Elephant in the Room? The Problem of Prescription Drug Abuse

By Roy M. Arnold, MD

A growing problem in the US, prescription painkillers accounted for 16,650 deaths in 2010, the most recent complete year for which statistics are available. Drug abuse overtook traffic accidents as a cause of death in 2009. Overdose deaths are only the tip of the iceberg. For every overdose death, there were 733 non-medical users of prescription painkillers, 108 persons with abuse or dependence, 26 Emergency Department visits for abuse or misuse and 10 hospitalizations for abuse or misuse of painkillers.

The most common types of prescription drugs abused are opioid painkillers like hydrocodone, found in Vicodin® or oxycodone found in Oxycontin®. Chronic opioid users account for $72.5 Billion in healthcare costs annually or 8.7 times the cost of non-users.

The United States accounts of 4.6% of the world’s population but consumes 80% of the world production of oxycodone and 99% of the world’s hydrocodone.

The most disturbing aspect of this situation is that many of the people who become addicted to prescription painkillers were initially prescribed these medications for legitimate medical conditions such as injuries or after surgery. Gradually, with frequent use, the opioid medications can cause tolerance, requiring ever increasing doses to achieve the same amount of pain control. Opioids can cause physical dependence with continuous use, often in fairly short periods of time. At this point, patients may experience very unpleasant withdrawal symptoms unless they continue taking the painkillers, even though the medical condition for which the drug was originally prescribed may have improved.

Frequently, persons who are addicted to painkillers may engage in drug-seeking behavior by visiting multiple physicians, or pharmacies, or by obtaining their drugs from non-medical sources. Anti-social behaviors such as theft or assault are not uncommon among persons with addictions. It is important to point out that the anti-social behavior is frequently a result of, not necessarily a cause of the disease of addiction. Most medical experts believe addiction is truly a disease caused by disordered neural pathways in the brain, not a weakness of character or poor willpower. One of the basic tenets of 12-Step recovery programs such as Narcotics Anonymous is the admission of powerless over the addiction.

Having realized out the magnitude of the problem, regulatory agencies and medical organizations are searching for solutions to the problem. Many state governments have established Prescription Drug Monitoring Programs requiring mandatory reporting by pharmacies of all controlled substances prescriptions to a central database. Such programs are currently active in 42 states including Indiana, Kentucky, Illinois, Ohio and Michigan. These programs may be accessed by pharmacies or prescribers for the purpose of patient care, or by law enforcement conducting an investigation. These reporting systems are useful in identifying persons who use multiple prescribers, multiple pharmacies and in monitoring dosage and frequency of narcotic use.

Approximately 10 years ago, the US Food and Drug Administration approved a drug known as buprenorphine for the treatment of opioid addiction. This drug is a partial opioid agonist, meaning it has weak opioid properties. It does produce some of the effects of opioids like euphoria and respiratory depression. Taken in low doses, it can often enable opioid addicts to discontinue the use of other opioids without experiencing withdrawal. It is often combined with a narcotic antagonist to prevent its abuse by injection or inhalation. Prescription of this medication is limited to certain physicians and must be considered substitution therapy for opioid abuse not a “cure.” It simply replaces one opioid with another, much the same way methadone can be substituted for heroin. The use of buprenorphine alone without other treatment and social support systems like 12-Step programs does not address the underlying disease of addiction.

Most recently, professional organizations like Physicians for Responsible Opioid Prescribing (www.supportprop.org) have published white papers urging prescribers to limit opioid prescriptions to no more than 90 days for non-cancer pain. The organization has also petitioned the FDA to change the labeling on oxycodone and hydrocodone to be used only for severe pain and only for 90 days. This petition which is still under consideration by the FDA has been endorsed by the Drug Enforcement Administration and advocacy groups like Public Citizen. (www.citizen.org)

The overall purpose of this article is to point out the magnitude of the problem of prescription drug abuse and explore alternatives to ongoing use or abuse. It also discussed some of the recent regulatory actions. Persons who believe they have a problem with prescription painkillers are encouraged to discuss the issue with their primary healthcare provider and to take advantage of the many treatment and recovery options which are available locally.

1 Prescription Drug Abuse and Overdose: Public Health Perspective (PDF) CDC’s Primary Care and Public Health Initiative, October 24, 2012
2 Ibid.
3 Avila, Jim and Murray, Michael. ABC News (online) April 20, 2011.

EPD Activity Report: May 20, 2013

This weekend, Memorial Day weekend marks the official start of the summer travel season. Many folks are gearing up for that summer vacation. Your Indiana State Police offer a few tips one should keep in mind when traveling. First, carrying large amounts of cash is not a good idea. Carry only enough cash to pay for cabs, shuttle services, and other minor incidentals.

Credit or debit cards are convenient but one must constantly guard against theft, not just of the card itself, but one must make sure they protect their credit card number. Don’t leave your card lying on the table in a restaurant or display it freely where someone could see your number. Be aware of someone who may be nearby who may attempt photograph the card with a camera phone. Keep your credit card company’s number in a separate, easily accessible place so if you do lose your card or if its stolen, you can report it immediately to have the missing cards canceled. It’s also best to carry no more than one or two credit cards while traveling.

When leaving home for that summer trip, let someone know where you are going, your route or means of travel, how to contact you in case of emergency, and when you expect to return. Stop your mail and newspaper delivery service. Nothing says, “No one is home” better than having several days worth of newspapers lying on the front porch. Turn off your water and water heater and make sure curling irons, hair dryers, and other small appliances are unplugged before leaving your house. Make sure all doors and windows are locked and have a timer set up to turn some lights on in your house during the evening hours and shut off at the time you would normally go to bed. Ask a neighbor or relative check your house daily while you’re away to make sure everything is okay.

Special precautions should also be taken when traveling outside the United States. Certain areas of Mexico and the Middle East can be very dangerous for U.S. citizens. Check the U.S. Department of State website at www.state.gov and click on the “travel” tab to get up-to-date information and tips for traveling abroad.

When loading up the family for the shorter trips to places like the Great Smokey Mountains, make sure your car is ready for the trip. Get the oil changed, check your tires (including your spare) for proper air pressure and for any possible defects. Check fluid levels, belts, and other critical mechanical parts to make sure your vehicle is roadworthy and throw a few tools such as a wrench set, breaker bar, flashlight, and other such items in a tool box in your trunk along with a gallon of antifreeze and a quart or two of oil. It’s also a good idea to obtain a AAA membership or other roadside assistance package “just in case.”

Prior to leaving, make sure you’re well rested. Have your route of travel mapped out and check ahead for any possible road construction on your route. Make sure everyone is buckled up and if you have small children, make sure they are properly restrained in a child restraint system. With small children it’s also a good idea to take books for them to read or other items to occupy their time to avoid the constant, annoying question, “Are we there yet?” Make frequent rest stops during your trip to stay well rested and keep your cell phone charged or have a car charger for your cell so if necessary, you can make an emergency call.

Another good idea when traveling with children is to write the child’s name, your name and cell number, as well as a close friend or relative’s name and number on a card. Include other information on the card such as allergies or any other health conditions your child may have. Give each child the card to carry with them in their pocket or back pack in case you get separated. Also, tell your children should they get separated, to stay in the area and not to wander off looking for you. Remind them not to speak with strangers or go anywhere with a stranger. Tell them to speak only to a police officer or other individual in uniform such as park rangers, uniformed amusement park employees, etc. Tell them to give the card with your contact information to the official so immediate contact can be made with you.

If you take prescription medication, make sure to take an adequate supply including extra in case you are unexpectedly detained for a few extra days. Make sure to take the prescription bottle with you as well. If you use one of the daily pill distribution containers and you don’t have your prescription with you, you are committing a felony violation by possessing a prescription drug without the prescription in your possession. You should also make sure your health insurance cards are current and have them with you in case it becomes necessary to seek medical attention while away from home.

Vanderburgh County – Monday night, May 20, at approximately 9:45 p.m., Trooper Wes Alexander stopped the driver of a 2007 Chrysler PT Cruiser for traveling 73 mph in a 50 mph zone on the Lloyd Expressway near McDowell Road. When Trooper Alexander approached the the vehicle he detected an odor of an alcoholic beverage and observed an open vodka bottle. The driver, Sarah Ricketts, 31, of Evansville, had bloodshot eyes and slurred speech. Further investigation revealed Ricketts was six months pregnant and had a BAC of .19%. She was arrested and taken to the Vanderburgh County Jail where she is currently being held without bond.