Prescription Addiction: Part three in a three part series examining the rise of prescription drug abuse in our community
As of 2006, opioid painkillers were involved in more overdose deaths than heroin and cocaine combined, according to figures released by the Centers for Disease Control and Prevention (CDC).
A PDF version is available here for your viewing pleasure.
Part one of the series.
Part two of the series.
Those figures were largely attributed by the organization to the easy availability to the drugs, either through legal prescription or other ways of obtaining the pills. In 2007, the CDC determined that drug overdoses were second only to motor vehicle crashes among leading causes of unintentional death.
Addiction Hits Home
By Darin J. McCann
They’re like so many other families who call this community home.
After raising three kids in a major metropolitan area, they picked up their roots and moved to the area to enjoy the coastal Sussex lifestyle. The kids had gone to private schools and were now off to college to take the next step in their respective educational and social paths, and the parents had gotten involved in local groups and organizations.
Life was good, and the future seemed impossibly bright.
But one of their children had suffered a traumatic experience — the loss of a close friend. The mother did notice that her son was depressed and suffering emotionally and, like any mother, she was distraught over seeing her son in pain. She was hopeful that the college experience would be good for her son, that he would be away from constant reminders of his departed friend, be meeting new people and see new opportunities unfold before him.
And then he approached his parents one day and told them that he had become addicted to prescription medication.
“It completely broadsided us,” said the mother, who approached us to tell her story after the first part of this series ran, in hopes of helping other families deal with this problem and under the condition of anonymity. “I had seen signs of emotional problems with him for about eight months, but I chalked it up to the loss of his friend and figured he needed time to cope with it… It’s an unbelievable feeling — like losing a lung.”
The young man fed his addiction while away at college, using campus doctors to secure legitimate prescriptions. Copies of his medical reports and prescriptions were brought in to the Coastal Point for review. Many of the prescriptions were given out just two to three weeks apart.
“I’ll never know exactly when this [addiction] started,” said the mother. “But I do know a lot of these drugs he was taking came from the campus health center. It’s really tough for me to swallow that a college student could go to college and just be given these drugs.”
Upon learning of their son’s addiction, the parents got him enrolled with Sober Living (www.soberliving.com). He went into rehabilitation for 30 days (“I was terribly impressed with the facility,” said the mother), and then went to live in a sober-living community. That community offered living quarters separated by gender and strict rules to follow. If the rules weren’t completely respected, the patients were removed from the program.
After a stay at that facility, the young man moved back home for a while, and he recently moved into a home with people he had met in rehabilitation. The mother stays in constant contact with her son and the roommates, to keep tabs on his progress.
She reported that her son is doing better now, but that she knows he still has a long, tough road before him. She also stated clearly that her son knows that the brunt of the responsibility for his addiction is his.
But she’s still angry at how easy it was for a college student, with no major physical problems in his life, to obtain prescriptions for strong painkillers. She said the majority of the drugs he got came from college, but he also received a few prescriptions here locally. She has had a change of heart regarding doctors.
“There’s a pretense of trust,” she explained. “You’re supposed to trust that doctors are looking out for you. But he can just go into any doctor’s office and come away with a prescription that can ruin his life? I don’t have that level of trust in doctors anymore.”
In July 2010, Gov. Jack Markell signed into law legislation in an effort to reduce this wave of “doctor shopping.” The law includes a central database that will monitor every prescription given out in the state for controlled substances and is expected to slow down some of the practice. State officials said they are in the process of obtaining the software for the new database, and it should be operational by the end of the year.
Still, that doesn’t help this particular family.
“He’ll be the first person to tell you that this is on him,” said the mother. “And he’s paying a huge price for it. But he’s the only person paying a price for it, and I don’t think that’s fair.”
“In the past two years, I’ve gone to three funerals for people under the age of 25,” said Sue Harris, treatment services director at the Thresholds facility in Georgetown. “They were overdoses. People can call it ‘accidental’ or label the people as ‘suicidal,’ but they’re dead. Any way you look at it, they’re dead. I don’t want to go to any more funerals.”
Thresholds has been helping people in the community deal with addiction since 1985. They often facilitate interventions, at which family members and friends of a person suffering from addiction will get together and confront the individual, in hopes of getting that person into treatment. The popular A&E television show “Intervention” has raised the profile of the intervention, but it’s not always in life as it appears on television.
“They do a pretty good job,” Harris said. “The problem is that you don’t see the months of preparation with the families before the intervention.”
Harris said they usually work with a family for six to eight weeks before an intervention, in order to find the right participants who will participate without being judgmental and accusatory.
Of course, the family usually does not tell the addict about their plans for an intervention, often bringing the individual to Thresholds under false pretenses.
“They think they’re going out to dinner, and all of a sudden they’re in an intervention,” said Harris. “A lot of people get very upset and storm out, but they often call me back in a few days. They might be upset about their family’s plans, but they want to change.”
And while a complete intervention program is but one method leading toward recovery, most experts agree that it is often up to family members and friends to confront their loved ones if they recognize a problem.
“Tough love is a bit of a cliché, but it’s still the right idea,” said Dr. Michael J. Hurd of Living Resources. “The tough part is telling loved ones (and one’s self) that, ‘You can control what you choose to do, even if it’s not easy.’
“The love part is, ‘While I won’t make excuses for you, I’ll recognize this is a genuine conflict for you, and so long as I see you making a sincere effort, I’ll stand by you.’ Treatment programs don’t always help the individual, but they can still help the family because they’re a way of proving that a sincere effort is being made.”
Families often find themselves struggling to help the addict in a way they consider substantial enough. Because of laws prohibiting doctors from discussing the treatment of patients with others, family members — particularly parents of young adults between 18 and 25 — often can’t get direct information from the caregivers regarding their loved one’s treatment.
“Oftentimes, these young adults are living at home, but the doctors still can’t give out specific information to the parents without a release form,” said Harris. “It can be incredibly frustrating for the parents, and I totally understand that, but it’s the law.
“I would suggest parents ask about the programs and treatments,” she advised. “I can discuss that freely, just like I am right now, but I can’t get into their individual cases without a signed release form. Try to get that signed upon the beginning of treatment if you want information.”
Harris suggested that parents and loved ones do their research into certified alcohol and drug treatment facilities before getting the patient enrolled.
“I tell parents to be informed consumers,” said Harris.
Of course, the significant factor in getting the loved one treatment is that individual deciding to seek treatment in the first place.
“For the person struggling with the problem, the best thing I can say is this: Own it,” said Hurd. “Talking to another person, including a counselor or support group, is a way of owning it. We own things by naming them aloud. They’re true whether we say them aloud or not, but somehow saying them makes them feel more true.
“This is the opposite of denial and all other things considered psychologically unhealthy. It’s a tired cliché to say, ‘Get help.’ To a lot of people, this means being yelled at or put down. That’s not help.”
“People need to find help where they feel comfortable,” said the Rev. Kim Tephabock of the Dagsboro Church of God and local group Unite Sussex. “Family and friends have to help that person understand they have a very real problem, and the person has to address that problem where he or she feels comfortable.
“That’s why it’s so important that local groups and organizations are more embraced by the community. When the community feels comfortable about a group, they are more likely to utilize that group’s resources.”
Unite Sussex was established to help the community and local service groups find each other – almost a database of support in one place. Their Web site (www.unitesussex.org) contains a listing of local organizations that can help, and the group is trying to add more organizations to its rolls.
One element that is no longer available to those struggling with addiction in Sussex County is the detox center in Ellendale, which was shut down by the state last year due to budget concerns. Tephabok explained that people from Sussex County who wish to go into detox must now travel to Wilmington or receive ambulatory care at home.
“I don’t fault the state for closing up the center,” said Tephabok. “But I do notice they kept the one open in New Castle County. There’s now a huge gap in Sussex County for people seeking care, and we really hope that at Unite Sussex we can work with the state and county, along with private groups, to open a new facility that’s feasible.”
It’s clear that experts on drug addiction find two things of immediate concern in regards to helping an addicted person find help: making that person understand the he or she indeed needs help, and doing some research into a facility that makes everyone comfortable.
Along with Unite Sussex, family members and those with addiction can check the Web site at www.addictionrecovery.net/delaware for facilities and centers throughout the state. People can also talk to the state’s department of health and social services, with more information available at www.dhss.delaware.gov/dhss.
And there’s always another option.
“With something like prescription drug abuse, start with your medical doctor and work outward from there,” advised Hurd. “You might or might not need a hospital stay for medical reasons, and your doctor will assess this. Tell the truth – and make sure it’s the whole truth – about the drugs you take. That’s the only way sound decisions can be made, by you or others you’re depending on.”
Hurd also is a fan of Rational Recovery (www.Rational.org).
“It’s tough but honest and, I think, an ultimately better approach to all addiction than AA or rehab programs,” said Hurd. “I agree with Rational Recovery that addiction isn’t a disease, but behavior. It’s behavior that people engaging in often feel conflicted about and wish they could change.”
The U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) most recently reported that 739,000 people older than 12 had received treatment in the past year for the use of prescription pain relievers. That was a significant jump from the 601,000 reported for 2008 and the 360,000 in 2002. The problem is gaining speed significantly.
The next step
Rising crime, addiction, death and families torn apart.
The continuous theme throughout our investigation into prescription drug abuse has been the ease with which people obtain dangerous medications for recreational use. Through doctor shopping (where individuals obtain prescriptions for the drugs by going to various doctors) to stealing from family member’s medicine cabinets to getting them from friends or street drug dealers, the accessibility of prescription medication is astounding.
As Ocean View Police Chief Ken McLaughlin said earlier in this series, “These are allegedly ‘controlled’ substances that aren’t being properly controlled.”
So, what’s being done about it?
James Collins, the director of the state’s Division of Professional Regulations, spoke about a few programs to offer hope.
Gov. Jack Markell signed an act last last year that will establish a central database for pharmacies to report to that will allow pharmacists and doctors to see if people are abusing these drugs. They are in the process now of obtaining the necessary software and Collins said he believes it will be up-and-running by the end of the year.
Dr. Gabe Somori of Coastal Pain Care Physicians in Lewes said his office will not take self-referrals, and his patients are carefully selected to avoid those who might be struggling with addiction. He also mentioned that family members will sometimes approach him in private and express concerns that the patients might be battling an addiction.
“I like those reports,” said Somori. “We see the patients for about 20 minutes at a time, and they’re on their best behavior. We don’t know how they are at night or on weekends. Families can give us a lot of information.”
Collins also mentioned a drug take-back program by the Drug Enforcement Agency (DEA). One held last September netted 121 tons of unused medicine, with 26 pounds of pills being collected in Selbyville alone. A New York Times article published on Sunday, Feb. 13, said a similar effort at Marine base Camp Lejeune last December resulted in 22,000 unused pills being returned.
David Dryden, the director of the Office of Controlled Substances in Delaware, said the DEA will be holding another national disposal event on April 30. People can visit the DEA Web site at www.deadiversion.usdoj.gov to find locations.
“The event will be held at law-enforcement offices with law-enforcement personnel,” said Dryden. “The public will empty their own containers of medications into collecting containers. No injectables or inhalation preparations will be accepted.”
The hope for the program is to simply get these pills out of reach.
Collins also said technology is coming that will make prescription pads tamper-proof, so users can not forge prescriptions anymore. The pads will have security features that are easily recognizable by pharmacies and impossible to forge, according to Collins.
Collins also said that Delaware has a unique restriction that only allows doctors to prescribe one month’s worth of controlled substances at a time, offering some control over the problem.
Selbyville Police Chief Scott Collins noted a rise in cases of people driving under the influence because they are on prescription drugs.
The Delaware Office of Highway Safety (OHS) recently published numbers from the Roadside Survey of Impaired Drivers, sponsored by the National Highway Traffic Safety Administration, that in 2007 more than 16 percent of 5,900 nighttime drivers were positive for illegal, prescription or over-the-counter medication. In Delaware, 10 percent of the 102 fatal crashes in 2007 involved individuals under the influence of drugs, according to OHS.
To deal with the problem, OHS is partnering with the Christiana Hospital Trauma Program, Beebe Medical Center Trauma Program, Milford Memorial Hospital and Atlantic Apothecary pharmacy in Smyrna to distribute educational flyers to their clients and patients, reminding them to follow their prescription labels – including the ones that caution against driving while taking some medications. The OHS has undertaken a massive publicity effort to spread that word.
Somori wrote an opinion piece in the Cape Gazette in December 2010 in which he discussed the problems with prescription medications. He discussed “pill mills” that write prescriptions for people without ever seeing them and the efforts to shut them down, with some levels of success in Florida.
He also wrote about efforts from the pharmaceutical industry to formulate a more tamper-resistant version of OxyContin, as well as a morphine pill called Embeda. He said both of the pills are in a matrix, so that if the pill is crushed, chewed or cut up, the drug is inactivated. Users often crush these pills to snort or inject them, and that destroys the time-release mechanism designed in the drug, making it more potent more quickly, and much more dangerous.
Steps are indeed being taken to minimize the accessibility to prescription pills by recreational users, as well as those who began their addictions through legitimate prescriptions. For many families, this can be viewed as closing the door after the horse has already left the barn. To others, these steps could save a life.
If you or a loved one has a problem, or potential problem, with the use of prescription drugs, share those concerns with a family doctor or a certified alcohol and drug counselor.
5 myths about Drug Addiction and Substance Abuse
MYTH 1: Overcoming addiction is simply a matter of willpower. You can stop using drugs if you really want to. Prolonged exposure to drugs alters the brain in ways that result in powerful cravings and a compulsion to use. These brain changes make it extremely difficult to quit by sheer force of will.
MYTH 2: Addiction is a disease; there’s nothing you can do about it. Most experts agree that addiction is a brain disease, but that doesn’t mean you’re a helpless victim. The brain changes associated with addiction can be treated and reversed through therapy, meditation, exercise, and other treatments.
MYTH 3: Addicts have to hit rock bottom before they can get better. Recovery can begin at any point in the addiction process– and the earlier, the better. The longer drug abuse continues, the stronger the addiction becomes and the harder it is to treat. Don’t wait to intervene until the addict has lost it all.
MYTH 4: You can’t force someone into treatment; they have to want help. Treatment doesn’t have to be voluntary to be successful. People who are pressured into treatment by their family, employer, or the legal system are just as likely to benefit as those who choose to enter treatment on their own. As they sober up and their thinking clears, many formerly resistant addicts decide they want to change.
MYTH 5: Treatment didn’t work before, so there’s no point in trying again; some cases are hopeless. Recovery from drug addiction is a long process that often involves setbacks. Relapse doesn’t mean that treatment has failed or that you’re a lost cause. Rather, it’s a signal to get back on track, either by going back to treatment or adjusting the treatment approach.