Legally Dead:
Exploring The Epidemic of Prescription Drug Abuse

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Prescription drug use has become more prevalent than ever – with 34% of American adults taking at least one prescription drug, and 11.5% taking three or more prescribed medications.

It was reported in 2009 that 16 million Americans, from ages 12 and up, had taken some type of prescriptive medication.

In a rapid response society, prescription medication has become the ultimate quick fix, from stressed out students cramming for exams, to ambitious professionals looking for an edge, to recovering soldiers returning from battle. And despite the death toll and the recurring headlines of Hollywood stars getting themselves into trouble, the rates of prescription drug abuse and addiction continue to steadily grow.

History of Prescription Drug Abuse

Before the opium poppy was utilized in medicine, it was used in food and ritualistic acts dating as far back as the Neolithic age. Ancient surgeons then introduced opium as a narcotic that provided pain relief and sleep inducement during surgical procedures.

In the decades and centuries following its discovery, opium was used for both medicinal and recreational purposes throughout the world, including Egypt, India, and Greek, Roman, Persian and Arab Empires.

In the 15th century, China began to use opium recreationally, under the misguided notion that opium could provide longevity and a more vigorous sex life. Shortly thereafter, opium smoking in tobacco pipes became a symbol of luxury and wealth in China, influencing infamous opium dens across the country, and around the world. Despite an opium prohibition in China in 1729, the use of opium steadily increased for decades. It was during this time that opium trading between the British and Chinese boomed and deteriorated, resulting in two Opium Wars in the 18th century.

In the 19th century, morphine was extracted from opium, playing a prevalent role in both the treatment and subsequent addiction of soldiers in the American Civil War. Opiates were also prescribed by physicians to treat menstrual pain, which resulted in two-thirds of opiate addicts being women at the time. In 1895, Bayer, a German pharmaceutical company, produced heroin with the intention of it being a less addictive form of morphine. It was offered as an over-the-counter drug for a short time until it was discovered that heroin was absorbed faster and was more addicting than morphine. In 1905, the US banned opium and passed an act that required the contents of medications to be listed and available for the public. This was called the Pure Food and Drug Act.

Morphine, heroin, codeine and methadone are all highly addictive derivatives of opium that were extracted and/or created with the intention of each being less harmful and addictive than its predecessor. All four substances are now considered among the most highly abused and addictive drugs available in the world. Today, opioids are strictly regulated by multiple government agencies and standards. Vicodin, OxyContin, and Percocet are commonly prescribed synthetic opiates that have been approved by the Food and Drug Administration, and are currently some of the leading names in prescription drug abuse.

Who is at risk?

Narcotic pain relievers now cause or contribute to nearly 3 OUT OF 4 prescription drug overdoses and about 15,500 DEATHS [anually]. Studies have shown that some people exhibit higher risk factors and may be more vulnerable to prescription drug abuse. Some factors include:

  • Adolescents and teens who are more susceptible to peer pressure, drug experimentation, and addictive tendencies
  • Previous substance addictions (alcohol included)
  • Access to prescription drugs (via healthcare environments)
  • Pre-existing psychiatric conditions

The biggest area of concern however, may be in the misconceptions regarding the safety of prescription medicine. According to studies performed at the Mayo Clinic and US Department of Health and Human Services, many people, including parents, are often unaware of the dangers in providing prescribed medication to those who are not the intended patient. In her testimony to the US Senate, Dr. Nora D. Volkow referred to the 2006 NSDUH, where, “55.7 percent of those 12 and older who misused pain relievers said they received their medications from a friend or family member, the vast majority of whom had gotten the drugs from just one doctor."

How Does Prescription Drug Abuse Happen?

Prescription drugs come in many forms and serve a variety of purposes. Pain relief medication may be prescribed following traumatic injury or surgical procedure. Sleep medications can be used to induce sleep or keep a person awake.

Addiction often occurs when the potency and/or frequency of dosages are being used beyond their recommended instruction. For this reason, an individual may become addicted to a prescribed substance whether or not it was legally obtained.

Addiction can also be caused by the body's tolerance for the medication increasing. When this change in the body’s central nervous system occurs, an increase in dosage of the substance will be required to meet the intended needs. In some cases, a physician may deem the change in prescription dosage to be necessary and make the adjustment. If a patient is denied the change in prescription however, he or she will often deviate from instruction.

In cases of prescription drug abuse by unintended parties, addiction can occur during a process of substitution of one drug for another. Many of the elements and effects of prescription medications mimic those of illegal narcotics.

For others, recreational or casual use may lead to addiction. Psychopharmaceuticals, such as used to treat ADHD are often favored for the enhancement of mental performance by students and professionals alike. Mood-altering stimulants like those to treat depression are also popular among social users. Other prescribed psychoactive drugs are often abused due to their ability to affect perception and consciousness.

Without proper education or monitoring by a licensed physician, a user may begin a new course of prescribed medication and inadvertently take more of the medication than is instructed or required, leading to an early addiction.

Side Effects and Symptoms of Addiction

Though medication is synthesized and intended to provide specific reliefs , its effects cannot be isolated to the designated injury or condition. Undesired side effects can be expected of prescribed medication, ranging from relatively benign (headaches or drowsiness), to uncomfortable (irritation of bowels), to outright dangerous (raised blood pressure or slowed breathing). For some, side effects can go beyond physical discomfort and affect mood or behavior, such as irritability or short temperedness or hallucinations. Due to the varied responsiveness of medication from person to person, side effects can also be as diverse. They are also not exclusive to prescription drug abusers, as symptoms appear in those who follow correct instruction as well.

Once a user becomes addicted to prescription medication, the dependency of the drug can cause erratic behavior, especially if supply becomes scarce or tolerance increases. The user may grow increasingly panicked and may go to extremes to replenish their fix. This includes stealing others’ prescriptions, going to multiple doctors to receive prescriptions, forging prescriptions, and stealing to afford prescriptions.

Celebrities Who Have Struggled with Prescription Drug Addiction

Celebrities are not immune to the dangers of prescription drug abuse and addiction. Perhaps even more common among the elite, it has become common for entertainers and celebrities to announce plans to attend a rehabilition facility following a public outburst or misbehavior. Often, higher profile individuals will seek treatment in celebrity rehab centers where privacy and discression are of paramount importance. Similar to specialized CEO & Executive rehabilitation centers addicted individuals can be more successful in their treaments when choosing to attend facilities that cater to their specific and tailored needs.

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Rush Limbaugh
NFL Athletes
Tatum O'Neal
Brett Favre
Whitney Houston
Dr. Gregory House

Rehabilitation and Treatment

Recovery for a prescription drug abuser can be a long and arduous road. Not only will he or she have to endure physical withdrawal, they must confront mental and emotional dependency as well. Rehabilitation and treatment for prescription drug abusers often employs different methods and combinations of counseling and detoxification, performed under a physician’s observation.

In cases for certain substances, particularly natural and synthetic opiates, medication (methadone and buprenorphine) can be used to combat addiction. Detoxification of an abused substance will often lead to withdrawals, which can be mentally exhausting and physically painful if not managed by a healthcare professional or treatment center. As the abuser’s system readjusts to the absence of medication, he or she may suffer disturbances in sleep, appetite, and mood or behavior.

According to the National Institute on Drug Abuse (NIDA), behavioral therapies should be employed for effectiveness of addiction treatments, in conjunction with detoxification. Examples of outpatient behavioral therapies include:

  • Cognitive-behavioral therapy: enables patients to identify, avoid and deal with environments/situations that may encourage drug abuse.
  • Multidimensional family therapy: catered to adolescents and young adults with drug dependencies and addictions, incorporates family to overall wellness.
  • Motivational interviewing: evaluates the willingness and preparedness prior to entering treatment.
  • Motivational incentives: utilizes positive reinforcement to abstain from drug use.

Some therapy centers may require a longer time commitment and will often provide residential facilities. Residential treatment centers are often beneficial, if not imperative, for severe sufferers of prescription addiction. Therapeutic communities (TCs) run anywhere from 6 to 12 months and rely heavily on a community-based treatment, from other residents and staff.

It is important to note that not all treatments and therapies are voluntary. Some prescription drug abusers may be required by law to attend therapy or TCs and may be subject to regular testing to prove sobriety.

Most Commonly Abused Prescription Medications

Most addictive prescription medication can be separated into three general categories: opioids, CNS depressants, and stimulants.

Opioids (or narcotic painkillers) attach to opioid receptors, which are proteins throughout the body (including brain, spinal cord, organs). Once an opioid is attached, the morphine derivative can reduce pain in the affected area. Unfortunately, opioids also influence parts of the brain that handle pleasure, which can often lead to addiction. Opioids are commonly prescribed for traumatic injuries and after surgical procedures, and are the most popular type of abused prescription medications. Popular abused opioids include: codeine, morphine, methadone, fentanyl and analogs, and oxycodone.

Central nervous system (CNS) depressants (or sedatives and tranquilizers) will decrease or slow down brain activity by inhibiting the activity of other brain cells, resulting in drowsiness or calm. Alcohol is another CNS depressant, so if combined with medication, can cause confusion, slowed breathing, and seizures. CNS depressants are commonly prescribed for anxiety and sleep disorders. Popular abused CNS depressants include: barbiturates, benzodiazepines (Valium, Xanax), and sleep medications (Ambien, Lunesta).

Stimulants mimic and increase the chemical structures of specific brain neurotransmitters, allowing for messages to be sent to each other. Stimulants can cause increase and improve attention, focus, alertness, and energy. Abuse of stimulants can cause anxiety, high blood pressure, and in some cases, heart attacks. Stimulants are often diagnosed to ADHD sufferers. Popular abused stimulants include: amphetamines (Adderall) and methylphenidates (Ritalin).

In a study conducted by the University of Michigan, Vicodin, a painkiller, was the top prescription drug abused by high school seniors, representing 8.1% of all drugs (pharmaceutical and nonmedical) used. Stimulant Adderall followed at 6.5%.

Profile of Prescription Drug Abuse

The Substance Abuse and Mental Health Services Administration (SAMHSA) reported that 26 million Americans between 26 and 50 have used prescriptive medication for non-intended/non-medical use. For those who are 50 years old and older and have abused prescriptions, that number is 13 million. For 18-25 year olds, it’s 9 million. And for those adolescents and teens who fall in the 12-17 range, 3 million have used prescriptions for non-medical purposes.

Regionally, the highest number of prescription drug abuse cases has occurred in Arkansas, Kentucky, Nevada, Oklahoma, Oregon, Tennessee, and Wisconsin.

Another alarming set of statistics comes from the accessibility of prescriptions. 55% of nonmedical prescription drug users reported that they were able to obtain medication from a friend or relative for free, while 11.4% purchased the medication from friends or relatives. Furthermore, 4.8% admitted to stealing or taking medication from friends or relatives without consent. Only 2.3% reported to obtain drugs from strangers and/or drug dealers, which means the majority of prescription drug abusers are within close proximity and accessibility to prescription medication.

Regulation of Prescription Drugs in America

Prescription medication is highly regulated in the United States, having to meet a strict set of prerequisites prior to testing and experimentation, and having to meet rigorous standards for approval and use.

There are four government agencies dedicated to prescription medication regulation:

  • Department of Health and Human Services
  • Food and Drug Administration
  • Department of Justice
  • Drug Enforcement Administration

Each organization or division serves a different purpose, from protecting the health of medication users to enforcing legal use of medication.

Medical Marijuana

The evolution of cannabis has been particularly noteworthy and controversial in the medical community. This once illegal substance found ground in medicine when a synthetic version was produced and approved in the US in the 1970’s.

Marijuana since then been found to be medically beneficial to a wide range of conditions, including those that affect cancer patients receiving chemotherapy.

Cannabis, when used for cancer patients, can alleviate the vomiting and nausea often induced by chemotherapy treatments. It is also used to treat glaucoma in the eyes. Other uses include treatment for multiple sclerosis, Alzheimer’s, HIV/AIDS, and even opioid dependence. For the latter, cannabis has been found to support the treatment for opioid abuse and addiction, by helping lessen the dependency.

The use of medical marijuana has been a subject of ongoing political and social controversy, and it is a frequent topic of debate and discussion among legislatures. Currently in the United States, 18 states, as well as Washington DC have legalized the use of medical cannabis, despite the absence of FDA approval. However, those who are prescribed medical marijuana must adhere to strict regulation regarding amounts in possession for treatment.

In 2012, Colorado and Washington became the first two states to legalize marijuana for recreational use. Users however, must also follow regulations, including where to purchase (state-administered dispensaries), and how much he or she can possess. Personal sales, overages on possession amounts, and usage for anyone under 21 years of age are still illegal in both states.

The Future

What do the rising numbers in prescription drug abuse mean for the future?

Prescription drug abuse has become a force to be reckoned with, its effects rivaling that of other illegal drug use. In 2008, prescription drugs were involved in more than half of the reported overdose deaths in the United States. And in addition to rising death tolls, prescription drug abuse is influencing the healthcare system, insurance companies, and laws both current and future.

In a 2007 study, the Coalition Against Insurance Fraud reported that prescription drug abuse costs were estimated over $70 billion. Primarily due to the increased number of associated emergency room visits, rehabilitation costs, an assortment of related health issues, prescription fraud could increase premiums and cost insurers $15,000 per year. On top of that, the Clinical Journal of Pain reported $42 billion in lost productivity and $8.2 billion in criminal prosecution thanks to prescription drug abuse.

Even newborns could be part of those rising premiums. When babies are born to mothers who have battled prescription drug abuse, they may suffer from withdrawal, meaning additional weeks spent in the hospital for treatment. A NYTimes article reported that in Maine’s two largest hospitals, cases of neonatal abstinence syndrome “climbed to 276 in 2010 from about 70 in 2005." Indeed a troubling trend considering that a single baby being treated for substance withdrawal could be upwards of tens of thousands of dollars.

And it’s not just hospitals and insurance companies that are having to deal with the swath of damage prescription drug abuse is cutting. Lawmakers are frantically trying to find solutions to the evolving prescription drug dilemma, which is made difficult by the new challenges prescriptions drugs present. Unlike illicit substances, prescription drug abuse has become much more ubiquitous. Whereas illicit drugs like cocaine or heroin are heavily supplied by Central America, prescription drugs come from hospitals and emergency rooms, clinics, and pharmacies. Instead of meeting with a dealer, drugs could be made readily available by a doctor by a simple prescription.

In order to battle the prescription drug epidemic, the Drug Enforcement Agency is also cracking down nationwide on the distribution of prescribed painkillers. Heavy monitoring of prescription dispensaries, from local pharmacies in small suburban areas to major chains like Walgreens, led to supply restriction and limited what pharmacists could distribute to patients.

As of October 2011, 37 states implemented a prescription drug monitoring program (PDMP) to identify possible drug use and/or distribution abuse. A PDMP, which is not regulated by the DEA, collects data regarding the prescriptions dispensed in a given state. Eleven additional states have also executed legislation to implement a PDMP. Moving forward, the challenge for policy and healthcare professionals seems to lie in balancing the monitoring of prescription drugs without infringing on patient privacy and not allowing restrictions to affect those who have legitimate need for medication.

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