“Chronic pain management is challenging… Opioids are an effective treatment, but their use requires constant vigilance to minimize risk and adverse effects.” ~ Dr. Carolyn Clancy, the interim Undersecretary for Health for the Veterans Administration Last week, in an article in the USA Today, Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said that in 2012, American doctors wrote 259 million prescriptions for painkiller medication. To give that figure its proper perspective, that is enough to give every single adult in the United States their own personal bottle of pills.
“A National Epidemic“
“Where opioids are concerned, we dramatically expanded their use, and then we went from having one tremendous public health problem – chronic pain – to having two, by adding the problem of prescription drug abuse… and the pendulum has been swinging between the two to try and figure out an effective strategy to keep people with pain treated and to avoid abuse, addiction, overdose, and death.”
~ Dr. Steve Passik, VP of Clinical Research and Advocacy at Millennium Health
In the 15 year period 1999-2013, the death rate due to an overdose of drugs more than doubled in the United States. A disproportionately large number of these deaths were because of opiates – the class of painkilling drugs that includes OxyContin, Vicodin, and Demerol among prescription medications and heroin among street drugs. In the United States, prescription painkiller overdoses kill 120 people a day. Every hour, one baby in America is born already suffering from opiate withdrawal. The Trust for America’s Health says that deaths related to prescription drug abuse now outnumber those from cocaine and heroin combined. In 29 states, more people die from drug overdoses than car crashes. It is estimated that the abuse of prescription painkillers costs over $53 billion a year in the United States in reduced productivity, medical expenses, and criminal proceedings. In 2013, the CDC’s Prevention Status Report stated that non-medical use of opioid pain relievers costs insurance companies $72.5 billion annually. In 2010, the admission rate for substance abuse treatment specific to opioid addiction was seven times higher than it was in 1999. Frieden has called opiate prescription drug abuse a “national epidemic“. Lawmakers seem to agree. In February of this year, bipartisan legislation was reintroduced reauthorizing the National All Schedules Prescription Electronic Reporting program. The NASPER program gives grants to the individual states grants for the maintenance, improvement, and expansion of prescription drug monitoring programs. Then in March, the proposed Opioid Overdose Reduction Act was introduced. The purpose of this bill is to protect family members, first responders, volunteers, and healthcare professionals who are educated in how to administer opioid overdose prevention drugs from civil liability in an overdose-related emergency situation.
“No one should be afraid to save a life because of a lawsuit. We cannot allow the prescription drug epidemic to spread from the emergency room to the courtroom as a result of good Samaritans administering life-saving drugs like Naloxone to prevent overdoses.”
~ Senator Edward J. Markey
The State of Idaho
When it comes to the misuse of prescription medications, size definitely does not matter. Idaho, which ranks 39th in the country for population, ranks #4 when it comes to the non-medical use of prescription painkillers among individuals aged 12 years or older. Look at some of these frightening facts about prescription drug abuse in Idaho –
- 20 % of Idaho high school students have used a prescription drug without actually having a doctor’s prescription.
- According to a 2013 report, Prescription Drug Abuse: Strategies to Stop the Epidemic, Idaho suffers 8 drug overdose fatalities per 100,000 people. This is double the rate in 1999.
- The Idaho Press reports that the Substance Abuse and Mental Health Services Administration estimates that illicit, over-the-counter, or prescription drug abuse kills an Idaho resident every 45 hours.
How to Recognize the Signs of Prescription Drug Abuse
“I did not know the extent, the magnitude of where he was in the progression of the addiction. People with addiction always have an excuse, and that’s because their body is telling them they need to have the substance or they’re going to die. So they’re driven to get it… As I go back, there were a lot of cues I missed.” ~ Melanie Curtis, founder of two Idaho entities that assist addicts – Supportive Housing and Innovative Partnerships and Second Chance Building Material Center. In 2011, Curtis own son Michael died of a prescription drug overdose. As with any addiction, prescription drug abuse carries with it a number of telltale warning signs:
- Physical Signs – chronic fatigue, red/glazed eyes, constant health complaints, and a persistent cough, changes in sleep patterns, rapid weight loss, slurred speech/impaired coordination, neglected personal appearance and hygiene
- Emotional Signs – rapid change in personality, abrupt mood changes, depressed self-esteem, extreme irritability, uncharacteristically irresponsible behavior/judgment, lack of interest in activities that were once enjoyable
- School or Work Problems – increased truancy/missed work shifts, excessive sick calls, poor attitude, rapid decline in grades or job performance
- Social Problems – withdrawal from friends, brushes with the law, hanging out with different friends who also abuse drugs
- Family Problems – breaking of family rules, engaging in unnecessary arguments, spending long periods of time alone in the bedroom, general withdrawal and apathy towards family activities, neglecting responsibilities, missing money
Abusers of prescription drugs also have several common habits and behaviors they will use as a means to procure drugs when their addiction is active:
- Faking injuries or exaggerating their severity in order to get painkillers
- “Shopping” doctors to find the ones that are willing to prescribe opioid painkillers
- Multiple trips to a number of doctors, in order to have several prescriptions
- Taking more than the prescribed dosage
- Hiding their medications and their usage of it.
Just meeting two of these criteria indicate a probable drug addiction. Although drug abuse is thought of to be a young person’s problem, prescription drug abuse among the elderly is becoming more common, primarily because older adults take more prescription medications than any other age group. 13 % of the US population is 65 years or older, but that age group consumes more than a third of all prescription drugs. Older adults can also “accidentally” abuse prescription drugs far easier than individuals in other age groups because they typically take several medicines every day. More medicine equals more chances for a mistake. Also, many conditions suffered by older adults are chronic, and when certain medications are taken over a long period of time, it increases the likelihood of addiction. This is especially true of opioids prescribed for pain management and benzodiazepines prescribed for anxiety or insomnia.
Know the Terms
Among young adolescents – 12-to-13-year olds, prescription medications are the most commonly-used drug:
- 30 % of teens don’t believe that prescription painkillers are addictive
- Roughly the same percentage of teenagers think that there is “nothing wrong” with the non-medical use of prescription medications.
- Five out of the top six drugs misused by high school seniors are prescription drugs or an over-the-counter cough and cold medicines.
Often, teenagers will speak openly about using drugs in front of their parents, using slang terms in the belief that their parents won’t have any idea what they’re talking about. Here are a few of the more common “street names” for various prescription drugs.
- Xanax – bricks, benzos, Z-bar
- Valium – blues
- Ritalin – vitamin R, Rid, Ritty, Jif
- Adderall – black beauties, Christmas trees, beans
- painkillers (Vicodin, OxyContin, Percocet, etc.) – Vike, cotton, OC, morph, Watson-387, big boys
- sedatives and tranquilizers – french fries, chill pills, tranqs
- In addition, a mixture of various prescription medications is called “trail mix”.
- Teenagers who are abusing prescription medications are said to be “pharming”
What Can Be Done to Safeguard against Prescription Drug Abuse?
“Prescription drugs can be a miracle for many, but misuse can have dire consequences. The rapid rise of abuse requires nothing short of a full-scale response – starting with prevention and education, all the way through to expanding and modernizing treatment.”
~ Jeffrey Levi, Ph.D., the executive director of the Trust for America’s Health
The Idaho Office of Drug Policy gives three main recommendations for individuals and families that want to combat potential prescription drug abuse at home –
- First – Dispose of any unused/expired medicines at a state-authorized drop-off/take-back location. There are numerous locations throughout each county.
When the Drug Enforcement Agency partnered with 4076 law enforcement agencies around the country at nearly 5500 take-back sites on the ninth annual National Prescription Drug Take-Back Day, they collected 617,150 pounds – over three hundred tons – of unneeded prescription medications. If your particular area does not have a take-back site, you can throw them in your trash, provided (1) there are no special disposal instructions on the label, and (2) you follow these recommendations from the FDA –
- Remove the medications from the original bottles/containers.
- To make the medications less attractive and recognizable, mix them with an unappealing substance – kitty litter, potting soil, used coffee grounds, etc. This will deter individuals who might go through your trash to look for drugs.
- Place the mixture in a sealable container before placing it in the trash. This prevents any contaminating leakage and additionally helps disguise the presence of the medication.
It is never recommended that you get rid of unneeded medication by giving it away to friends or family members. Simply flushing your medications down the toilet is also not advisable, because concerns exist about drug residue ending up in community drinking water supplies. “…You wouldn’t want to throw something in the trash that contains a powerful and potentially dangerous narcotic that could harm others.” ~ Jim Hunter, R.Ph., M.P.H., a pharmacist reviewer on FDA’s Controlled Substance Staff
- Second – Take a complete inventory of all of your medications, lock them up securely, and perform regular follow-up inventories. The “Lock Your Meds Idaho” campaign offers suggestions about how best to go about properly securing prescription medicines. Lock Your Meds Idaho is supported by the Prescription Drug Abuse Prevention Workgroup, funded by the Idaho Millennium Fund, and under the direction of the Idaho Office of Drug Policy.
- Third – educate yourself and others – your children, your family members, your friends, and even your coworkers – that prescription medication abuse is just as hazardous as abusing illicit drugs such as meth, cocaine, and heroin.
Part of the problem lies with irresponsible doctors who over-prescribe dangerous opiate painkiller medication. To that end, Idaho has the Prescription Drug Monitoring Program, which collects data on certain controlled substances that are doled out by doctors and pharmacists. Last fiscal year, almost 3 million prescriptions for monitored drugs were dispensed in Idaho. Idaho also requires physicians to check the program’s database before prescribing. The practice is not always followed, however. Last year, there was only about one record check for every 15 drugs prescribed.
What Do I Do If Someone I Love Has an Addiction to Prescription Drugs?
If you think your adult loved one/friend is addicted, the first, most important thing you need to know is that you cannot fix the problem without help. Addiction treatment may be their only option. One helpful mantra to keep in mind is the “3 C’s” slogan that originated in 12-step meetings and drug treatment programs –
- “You Didn’t Cause It” – Their addiction is not YOUR fault. You have no reason to feel unproductive guilt.
- “You Can’t Control It” – Drug addiction is a disease. You cannot reason with it, bargain with it, or wish it away. More specifically, if you are not the addict, then the disease doesn’t belong to you either. The person with the addiction has to want help or drug treatment for themselves.
- “You Can’t Cure It” – Drug addiction is incurable. A person who has been addicted will need to deal with their compulsion one day at a time, every day, for the rest of their life. With the help of trained professionals, you may be able to arrest its inevitably fatal progression.
If at first, your loved one is not willing to receive help, the best thing you can do is educate yourself about their disease. Focus on YOURSELF, YOUR sanity, and YOUR serenity. Learn about the steps you may have been making that helped enable their drug use, and then stop making those steps, no matter what. 12-step meetings or support groups can be very helpful, and you may want to speak to a professional at a drug rehab facility to see about any other measures that may be necessary.
What If I Am the One with the Problem?
If you are here, then the assumption is that you are looking for help. Congratulations – realizing that your life has become unmanageable due to your addiction is the first, most important step you will ever take on your journey to lasting sobriety. If you are ready to continue moving forward, there are any number of drug counseling programs and drug rehab facilities available to help you, both with inpatient treatment and intensive outpatient approaches. With the tiniest modicum of patience, you will be able to find an addiction treatment program that perfectly fits your goals, exceeds your expectations, and helps you discover the tools you will need to confront your own disease confidently, and ultimately, successfully. https://www.usatoday.com/story/news/2015/05/24/addiction-treatment-shortage/27181773/ https://www.militarytimes.com/story/military/benefits/veterans/2015/03/26/va-opiate-painkiller-prescriptions/70494382/ https://www.markey.senate.gov/news/press-releases/markey-applauds-new-federal-action-on-prescription-drug-and-heroin-addiction_ https://www.markey.senate.gov/news/press-releases/markey-ayotte-introduce-bipartisan-legislation-to-help-prevent-heroin-and-prescription-drug-overdoses https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm https://nasper.org/ https://www.govtrack.us/congress/bills/114/s707 https://healthyamericans.org/reports/drugabuse2013/release.php?stateid=ID https://www.idahopress.com/members/canyon-county-not-immune-to-prescription-drug-abuse/article_c74ad40c-6843-11e2-bf2f-0019bb2963f4.html?mode=jqm https://www.cdc.gov/psr/npao/2013/ID-npao.pdf https://nationalpainreport.com/opioid-misuse-study-questioned-8825907.html