Robby McMahon was 21 when the forklift he was driving at work tipped over. It was 1999 and the lower half of his leg was crushed. He went to the hospital; the bone was broken. He needed to have his leg reconstructed, skin grafts, the lot.
“Before my son broke his leg he was an outdoor person, he loved being outside. Sky diving, playing sport. He was working. He had a girlfriend. He was social,” Robby’s mother, Anna McMahon, told Mamamia.
While he was in hospital he contracted osteomyelitis, or an infection of the bone. For 18 months, while he fought this infection, the break could not fuse.
“His girlfriend broke up with him. He couldn’t work. He felt like he couldn’t do what he wanted,” Anna said.
“He was on high dose of antibiotics for the infection, and his doctor started giving him stronger medication to manage the pain. He was also on anti-depressants.
“Other than fixing his leg, he knew things would get better. He could see forward and see a future; he just didn’t know how he was going to get there.”
The infection Robby contracted in hospital meant he had to have bone-shortening surgery. It was better than amputation.
One day after the surgery, Robby asked Anna to take him to the doctors for a Pethidine shot. "He didn't like using pain medication, his preference was to only take Panadeine Forte," Anna said. "The day he asked for Pethidine, I knew he wasn't in pain. 'No', he admitted. He wanted the Pethidine to sleep."
Anna told the doctor the same thing. The doctor asked how she knew, and administered the shot. "I said to Robby, 'We need to find an alternative'."
Then, Robby went to a doctor who did not know his history. He did not want an alternative. Over the course of four weeks, he was given several repeat prescriptions for higher and higher doses of Morphine.
He died from an overdose leading to aspiration. He was 23.
"Morphine is an opioid that suppresses the respiratory centre. With a high enough dose, the automated part of the brain stem (telling you to breathe in and out) can be stopped completely," medical practitioner and an expert in opioids and benzodiazepines, Dr Hester Wilson, told Mamamia.
"When it stops, there is no oxygen flowing to the heart and the person dies. This can happen when the dose is too high, or when opioids are mixed with other sedatives such as alcohol, relaxants, anti-histamines (allergy medication) and anti-depressants. Most of the coroner's cases I see are combination cases."
Drug dependency is not something we think about; the same way we don't think about a forklift landing on us at work. It won't happen to me.
Too easily, we put medication dependency down to "addicts" or people who've somehow "chosen" that life.
"It's a stigmatised issue, but it could happen to anyone," Dr Wilson told Mamamia. "Medications act on the receptor sites in the brain. Over time, the body makes more receptor sites and more of the drug is needed to have the same effect."
It can happen to a 22-year-old forklift driver, a person at the very beginning of the rest of his life. It can happen to mothers and daughters and young people and older people. Now, it's happening more than ever.
In Australia, accidental deaths from pharmaceutical medications have doubled in the last decade, according to new statistics from the Alcohol and Drug Foundation (ADF). There are more Australians dying from pharmaceutical overdoses than from illicit drugs. Two thirds (69 per cent) of accidental drug-related deaths are caused by prescription medication.
Read that again: Two thirds of accidental overdoses are caused by prescription medication. And we don't hear anything about it.
These are not people constantly searching for their next hit. These are people who are taking a combination of medications - to manage pain alongside depression or anxiety or allergies or alcohol - without realising the combination is dangerous. These are people who've consulted a doctor and received a higher dose of medication. We have this idea: it's prescribed by a doctor, it must be safe.
In Australia, one in 20 women aged between 40 and 49 are taking pharmaceutical drugs for non-medical purposes. Likely, their use started out as being for medicinal purposes. These women - women in their 40s - are one of the groups at greatest risk of developing a substance abuse disorder while taking prescription medication.
"In Victoria, the effects of prescription medication cause more fatalities than people dying on the roads," Vice President of the Australian Medical Association (AMA) Dr Tony Bartone told Mamamia.
The road toll in Victoria in 2015 was 257. The same year, 358 people died from pharmaceutical overdoses, compared to 227 from illegal drug overdoses. "I suspect those figures can be reflected nationally. It is a significant problem that needs immediate attention," Dr Bartone continued.
As you can see, Robby's story isn't unique.
Soula Mantalvanos was 37 when she was sitting on a fit ball and it burst. She landed on concrete, hard.
"It was a split second. It was bone to concrete and it felt that way. I was in shock and then thought 'I can't move, I can't move'. Slowly, I turned over and crawled to the carpet," Soula told Mamamia.
Before then, Soula walked everywhere. She lived with her partner in the heart of Collingwood, Melbourne. They would walk to see friends, walk to dinner. Soula did yoga four times a week. She could hold a shoulder stand for eight minutes.
"I had a full life, creating art, working as a graphic designer, travelling overseas once a year. I had no limits. Now, my life is 30 per cent of that," she said. It's been 10 years since the fit ball burst.
Soula went to the doctor, was given pain medication and told to come back in eight weeks if the pain wasn't reduced. Yet it worsened.
"Nerve pain, of course, doesn't show on X-Rays," she said. "It took me four and a half years to receive an accurate diagnosis. The pain would come and go with no routine. I would be fantastic one minute; the next I was spasming, burning, couldn't function."
Soula damaged the way her pudendal nerve, which stems from the sacrum and is responsible for motor supply to the pelvic muscles, signals the brain. When she sits, drives, lifts something, or moves suddenly, the nerve creates pain signals for no reason.
"I tried Lyrica (anti-siezure medication), nerve inhibitors, Tramadol (an opiod)," Soula said. She couldn't work. She tried lying on her stomach on the studio floor, unable complete more than 15 minutes of work at one time.
"I took anti-depressants but these lowered my mood overall. My pain levels shifted constantly, and my GP told me to increase the dose of pain medication until it felt better."
Soula became dependent. "I shrunk as a person. The medication fogged my mind. I couldn't cross the road. I had to activate spell check on my phone. I didn't have the ability to think properly any more," she said.
"The most horrific part of this was the breathing. I would wake up in the middle of the night and realise I hadn't taken a breath in ages. I would take a huge breath and start to panic."
Dr Wilson calls this "non-fatal overdosing", and it can cause long-term damage.
"This is when people have overdosed on medication, but not died," she explains. "They've stopped breathing, or their breathing rate has been extremely low while sleeping, and they don't even realise it. Overtime, this kills brain cells and the individual's rational and cognitive ability becomes extremely impaired."
Beating drug dependency is different for everyone. Some people will never overcome opioid dependency, and they're left taking medication to manage their addiction for the rest of their life. There is no treatment for people dependent on benzodiazepines - relaxants such as Xanax and Valium - and staying on these medications for too long has been shown to drastically reduce quality of life.
"There is evidence that taking benzodiazepines for a long period of time can worsen sleep and increase anxiety," Dr Wilson said. This is ironic, given these are the symptoms benzodiazepine is often prescribed to manage.
"Long term use can also lead to people becoming oversensitive, so they can't stand light, their skin becomes overly sensitive, and noises are unbearable," she continued.
"There is no way to come off opioids and benzodiazepines without withdrawal symptoms. Some can shake dependency quickly, for others it will take months, years even. But withdrawal symptoms are inevitable."
The solution? It's complicated.
In Soula's case, she took herself to the doctor and asked to come off the medications. "This is not the path for me," she told her doctor. It took her several months to reduce her dependency. Now, she has a whole team of doctors to assist in pain management. She has an anaesthetist, a physiotherapist, a psychologist. She has a remote-controlled neurostimulator implanted in her pelvic cavity, which she can turn on and off to trigger different nerves to distract her from the pain.
But how many patients are likely to do the same?
"Most people don't even know they're dependent. They don't think there's a problem with medications prescribed by doctors," Ilka Burnham-King, spokesperson for the ADF, told Mamamia.
Burnham-King believes patient education and empowerment - like in Soula's case - will reduce the rate of accidental dependency. But to get there, our expectations of doctors need to shift.
"We are living in this culture where we go to a doctor and we feel like we need to come away with a prescription," she said. "We're prescribed pain medication for back pain. Relaxants if we can't sleep. These are not long-term solutions and we need to start looking at alternatives."
With enough awareness, patients are more likely to ask their doctor about different methods for managing pain; or to question the dosage; or to ask about prescription combinations and the risk of dependency and overdose.
"People with a family history of substance use disorder are at a greater risk of becoming dependent. Those with respiratory conditions such as asthma or emphysema are at a greater risk of overdose," Dr Wilson said. Robby, for example, also suffered chronic asthma.
"Yes, opioids and benzodiazepines are essential drugs with an important place in medicine. But patients need to understand these are band-aids for the pain, not solutions. Other methods - psychology, mindfulness, physiotherapy - are not only safer, they're also more effective."
Doctors need to do their bit, too.
"We need to be clear about discussing side effects with patients," Dr Bartone from the AMA said. And dependency is a known side effect of both opiate and benzodiazepine use, the same way rashes or vomiting or migraines are possible side effects of other medications.
"There're no specific regulations for what needs to be discussed with patients before they start taking prescription drugs," Dr Bartone continued.
The government also has a role.
According to Dr Bartone, "there should be more facilities to help patients who've become unnecessarily dependent". There is also the fact prescription medication is, in many cases, less expensive and more accessible than physiotherapists, psychologists and pain management clinics.
The Tasmanian and Victorian State Governments are leading the way. They've implemented real-time prescription monitoring, designed to prevent "doctor shopping" by those people who know they're dependent, and have no other option but to shop around.
"Real-time prescription monitoring allows general practitioners to know immediately what medications other doctors, in other parts of the state, have prescribed to this patient," Dr Bartone said. Before Tasmania rolled out the program in 2008, it had the highest rate per capita of Oxycontin (an opioid) use in the country. Now, it has the lowest.
"It's been shown to significantly reduce the rate of misadventure, overdose and fatalities on prescription drugs,' Dr Bartone said.
Another possible - more controversial - safeguard, could be the mandatory prescription of naloxone alongside opioid medication. Naloxone is the antidote to opioid overdose and it's commonly given to the family and friends of people who inject opioids in the form of heroin.
"Anytime we are prescribing opiods, we could consider prescribing naloxone and teaching the patient and their family how to administer the antidote in the event the patient stops breathing," Dr Wilson said. "If anything, this will increase awareness and drive home the fact; this medication can cause death."
Most of all, we need to stop turning away. These are not deaths we can put down to the "bad choices" of drug addiction. These are deaths of people who've followed the instructions of health professionals and, without their realising it, things have become undone.
Robby should never have been found slumped over in his friend's car, unable to be revived, because his body couldn't handle his medication.
One in 20 Australian women shouldn't be reliant on prescription medication, at risk of overdosing, because they either don't understand they're dependent, or they're unsure how to stop taking the pills-that-the-doctors-keep-giving-them
We - all of us, the public, health professionals, the government - have a responsibility to talk about and learn from the hundreds of deaths every year that are accidental, and completely preventable. It's through awareness, more than anything, that the death toll might decline.
"My son was not a drug addict. He was an accidental addict. It's easy to feel anger at the medical system - my son never should have been prescribed morphine - but it's not helpful," Anna said.
"We need more awareness. To teach people to ask for more details about the drugs they're prescribed. To ask for a print out of all the medications they're on. And to look at alternative ways other than medication. These deaths are so preventable and they're all too common. My son didn't want to die."
To learn more about the risks of prescription medication, visit the ADF website here.