. Only this week, Theresa May made an election manifesto commitment of 10,000 more staff in mental health. Unfunded, needless to say, but also – more audaciously – a promise made on the back of the 6,700 mental health staff already culled since the Conservatives came to power in 2010. It’s this kind of political doublespeak that compels doctors to challenge loudly the government line that – despite the most brutal funding squeeze in NHS history – everything is going swimmingly.

In microcosm, we already know what happens when cost-cutting is prioritised above patient care. The scandal of Mid Staffs – a stain upon the history of the NHS, in which patients in their thousands were subjected to inhumane care – arose when one hospital trust strove to slash costs by millions. Yet currently, the government is enforcing £22bn of “efficiency savings” across the NHS, while insisting excellence of care can somehow continue.

Doctors should call out this claptrap for what it is. We are, after all – perhaps more than anyone – trusted to tell unpalatable truths. In this case, the hard medicine is more taxes. A world-class health service requires world-class funding. Either we provide the budget to fit the health care we want, or we cut the NHS to fit the amount we’re willing to spend on health. With a government too cowardly to confront this simple truth out loud, doctors should force an honest debate.

Yet – with a few notable exceptions (Taj Hassan and Neena Modi, for example, the presidents of the Royal Colleges of Emergency Medicine and of Paediatrics and Child Health respectively), the medical establishment is loath to rock the boat. Where is the joint statement from the Royal Colleges, for instance, urging increased taxation to bring our NHS and social care spend to at least the levels of Germany and France? Where are the hospital medical directors brave enough to speak out in public against the ever more fanciful diktats from on high to keep on delivering as their funding dries up?

Having to break bad news to a patient is never easy. But unflinching conversations are a cornerstone of good medicine. Nationally, doctors should be telling it like it is: without more money, our NHS is in relentless, terminal, and wholly avoidable decline.

Doctors partly to blame for opioid addiction | Letters

Only a week ago I told a patient there would be a scandal soon about our over-prescribing of opioid medication for chronic pain. What comes across in your article (Doctors call for action after prescriptions for addictive painkillers double in decade, 6 May) is the absence of any sense of the profession’s complicity in this process. I suggested to a colleague a few years back that we prescribed too much Valium (diazepam) and opioids. “About the same as everyone else,” was the reply. We are effectively legalised pushers and should acknowledge this because, in doing so openly with patients, we shoulder some of the blame for their habit. I also remember helping a woman in her 50s wean herself off diazepam, alcohol, co-codamol, antidepressants and cigarettes after 30 years of using these to block the pain of her second son being born with cerebral palsy and being taken into care. It was a struggle for her but it brought her back into her relationship with her husband: a few months later he tearfully related how he had re-met the woman he married 30 years before. This was only possible – I believe – because, at the outset, I said that it was we doctors who were responsible for her addiction.
Dr Hugh van’t Hoff
GP, Stonehouse, Gloucestershire, and director of Facts4Life

As someone living with lifelong chronic pain, I was interested to read your article highlighting that opiate use had doubled in the last decade with associated risks of addiction and dependency. While I agree this is worrying, I would argue that it reflects the dominant biomedical model of pain management within the NHS. There is little or no science involved in matching an individual patient with the complex range of painkillers available. It is largely a case of try it and “see how you get on”. I have been on dozens of painkillers, including opiates, throughout my life. I found most have unbearable side-effects and limited impact on my pains. We need a holistic approach to pain that can offer comprehensive individual assessments and access to a wide range of treatments. Opiates and other painkillers can have an important but not a primary role in pain management.
Martin Hoban
Pontyclun, Rhondda Cynon Taff

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Fashion models in France need doctor’s note before taking to catwalk

Fashion models in France will need to provide medical certificates proving they are healthy in order to work, after a new law was introduced banning those considered to be excessively thin.

A further measure, to come into force on 1 October, will require magazines, adverts and websites to mark images in which a model’s appearance has been manipulated with the words photographie retouchée (retouched photograph).

Doctors are urged to pay special attention to the model’s body mass index (BMI), a calculation taking into account age, height and weight. However, unlike similar legislation passed in Italy and Spain, models will not have to reach a minimum BMI.

Under World Health Organisation guidelines an adult with a BMI below 18.5 is considered underweight, 18 malnourished, and 17 severely malnourished. The average model measuring 1.75m (5ft 9in) and weighing 50kg (7st 12lb) has a BMI of 16.

Announcing the introduction of the new rules on Friday, France’s health minister said they were aimed at preventing anorexia by stopping the promotion of inaccessible ideals of beauty.

“Exposing young people to normative and unrealistic images of bodies leads to a sense of self-depreciation and poor self-esteem that can impact health-related behaviour,” the health and social affairs minister, Marisol Touraine, said.

Given Paris’s iconic role in the fashion industry, the measures – passed in 2015 but only just coming into effect – are likely to have a symbolic impact around the world.

The proposals had originally suggested a minimum BMI for models but, following an outcry from fashion executives and modelling agencies, this was ditched in favour of allowing doctors to decide whether a model is too thin.

Agencies who use models without valid medical certificates will face a fine of €75,000 (£54,000) and staff face up to six months in prison. Failing to flag-up retouched images will incur a fine of €37,500, or up to 30% of the amount spent on the advert.

Fashion models in France need doctor’s note before taking to catwalk

Fashion models in France will need to provide medical certificates proving they are healthy in order to work, after a new law was introduced banning those considered to be excessively thin.

A further measure, to come into force on 1 October, will require magazines, adverts and websites to mark images in which a model’s appearance has been manipulated with the words photographie retouchée (retouched photograph).

Doctors are urged to pay special attention to the model’s body mass index (BMI), a calculation taking into account age, height and weight. However, unlike similar legislation passed in Italy and Spain, models will not have to reach a minimum BMI.

Under World Health Organisation guidelines an adult with a BMI below 18.5 is considered underweight, 18 malnourished, and 17 severely malnourished. The average model measuring 1.75m (5ft 9in) and weighing 50kg (7st 12lb) has a BMI of 16.

Announcing the introduction of the new rules on Friday, France’s health minister said they were aimed at preventing anorexia by stopping the promotion of inaccessible ideals of beauty.

“Exposing young people to normative and unrealistic images of bodies leads to a sense of self-depreciation and poor self-esteem that can impact health-related behaviour,” the health and social affairs minister, Marisol Touraine, said.

Given Paris’s iconic role in the fashion industry, the measures – passed in 2015 but only just coming into effect – are likely to have a symbolic impact around the world.

The proposals had originally suggested a minimum BMI for models but, following an outcry from fashion executives and modelling agencies, this was ditched in favour of allowing doctors to decide whether a model is too thin.

Agencies who use models without valid medical certificates will face a fine of €75,000 (£54,000) and staff face up to six months in prison. Failing to flag-up retouched images will incur a fine of €37,500, or up to 30% of the amount spent on the advert.

‘Unnecessary’ painkillers could leave thousands addicted, doctors warn

Powerful and potentially addictive opiate painkillers are being handed out too readily, leading doctors have warned after it emerged that the number of times the drugs are being prescribed in the UK has doubled in the past decade.

The Faculty of Pain Medicine and the Royal Pharmaceutical Society said they were worried about the high and growing use of opioid drugs such as codeine and tramadol – while other experts warn that hundreds of thousands of patients could be addicted to them.

Dr Barry Miller, dean of the Faculty of Pain Medicine, said that the increase in the prescription rates of painkillers in the UK should be “met with concern”, adding: “While some of the increase can be attributed to an improved understanding of the effectiveness of these medications by medical professionals, we are concerned by reports of unnecessary prescription.”

NHS Digital figures released last week showed that prescriptions of opioids have doubled in the past decade, with the number of prescriptions issued rising from 12m in 2006 to 24m in 2016. One of the highest increases in prescriptions was for oxycodone, which shot up from 387,591 to 1.5m – a 287% rise – over that period. There was a 236% increase in prescriptions for morphine sulphate and a 143% rise for fentanyl.

“Our greater understanding of these medications can improve the quality of life for tens of thousands of patients in the UK living with complex pain. However, all NHS staff prescribing these medications need to ensure they are not doing more harm than good,” said Miller, whose organisation represents anaesthetists who specialise in the relief of acute, chronic and cancer pain.

rising rates of pain killer prescriptions

Doctors have warned about the numbers of people in Britain who may be addicted to these drugs as a result, with recent estimates suggesting over 192,000 could be dependent, partly because some medics prescribe them too readily.

In the US, since 1999 the number of overdose deaths involving opioids such as oxycodone, hydrocodone and methadone has more than quadrupled. The number of prescriptions of these drugs rose dramatically – from 76m to 219m a year between 1991 and 2011. This comes despite the fact there has been no change in the amount of pain Americans report.

Harry Shapiro of the DrugWise information service warned of the growing risks of addiction in the UK and said the growing prescription of painkillers was leading to a “public health disaster hidden in plain sight”. He is calling for more dedicated specialist centres to help people with painkiller addiction and also to help track the scale of the problem.

“People are not staggering around the streets and buying dodgy drugs off dealers, they are getting painkillers. It’s a problem hidden in plain sight – a problem in every GP surgery and pain specialist clinic,” he said.

Martin Johnson, clinical lead for chronic pain at the Royal College of General Practitioners, raised concern about the number of people who may be on repeat prescriptions. He said those with other conditions such as diabetes were monitored while on medication, but it doesn’t always happen for people with chronic pain. He called for an annual review, potentially conducted by pharmacists, to check in on those given these drugs. “So many say painkillers don’t do anything, but they keep getting prescribed them,” he said.

Many patients also reportedly use these drugs recreationally, obtaining them non-prescriptively after being introduced to them by their doctors. In Britain, there is less recreational use and most people are given opioids by their doctor for chronic pain.

Opioids act on different parts the brain and nervous system, including the spinal cord. The latter receives sensations from the body before sending them to the brain. Opioids work on this area to decrease feelings of pain, even after injury. One of the risks with the drugs is that they are addictive, with users complaining of withdrawal symptoms when they stop taking them.

But doctors say that while medications such as codeine can be effective for cancer patients and for tissue damage, they do not always help the growing number of patients now taking them for long-term pain. These drugs also have side effects such as severe constipation and dangerous sedation.

Dr Jane Quinlan, consultant in anaesthesia and pain management at Oxford University Hospitals NHS foundation trust, said: “For the majority of patients with chronic pain opioids don’t reduce their pain, but the side effects can significantly worsen their quality of life. Over time opioids can actually make people more sensitive to pain, she added.

One former user, who asked to remain anonymous, said: “I was prescribed tramadol for about three years for my ongoing back condition. I was addicted to them after a few months, it got to the stage where it became part of my routine. I suffered awful withdrawal when I stopped taking them. Without them my pain was overwhelming.”

Yasir Abbasi, a psychiatrist with Mersey Care NHS trust, said: “Being dependent or addicted to prescribed painkillers can lead towards a slippery slope of illicit behaviour, which can pave the way for hardcore drugs. There are not enough non-pharmacological interventions available to reduce our reliance on opioid medication.”

Cathryn Kemp, 45, from Hastings: ‘I ended up in rehab after taking 60 fentanyl lozenges a day’

Cathryn Kemp


Cathryn Kemp: ‘In the morning I would wake up, crawl to the bathroom and take six lozenges.’ Photograph: Andrew Hasson for the Guardian

I was working as a journalist when, after a period of illness, I was finally diagnosed with a disorder of the sphincter. I had lots of scary procedures to make me better. I was very ill and eventually discharged with a repeat prescription for fentanyl lozenges. I’ve since been told that fentanyl is 100 times stronger than heroin.

At the time, I was told to take a maximum of eight lozenges a day. I was also on fentanyl transdermal patches – 100mg ones, the strongest. That shows the level of pain I was in. Then one day I took an extra lozenge and after that my use of the drug spiralled.

Two years later I ended up in rehab after taking 60 lozenges a day – all of them on prescription from my GP. I kept thinking I was in loads of pain and needed more.

I felt like I was taking control of things, which is completely insane. I hid the problem brilliantly from my family and friends. I used to hide lozenges around the cottage where I lived, putting them in tampon boxes so no one would know how many I was taking. Taking fentanyl would make me woozy and then about an hour or two between doses I would go to withdrawal – vomiting, shaking and hallucinating.

In the morning I would wake up, crawl to the bathroom and take six lozenges. This would stop me shaking. I would then be well enough to get a cup of tea and then have to take six more. This would go on all day. The tiny bit of me that was still myself at this point knew I was abusing drugs, but I was afraid to stop as I feared living in pain again.

At this stage I was dangerously dependent. My GP said he would write me my last fentanyl prescription and I was forced to borrow lots of money from my parents and sell my cottage in order to pay for private rehab. My GP applied for NHS detox for me, but I was told that I was refused it because I wasn’t homeless and I wasn’t offending.

By then I knew going to die if I carried on so I did whatever it took to get help. Coming off it I had to go through a pain barrier. The body stops producing endorphins, the body’s natural painkillers, because it is receiving opiates instead.

I lost everything. I had to leave work because I was so ill. I lost my relationship, my career and my home – I lost everything I had built up over my writing career. I nearly lost my life.

I now run a charity dedicated to helping people cope with painkiller addiction. I haven’t come across anyone who has had such a complete breakdown like me. But I hear from lots of people, mainly women, who say they have kids to sort out and they cannot stop to have a pain condition. They think they have to keep going and so become trapped by the drugs they are taking.

What I am really hearing is the fact in the medical community there is still no support for dealing with these cases – no specific or very few specific resources to refer people too, so many are left hanging. We really need to engage NHS England in accepting that we need proper treatment services to deal with chronic pain as well as the addiction side.

It’s heartbreaking because it’s everyday people who are affected. We look at America and are horrified that opioid deaths are higher than deaths caused by car crashes. We do have a different system here, but estimates suggest hundreds of thousands of patients in the UK today are addicted to prescribed painkillers.