Beyond the top two drugs of choice; tobacco, estimated to cause 40% of all hospital illnesses, and alcohol involved in more than 50% of all visits to the hospital emergency rooms, it is marijuana followed by prescription drugs as the top two illicit drugs of choice. When prescription drugs are used for something other than their prescribed use, it’s abuse – whether it’s done one time or one hundred times, is irrelevant.
In 2010, the specific illicit drug category with the largest number of recent initiates among persons aged 12 or older was marijuana with 2.4 million users. Nearly double, with a combined total of 4.1 million users, was prescription drug abuse when including opioid pain relievers, tranquilizers, stimulants and sedatives. Source: National Survey on Drug Use and Health (SAMHA web Site).
Prescription drug abuse is clearly on the rise, across all demographics. In older Americans, anti-anxiety drugs such as benzodiazepines and opioid pain relievers are leading the list. Although only 13 percent of the population, the elderly account for about 1/3 of the prescriptions, as reported by NIH (2010 National Survey on Drug Use and Health [NSDUH]). The U.S. Department of Health and Human Services (HHS) reports that nearly 3 million people in the 12 to 25 age group become new abusers of prescription drugs each year. Finally, one in ten high school seniors in the USA admit to abusing prescription drugs.
Within the prescription drug group, misuse of opioid pain relievers represents three-fourths of the overall problem. Opioids are some of the most powerful medications available, and the number of prescriptions sold to pharmacies, hospitals, and doctors’ offices was 4 times larger in 2010 than in 1999. Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for one month.
Prominent on the list of pain relievers is oxycodone and methadone which have seen significant increases in abuse along with hydrocodone which is the most commonly abused pharmaceutical in the USA today. Not only is opioid use increasing, doctors and rehabilitation therapists report that prescription painkiller abuse is one of the most difficult addictions to treat.
Overdose Related Deaths are Rising
Nearly three out of four prescription drug overdoses are caused by prescription painkillers. The USA consumes 71% of the world’s oxycodone and uses 99% of the world’s hydrocodone, and there is an unmistakable correlation between prescriptions filled, reports of prescription drug abuse, and overdose deaths from these drugs.
So alarming is the increasing rate of deaths relating to prescription drug abuse, it has been classified as an epidemic by the Center for Disease Control and Prevention. The rates vary substantially across the country but are most severe in the Southwest and Appalachian region. The highest drug overdose death rates in 2008 were found in New Mexico and West Virginia, which had rates nearly five times that of Nebraska, reporting the lowest rate.
In a period of nine months, a tiny Kentucky county of fewer than 12,000 people sees a 53-year-old mother, her 35-year-old son, and seven others die by overdosing on pain medications obtained from pain clinics in Florida.
In Utah, a 13-year-old fatally overdoses on oxycodone pills taken from a friend’s grandmother.
These are not isolated events. Overdose death rates in the United States have more than tripled since 1990 and have never been higher. Prescription drugs are now responsible for more over-dose deaths (45%) than cocaine, heroin, methamphetamine and amphetamines (39%) combined.
Opiate overdoses, once almost always due to heroin use, are now increasingly due to abuse of prescription painkillers. These drugs are not limited to particular socioeconomic boundaries. A publicized example of abuse is radio commentator Rush Limbaugh’s on-air statement when he said “I am addicted to prescription pain medication. I first started taking painkillers [some] years ago when my doctor prescribed them to treat post-surgical pain following spinal surgery….Over the past several years I have tried to break my dependence on pain pills and, in fact, twice checked myself into medical facilities in an attempt to do so.” –Excerpted from radio commentators Rush Limbaugh’s on-air statement, Friday, Oct.10, 2003, according to Premiere Radio, his broadcaster.
The recent deaths of actor Heath Ledger, Anna Nicole Smith and singer Whitney Houston have further demonstrated the seriousness of the problem. The National Institute of Health points out that emergency room visits due to prescription drug abuse are on the rise. Since 1990, mentions of tranquilizers by emergency departments have increased by 170% and a staggering 450% increase for prescription pain relievers. More than 200,000 visits to emergency rooms around the country each year are because of prescription drug abuse.
Is availability an Issue?
The latest National Survey on Drug Use and Health shows that over 70% of people who abused prescription pain relievers got them from friends or relatives, while approximately 20% got them from a drug dealer, stranger or over the internet.
Just because drugs can be prescribed by healthcare professionals and dispensed by pharmacists, doesn’t make them safe. In fact, it’s the perception of safety that makes prescription drug abuse so dangerous. By survey, almost 50% of teens believe that prescription drugs are much safer than Illegal Street drugs, nearly half the teens abusing prescription drugs are taking painkillers, and 60% to 70% say that home medicine cabinets are their source of drugs.
Harmful in their own right, when abused, prescription drugs are becoming gateway drugs for many school aged youths. According to the National Center on Addiction and Substance Abuse at Columbia University, teens who abuse prescription drugs are twice as likely to use alcohol, five times more likely to use marijuana, and twelve to twenty times more likely to use illegal street drugs such as heroin, ecstasy and cocaine than teens who do not abuse prescription drugs. So strong is the addiction, armed robberies of pharmacies have occurred where the robber demanded only oxycontin and not cash.
The Reality of Opioid Pain Relievers
Drugs are essentially poisons. Whether they are helpful or hurtful is simply determined by the amount consumed. The effect of prescription drugs vary from person to person, but in general a lesser amount taken acts as a stimulant and speeds you up. A greater amount acts as a sedative and slows you down. A large amount, considered abuse of the drug/poison, can kill. Only the amount needed to achieve the effect differs.
Pain relievers have another liability, in that, they affect the nervous system’s transmission of nerve signals we perceive as pain. They also stimulate areas of the brain that are associated with pleasure. So at the same time they are blocking pain, they produce a ‘high’ and can distort the users’ perception of reality. The person’s behavior can be irrational, inappropriate, and even destructive to him/herself and others. They are not discriminate to which sensations are blocked to the brain. The desirable sensations, unfortunately, get blocked along with the unwanted ones. So while providing short-term help for relieving pain, they also affect alertness and cloud one’s thinking. Hence the warning about driving or operating mechanical equipment while taking medications. Because of the way drugs affect the way your body works and clouds the mind, if drugs are not used as intended, they can be as dangerous as illegal drugs.
Pain management drugs, by design, are intended to ‘mask’ the pain for which they are taken. They do not ‘cure’ anything. Overlooked, by users, is the risk they assume by taking these highly potent and mind-altering drugs. Long-term uses of painkillers can, and often do, lead to dependence. This includes people who are justifiably prescribed painkillers to relieve a medical condition but eventually fall into the trap of abuse followed by addiction. In some cases, the dangers of painkillers don’t surface until it’s too late. In 2007, for example, abuse of the painkiller Fentanyl killed more than 1,000 people, and was ultimately determined to be 30 to 50 times more powerful than heroin.
A Brief History
Highly addictive opiates, originally derived from the poppy plant, have been used for thousands of years for both recreational and medicinal purposes. The most active substance in opium is morphine–a very powerful painkiller which is also highly addictive. First extracted from opium in a pure form in the early nineteenth century, it was widely used as a painkiller during the American Civil War, where many solders became addicted.
In 1874, chemists, worked to find a less addictive form of morphine, and created heroin. They ultimately discovered heroin had twice the potency of morphine, and heroin addiction soon became a serious problem.
Methadone, a synthesized (man-made) opiate, was developed while searching for a painkiller that would be easier to use during surgery while less addictive than morphine or heroin. However methadone is believed by many to be even more addictive than heroin.
Newer, man-made, opiates came on the market which imitates the body’s own painkillers and received approval from the Food and Drug Administration. They are opium-like compounds manufactured to react on the nervous system in the same way as drugs derived from the opium poppy–like heroin. Of these new synthesized opiates, oxycodone, which is as powerful as heroin, affects the nervous system in the same way. It is sold under many familiar names such as: Percodan, Percocet and Oxycontin, and has the greatest potential for abuse along with the greatest dangers.
Hydromorphone (Dilaudid), available in tablet form, is considered eight times more potent than morphine and is often called “drug store heroin” on the streets. Users have been known to crush the tablets prior to injecting, snorting or smoking the drug. ‘Crushing’ the tablets destroys the controlled released mechanism, and provides the users more immediate effect (NIDA for Teens: The Science behind Drug Abuse). Users that inject it, report it to produce a feeling that is identical to shooting heroin.
What’s the Solution?
States play a central role in protecting the public health, and regulating health care and the practice of the health professions. As such, States are a critical component to reversing the prescription drug overdose epidemic. The CDC recommends Prescription Drug Monitoring Programs (PDMPs) to address the problem. Thirty-six states have adopted operational Prescription Drug Monitoring Programs which are State-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. Source: ONDCP’s Prescription Drug Abuse Plan, National Drug Control Strategy. They are designed to monitor this information for suspected abuse or diversion. This information can help prescribers and pharmacists identify high-risk patients who would benefit from early interventions.
The CDC also recommends that PDMPs link to electronic health records systems so that PDMP information is better integrated into health care providers’ day-to-day practices. Included in the overall plan are:
- Patient review and restriction programs
- Health care provider accountability
- Laws to prevent prescription drug abuse and diversion
- Better access to substance abuse treatment
Drug testing professionals also can, and should, play an active role in stemming this epidemic. Corporate clients rely on their TPAs and TPPs to provide the advice needed to keep their workforce healthy and the workplace safe. Testing recommendations should include expanding the number of drugs being tested beyond the 5 panel test. Testing only for illicit drugs is no longer sufficient to address the fastest growing area of drug abuse in our society.
This article was written for and appears in the DATIA Winter’13 quarterly magazine FOCUS. Gary F Patrone is CEO of ARCpoint Labs of Tempe, and is centrally located within the Phoenix Valley. Gary serves both corporate and private clients in drug, alcohol, DNA and steroid testing services and creates workplace policies for both DOT and non-mandated companies. Gary is an active member of the Tempe-South Rotary Club, an Ambassador of the Tempe Chamber of Commerce, member of the Advisory Council for Brookline College and writes a monthly column for the Arizona Republic.
1Source: CDC website. http://www.cdc.gov/homeandrecreationalsafety/rxbrief/. 2Source: Drug Free World website. http://www.drugfreeworld.org/drugfacts/drugs/why-do-people-take-drugs/html. 3Source: 2002-2013 www.AddictionWithrawal.com, Fentanyl Statistics.