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Prescription Drugs Addiction on the Rise
August 2, 2008
By MARK MUCKENFUSS
Legal drugs become addictive, deadly for rising numbers
She'd been sober for a year and a half, but Kristina had already begun to backslide when an ear infection sent her to the emergency room.
She told the doctor the pain was only moderate. She also told him she was a methamphetamine addict and asked for some ibuprofen. He gave her a prescription for 30 Vicodin pills with an option to refill it. One dose of the addictive narcotic was enough for her to know she'd found a new drug of choice.
"That first day, I was in love with it," Kristina said. "Instead of one, I took two. I said, 'I'm going to like this.' "
She's one of a growing number of people addicted to prescription drugs.
The rising numbers have alarmed some officials, who attribute the trend to such factors as physicians writing more prescriptions for potentially addictive drugs, increased availability of stronger drugs and greater access to such drugs by minors.
Kristina ended up seeking help in rehab. Other addicts pay a higher price.
Deaths attributed to prescription drug abuse, either as a primary cause or a contributing factor, are rising. And the trend is not just local.
A nationwide study released Monday by researchers at UC San Diego showed that from 1983 to 2004, accidental overdoses involving prescription drugs taken at home -- either alone or in combination with alcohol or other drugs -- rose from 1,132 to 12,426. When adjusted for population growth, that represents an increase of more than 700 percent.
In San Bernardino County, recent records show there has been an upward trend in prescription drug related deaths, although the rise has not been steady. In 2003, there were five deaths in the county where prescription drugs were determined to be a contributing factor in an otherwise natural death. The next year, that figure jumped to 25, the highest to date. But this year, the county coroner has already reported 20 such deaths through the end of May. If that pace continues, it would result in 48 deaths from prescription drugs by the end of the year.
Riverside County reported 51 nonsuicidal deaths as a result of prescription drug overdoses in 2006. That number jumped to 72 in 2007. This year's figures are ahead of last year's, with 35 such deaths reported through May.
The problem has become such that our state has established task forces to deal specifically with prescription drug crimes such as people using fictitious names to get multiple prescriptions or forging prescriptions on stolen forms. Until recently, one such task force was at work in Riverside County. A regional task force is now operating out of Orange County.
A paper issued by the Coalition Against Insurance Fraud, a Washington-based group of consumer, insurance and governmental agencies, indicates that prescription drug abuse, also referred to as drug diversion, has mushroomed into a problem that costs taxpayers and insurers $97 billion annually.
According to the coalition report:
While the U.S. population increased 13 percent between 1992 and 2002, prescriptions for controlled drugs went up 154 percent.
More potent pain medications have aided patients but also have made the drugs more attractive and more lucrative to illegal sellers.
An estimated 20 million Americans, nearly 7 percent, were expected to abuse prescription drugs last year.
Common at Rehab Units
Steve Z., 51, of Moreno Valley said he began taking Vicodin in 2002 for pain in his hips. He eventually had both hips replaced. But well before his final operation this February, he had become addicted to the painkiller. Instead of the five or six Vicodin per day he started out taking six years ago, he was consuming the equivalent of 45 per day.
"I knew I had a problem when I had to quit," said Steve, who works as an electrician. "I didn't have seizures but it's very difficult. It was like my body was freezing and melting at the same time. It felt like every molecule in my body hurt."
He spent 10 days in a detoxification unit at the Riverside Center for Behavioral Medicine.
"There were probably 15 to 25 people detoxing and most of them were there for the same thing I was," he said. There were a couple of alcoholics and two heroin users, he said, but the rest of the patients were coming down off of prescription meds.
"Some of them had surgeries, some of them had chronic pain," he said. "All the people I know that ended up messed up on it started out with a legitimate reason."
Steve Z.'s observation jibes with what Christine Massey, has seen. She is a substance-abuse counselor for the Riverside Center for Behavioral Medicine.
She used to spend most of her time dealing with alcoholics. That changed about four years ago.
Now, she said, most of the patients entering detox at the center are addicted to opiate-based prescription drugs.
"It has drastically shifted," Massey said.
Old Problem, New Attention
The recent death of Heath Ledger brought attention to the prescription drug problem. But Sarah Simpson, special agent in charge for the California Department of Justice's Bureau of Narcotic Enforcement, said law enforcement has been dealing with the issue for a long time.
Simpson spent three years on a prescription drug task force in San Diego and now works out of Orange County. She said a state monitoring system went into effect three years ago that is helping to track abusers.
The Controlled Substance Utilization Review and Evaluation System tracks prescription drugs, dosage amounts, patient names and addresses, and pharmacy and physician information. That information, Simpson said, makes it easier for law enforcement officials to identify people abusing the system.
In June, State Attorney General Edmond G. Brown Jr., announced a plan to allow pharmacists and physicians to access the online database in order to get real-time data on prescriptions their patients might be taking.
Ned Wigglesworth, a spokesman for the California Medical Association said his organization supports the effort. But some consumer groups, concerned about privacy issues, are opposing the plan.
Currently, Simpson said, it is not always easy to catch abusers, who often use multiple names and pharmacies.
"They'll call a pharmacy and usually get an answering machine and they say, 'I'm Sue from Dr. Smith's office,' " she said. They'll leave a fictitious patient name but provide a real prescription and physician number.
"It's not difficult to do," Simpson said. And very often, the pharmacy won't pick up on the ruse.
Easily Available
There are also abusers from the supply side of the system. In May, state investigators arrested a Dr. who was charged with writing illegal prescriptions from a makeshift office in a room at the Lake Elsinore Hotel & Casino. He pleaded not guilty and has been found mentally incompetent to stand trial.
Many other doctors are just not tuned in to the dangers related to the medications they are prescribing, said Betty Burks, program coordinator at MFI Recovery Center.
"I don't know that they know the seriousness or how addictive it is," said Burks, who has called doctors on more than one occasion to discuss inappropriate prescriptions they've written for her clients.
But it's not just doctors. The explosion of drugs available over the Internet has also contributed to the problem.
"My husband is at a funeral today of a friend who OD'd on prescription drugs that he got on the Internet," Burks said.
A young woman of Indio, is one of Burks' clients. A resident at the recovery center, she says she has been through rehab numerous times. She became a heroin user at 18. Subsequently diagnosed with major depression and post-traumatic stress disorder resulting from a rape, she was prescribed mood-stabilizing medication. When she ruptured a disk in her back, she became addicted to the painkillers she was given.
"When I was out of the mental health medication, I would take the pain medication so I wouldn't get all stressed out and panicky," Crapo said. "Percocet, Oxycontin, Vicodin, I liked them all."
This woman said when she didn't have any of her own pills, she would take some from her mom or brother. She would also visit multiple doctors to get her hands on more medication and said she knows plenty of other abusers who've done the same.
Patients Getting Younger
"I kind of think there are more people (at the rehab center) who are on prescription than street drugs," she said.
One such patient is Kristina, who said that in some ways, prescription drugs have become the new street drugs. It's easy, she said, to find Vicodin on the street, where $20 can get you a bottle of 100 pills.
Massey, the drug counselor, thinks the ease of getting prescription drugs is responsible for the ever-younger patients she is seeing in her practice.
"We're seeing them start earlier," she said. "They start in high school and go in the medicine cabinet. The majority of them have never had a prescription for the drug they are taking."
Craig Lambdin is executive director of the MFI Recovery Center and a licensed therapist. He too has seen a jump in adolescents needing help with prescription drug abuse.
Of the patients at his clinics, Lambdin said, "I would say 50-60 percent of the kids admit to use of prescription drugs. It's the drug of choice for middle school because of access -- stealing them, bringing them to school and sharing them with each other. They can trade them and sell them. It's all about the access. I think that's a reflection of how much of this stuff is in the adult world."
'Very Difficult to Treat'
**Those adults, Lambdin said, represent a greater challenge when it comes to treatment. Because many of them have a legitimate need for the medication they are abusing, it's not simply a matter of removing them from the source of their problem.
"If they're addicted to heroin, we just say, 'That's bad for you,' " he said. "If they're addicted to Tylenol with codeine, that's a whole 'nother story. It's like being on a food diet. You have to eat the food, but the food creates a craving. How much is the right amount is the question.
"It ends up very difficult to treat," he added. "It's very important to have a good doctor who knows their medications and knows addiction. They have to carefully interview and follow the client."
Massey thinks such doctors are currently a minority. But she is seeing a shift.
"Because the addiction part of this has gotten so much worse," Massey said, "I think the doctors in our community have educated themselves.
"I would say over the last year or so we're getting more referrals from doctors. They want to be part of the solution."
Mr. Z., who now attends evening classes at Massey's facility to maintain his recovery, suggests that people who are taking potentially addictive drugs should consult with a treatment center if they have concerns.
"They'll tell them if it might be a good idea to do something about it then or if they're OK taking it as prescribed," he said.
He added that there is a fairly simple test for addiction.
"One thing people could do is try quitting on their own," he said. "You'll find out real quick if you've crossed the line. Your body will tell you."
DEPENDENCE RISK
Vicodin: Painkiller combining non-narcotic acetaminophen with hydrocodone bitartrate, an opioid effective for pain and as a cough suppressant. Prolonged use of two weeks or more can lead to dependence.
OxyContin: Painkiller whose main ingredient is oxycodone hydrochloride, a derivative of the opium alkaloid, thebaine. Has a dependency potential similar to morphine.
Xanax: Anti-anxiety medication in a class of drugs called benzodiazepines. Similar to Valium, but not as long lasting. It works by decreasing abnormal excitement in the brain. Prolonged use can lead to addiction.
Sources: National Institutes of Health, drugs.com and U.S. Food and Drug Administration
--------------
Source: — The Press-Enterprise, CA
Prescription Drugs Addiction on the Rise
August 2, 2008
By MARK MUCKENFUSS
Legal drugs become addictive, deadly for rising numbers
She'd been sober for a year and a half, but Kristina had already begun to backslide when an ear infection sent her to the emergency room.
She told the doctor the pain was only moderate. She also told him she was a methamphetamine addict and asked for some ibuprofen. He gave her a prescription for 30 Vicodin pills with an option to refill it. One dose of the addictive narcotic was enough for her to know she'd found a new drug of choice.
"That first day, I was in love with it," Kristina said. "Instead of one, I took two. I said, 'I'm going to like this.' "
She's one of a growing number of people addicted to prescription drugs.
The rising numbers have alarmed some officials, who attribute the trend to such factors as physicians writing more prescriptions for potentially addictive drugs, increased availability of stronger drugs and greater access to such drugs by minors.
Kristina ended up seeking help in rehab. Other addicts pay a higher price.
Deaths attributed to prescription drug abuse, either as a primary cause or a contributing factor, are rising. And the trend is not just local.
A nationwide study released Monday by researchers at UC San Diego showed that from 1983 to 2004, accidental overdoses involving prescription drugs taken at home -- either alone or in combination with alcohol or other drugs -- rose from 1,132 to 12,426. When adjusted for population growth, that represents an increase of more than 700 percent.
In San Bernardino County, recent records show there has been an upward trend in prescription drug related deaths, although the rise has not been steady. In 2003, there were five deaths in the county where prescription drugs were determined to be a contributing factor in an otherwise natural death. The next year, that figure jumped to 25, the highest to date. But this year, the county coroner has already reported 20 such deaths through the end of May. If that pace continues, it would result in 48 deaths from prescription drugs by the end of the year.
Riverside County reported 51 nonsuicidal deaths as a result of prescription drug overdoses in 2006. That number jumped to 72 in 2007. This year's figures are ahead of last year's, with 35 such deaths reported through May.
The problem has become such that our state has established task forces to deal specifically with prescription drug crimes such as people using fictitious names to get multiple prescriptions or forging prescriptions on stolen forms. Until recently, one such task force was at work in Riverside County. A regional task force is now operating out of Orange County.
A paper issued by the Coalition Against Insurance Fraud, a Washington-based group of consumer, insurance and governmental agencies, indicates that prescription drug abuse, also referred to as drug diversion, has mushroomed into a problem that costs taxpayers and insurers $97 billion annually.
According to the coalition report:
While the U.S. population increased 13 percent between 1992 and 2002, prescriptions for controlled drugs went up 154 percent.
More potent pain medications have aided patients but also have made the drugs more attractive and more lucrative to illegal sellers.
An estimated 20 million Americans, nearly 7 percent, were expected to abuse prescription drugs last year.
Common at Rehab Units
Steve Z., 51, of Moreno Valley said he began taking Vicodin in 2002 for pain in his hips. He eventually had both hips replaced. But well before his final operation this February, he had become addicted to the painkiller. Instead of the five or six Vicodin per day he started out taking six years ago, he was consuming the equivalent of 45 per day.
"I knew I had a problem when I had to quit," said Steve, who works as an electrician. "I didn't have seizures but it's very difficult. It was like my body was freezing and melting at the same time. It felt like every molecule in my body hurt."
He spent 10 days in a detoxification unit at the Riverside Center for Behavioral Medicine.
"There were probably 15 to 25 people detoxing and most of them were there for the same thing I was," he said. There were a couple of alcoholics and two heroin users, he said, but the rest of the patients were coming down off of prescription meds.
"Some of them had surgeries, some of them had chronic pain," he said. "All the people I know that ended up messed up on it started out with a legitimate reason."
Steve Z.'s observation jibes with what Christine Massey, has seen. She is a substance-abuse counselor for the Riverside Center for Behavioral Medicine.
She used to spend most of her time dealing with alcoholics. That changed about four years ago.
Now, she said, most of the patients entering detox at the center are addicted to opiate-based prescription drugs.
"It has drastically shifted," Massey said.
Old Problem, New Attention
The recent death of Heath Ledger brought attention to the prescription drug problem. But Sarah Simpson, special agent in charge for the California Department of Justice's Bureau of Narcotic Enforcement, said law enforcement has been dealing with the issue for a long time.
Simpson spent three years on a prescription drug task force in San Diego and now works out of Orange County. She said a state monitoring system went into effect three years ago that is helping to track abusers.
The Controlled Substance Utilization Review and Evaluation System tracks prescription drugs, dosage amounts, patient names and addresses, and pharmacy and physician information. That information, Simpson said, makes it easier for law enforcement officials to identify people abusing the system.
In June, State Attorney General Edmond G. Brown Jr., announced a plan to allow pharmacists and physicians to access the online database in order to get real-time data on prescriptions their patients might be taking.
Ned Wigglesworth, a spokesman for the California Medical Association said his organization supports the effort. But some consumer groups, concerned about privacy issues, are opposing the plan.
Currently, Simpson said, it is not always easy to catch abusers, who often use multiple names and pharmacies.
"They'll call a pharmacy and usually get an answering machine and they say, 'I'm Sue from Dr. Smith's office,' " she said. They'll leave a fictitious patient name but provide a real prescription and physician number.
"It's not difficult to do," Simpson said. And very often, the pharmacy won't pick up on the ruse.
Easily Available
There are also abusers from the supply side of the system. In May, state investigators arrested a Dr. who was charged with writing illegal prescriptions from a makeshift office in a room at the Lake Elsinore Hotel & Casino. He pleaded not guilty and has been found mentally incompetent to stand trial.
Many other doctors are just not tuned in to the dangers related to the medications they are prescribing, said Betty Burks, program coordinator at MFI Recovery Center.
"I don't know that they know the seriousness or how addictive it is," said Burks, who has called doctors on more than one occasion to discuss inappropriate prescriptions they've written for her clients.
But it's not just doctors. The explosion of drugs available over the Internet has also contributed to the problem.
"My husband is at a funeral today of a friend who OD'd on prescription drugs that he got on the Internet," Burks said.
A young woman of Indio, is one of Burks' clients. A resident at the recovery center, she says she has been through rehab numerous times. She became a heroin user at 18. Subsequently diagnosed with major depression and post-traumatic stress disorder resulting from a rape, she was prescribed mood-stabilizing medication. When she ruptured a disk in her back, she became addicted to the painkillers she was given.
"When I was out of the mental health medication, I would take the pain medication so I wouldn't get all stressed out and panicky," Crapo said. "Percocet, Oxycontin, Vicodin, I liked them all."
This woman said when she didn't have any of her own pills, she would take some from her mom or brother. She would also visit multiple doctors to get her hands on more medication and said she knows plenty of other abusers who've done the same.
Patients Getting Younger
"I kind of think there are more people (at the rehab center) who are on prescription than street drugs," she said.
One such patient is Kristina, who said that in some ways, prescription drugs have become the new street drugs. It's easy, she said, to find Vicodin on the street, where $20 can get you a bottle of 100 pills.
Massey, the drug counselor, thinks the ease of getting prescription drugs is responsible for the ever-younger patients she is seeing in her practice.
"We're seeing them start earlier," she said. "They start in high school and go in the medicine cabinet. The majority of them have never had a prescription for the drug they are taking."
Craig Lambdin is executive director of the MFI Recovery Center and a licensed therapist. He too has seen a jump in adolescents needing help with prescription drug abuse.
Of the patients at his clinics, Lambdin said, "I would say 50-60 percent of the kids admit to use of prescription drugs. It's the drug of choice for middle school because of access -- stealing them, bringing them to school and sharing them with each other. They can trade them and sell them. It's all about the access. I think that's a reflection of how much of this stuff is in the adult world."
'Very Difficult to Treat'
**Those adults, Lambdin said, represent a greater challenge when it comes to treatment. Because many of them have a legitimate need for the medication they are abusing, it's not simply a matter of removing them from the source of their problem.
"If they're addicted to heroin, we just say, 'That's bad for you,' " he said. "If they're addicted to Tylenol with codeine, that's a whole 'nother story. It's like being on a food diet. You have to eat the food, but the food creates a craving. How much is the right amount is the question.
"It ends up very difficult to treat," he added. "It's very important to have a good doctor who knows their medications and knows addiction. They have to carefully interview and follow the client."
Massey thinks such doctors are currently a minority. But she is seeing a shift.
"Because the addiction part of this has gotten so much worse," Massey said, "I think the doctors in our community have educated themselves.
"I would say over the last year or so we're getting more referrals from doctors. They want to be part of the solution."
Mr. Z., who now attends evening classes at Massey's facility to maintain his recovery, suggests that people who are taking potentially addictive drugs should consult with a treatment center if they have concerns.
"They'll tell them if it might be a good idea to do something about it then or if they're OK taking it as prescribed," he said.
He added that there is a fairly simple test for addiction.
"One thing people could do is try quitting on their own," he said. "You'll find out real quick if you've crossed the line. Your body will tell you."
DEPENDENCE RISK
Vicodin: Painkiller combining non-narcotic acetaminophen with hydrocodone bitartrate, an opioid effective for pain and as a cough suppressant. Prolonged use of two weeks or more can lead to dependence.
OxyContin: Painkiller whose main ingredient is oxycodone hydrochloride, a derivative of the opium alkaloid, thebaine. Has a dependency potential similar to morphine.
Xanax: Anti-anxiety medication in a class of drugs called benzodiazepines. Similar to Valium, but not as long lasting. It works by decreasing abnormal excitement in the brain. Prolonged use can lead to addiction.
Sources: National Institutes of Health, drugs.com and U.S. Food and Drug Administration
--------------
Source: — The Press-Enterprise, CA
