The Prescription Drug Epidemic

Illicit drugs have a long standing negative image in modern American culture. They are widely regarded as something only those on the fringes of society make use of, but certainly not consumed by upstanding citizens. But, as history has shown, America has long held the door open to the use of drugs by all ranks of our society.

The patent drugs of the 19th century openly contained and promoted the use of drugs like cocaine and morphine and were available without prescription at the corner drugstore. There was little or no social stigma attached to their use.

Our society has moved on from those days, but not as much as one might think. We’ve formulated new and different drugs and put in place modest legal barriers to their use. As for the social stigma, it has been in recent times, quite fashionable to have the need for a Xanax prescription. We’ve come to love our prescription drugs. So much so that America is in the throes of a prescription drug epidemic. Every day in America, more people die from prescription drug addiction than gunshot wounds, car accidents, or suicide with 100 people losing their lives daily as a result of misusing medication.

Painkiller addiction cuts a wide path across American society. In popular culture, it is a well-known celebrity health hazard, with a widely recognized group of young entertainers attributing their downward spirals to dependence on drugs like OxyContin, oxycodone, and Vicodin. Despite much negative notoriety, Hollywood’s predilection for prescription drugs has a certain hip appeal to some impressionable people, making it seem that drug abuse is somehow OK. They too want to be a part of the scene and begin to frequent well known “feel good” doctors for prescription pills in a bid to emulate their screen idols.

The prescription problem lies not only with the young-and-hip or down-and-out, but with over 300,000 seniors in the U.S. that misuse their medications. USA Today reports, “Hundreds of thousands of the nation’s seniors are misusing prescription drugs, spurred by a medical community that often is quick to offer narcotic pain killers, anxiety medications and other pharmaceuticals for everything from joint pain to depression. And despite a push by public health officials to slash dispensing rates, doctors are prescribing the highly addictive drugs at record levels.”

Prescription drug abuse is inflicting painful and costly trauma on our nation, injury that warrants the full attention of private and governmental agencies. There are many aspects and elements stemming from the prescription drug problem. Why are these drugs widely available to a highly susceptible public? What are the consequences of uncontrolled use? A starting place might be to focus on those who get most easily addicted.

Who Gets Addicted and How?

The widespread availability of these drugs has certainly played a key role in rising addiction rates. Many doctors understand that pills are often the quickest, easiest way to address their patient’s symptoms. Patients, in turn, trust that pills legitimately given to them by a doctor are the answer for their ailments. People tend to think of prescription drugs in terms of: It was prescribed by a doctor, dispensed by a pharmacist, so it must be safe.

Of societal groups involved in drug abuse, senior addiction is at once the most surprising and the most alarming. It doesn’t fit into the image we have of seniors, veterans of tough circumstances beyond those experienced by many younger Americans. But as almost anyone approaching their senior years can attest, backs, elbows, hips, and knees have a tendency to become an ongoing source of pain; pain that can make normal life difficult if not impossible. Doctors can be quick to prescribe any one of an increasing number of modern pain medications, many of which have highly addictive characteristics.

When older patients are medicated for a chronic problem, their tolerance of and resistance to the medication grows, and they begin to ask for increasing amounts of pills. Dosages escalate over time, leading to dependence. Thus begins a downward spiral often with devastating consequences.

By many measures – rising overdose deaths, a spike in emergency room visits, increasing admissions to addiction treatment programs – the toll on the senior community is enormous. The Substance Abuse and Mental Health Services Administration (SAMHSA) states that among people 55 and older seeking substance abuse treatment from 2007-11, there was a 46% jump in the share of cases involving prescription narcotics.

Prescription drugs present a new menace to those that have become addicted to them, but never thought of themselves as addicts. A few years ago, the commonly prescribed pain killer OxyContin, widely known as “hillbilly heroin” because of its abuse in Appalachian communities, was the drug of greatest concern to law enforcement authorities. Pill mills, many in Florida, were the source of Oxys and other pain killers for many states in the South. But as pill prices rose with demand, users came to realize that heroin had the same desired effects as OxyContin with the added advantage of lower price. Thus, OxyContin became the gateway drug for many new heroin addicts. Last year nearly 700,000 Americans took heroin, twice as many as a decade ago. Some of these addicts unexpectedly come from a highly regarded group of professional people.

Last year, the Carolinas Medical Center in Charlotte was seeking a better understanding of patients who were coming into detox for heroin. These people were cops, lawyers, nurses and ministers, all recognized as high achievers in the community. When questioned about the reasons for their heroin addiction, they shared a common story: “We used to take pills, but now we inject heroin.”

A spokeswoman with the National Institute on Drug Abuse told CNN News recently that nearly half of young people who inject heroin say they abused prescription opioids before turning to the illegal drug. For them, the path from “legitimate” drug user to addict proved to be an all too short one.

California’s Answer to Prescription Drug Abuse: CURES

While most state governments have addressed the prescription drug in some manner, California has taken the lead in legislative measures designed to tackle the problem. As early as 1939, the Triplicate Prescription Program (TPP) was created, which “captured” or collected Schedule II prescription drug information. Many of the frequently abused drugs like OxyContin, Vicodin, and Hydrocodone are classified as Schedule II drugs.

Eventually the CURES (Controlled Substance Utilization Review and Evaluation System) program, which initially incorporated TPP, totally replaced TPP in 1999. CURES is a database containing information on Schedule II through IV controlled substances dispensed in California. It is intended to be a valuable investigative, preventive, and educational tool for the healthcare community, regulatory boards, and law enforcement. The program promotes increased awareness of abuse of prescription drugs without interfering with legitimate medical practice and patient care. It also combats the practice of diversion, in which controlled substances are “diverted” into the hands of those who have no legal or legitimate use of the substances.

In 2009, The California Prescription Drug Monitoring Program (PDMP) was introduced as a searchable, client oriented component of the CURES database. The function of PDMP is to accumulate scheduled substance prescriptions (for controlled drugs like OxyContin) and collect information on the dispensing of controlled substances for the purpose of facilitating diversion awareness and intervention of potential abusers. PDMP works on the principle that prescribers and pharmacists will dedicate their professional skills to identify and assist controlled substance abusers.

The PDMP allows authorized users, including licensed healthcare prescribers eligible to prescribe controlled substances, pharmacists authorized to dispense controlled substances, law enforcement, and regulatory boards, to access patient controlled substance history information maintained in CURES. The PDMP is committed to assisting in the reduction of pharmaceutical drug diversion without affecting legitimate medical practice or patient care.

Circumventing the System

Programs like California’s CURES address drug abuse by controlling the legal avenues by which potential addicts obtain their drugs. But these avenues are not the only method of obtaining controlled substances and much of the drug abuse problem is rooted in illicit procurement of controlled substances.

From national surveys, the Centers for Disease Control and Prevention determined that most people (about 60 percent) who report using prescription painkillers non-medically (without a prescription or for the feeling they cause) obtain them from family or friends. More than one in six people (17 percent) who report using prescription painkillers non-medically said that they got the drugs they most recently used through a prescription from one doctor.

The more often people use such drugs non-medically, the more likely they are to turn to other sources such as drug dealers. The CDC has also determined that a large number of people who die of prescription painkiller overdoses obtain their drugs without a prescription. It is difficult to estimate these numbers exactly because the source information is often not available or not accurate. Interestingly, women are more likely to start with a prescription and then move to non-medical use than are men.

Convenience and Easy Fixes

A quick observation of the prescription drug epidemic in America reveals its firm foundation on national values. As a country, we value convenience and easy fixes and what is easier than taking a few pills? Besides, they are often just what the doctor ordered. Prescription drugs can be necessary and lifesaving in many circumstances, but the correlation between prescription drugs and prescription drug addiction is undeniable. And the adverse effects are becoming increasingly apparent.

Daniel R. Perlman, Esq.

Law Offices of Daniel R. Perlman