The use of prescription drugs in any manner other than that ordered by a physician is deemed as prescription drug abuse. In this paper, I will explore recent statistics in prescription drug abuse, the misconceptions behind prescription drug abuse, and the most commonly abused prescription drugs. I will also discuss various methods that are used to obtain excessive amounts of prescription drugs and the precautions used by those in the medical profession to control prescription drug abuse.
In closing, I will focus on the government’s effort to control prescription drug abuse through the tracking of prescriptions and the imposition of tougher penalties on those who violate the law. In 1999, an estimated 9 million people were using prescription drugs for uses other than prescribed by their physicians. Of those who admitted to using prescription drugs in an abusive manner, over a quarter of the 9 million had just begun to do so in the previous year. Listed among the abused prescription drugs recognized in 1999 surveys are: pain relievers, sedatives, tranquilizers, and stimulants.
Due to the fact that they are generally less healthy and that they are more likely to receive a greater amount of prescriptions, the most stable and definite abuse of any type of drug for the elderly is that of prescription drugs. For those in the age group of 12 to 17, primary abuse lies in the misuse of psychotherapeutic such as painkillers, tranquilizers, and stimulants. The scales do not seem to tip to either side when considering which gender abuses prescription drugs more often. What we do know is that young women tend to abuse psychotherapeutic drugs more often than young men.
Even if everyone in America over the age of 12 could have been surveyed for the aforementioned statistics, there would still be a large margin of error in these already staggering numbers. The reasoning behind this error lies in the way that we view prescription drugs, the people that prescribe them, and basic denial. Prescription drugs are sanctioned and regulated by the federal government. The Food and Drug Administration (FDA) monitors prescription drugs from conception to inception.
The general belief is that after such scrutiny is exerted, any product that enters the market for medicinal purposes has been deemed safe by the federal government and is therefore safe enough for consumption. Normally, if something is legal to obtain and safe to consume, a negative term such as “abuse” for a small amount of misuse does not seem appropriate. For this reason alone, statistics will waiver towards a lesser amount than what is known. We must also consider the fact that much trust is given to physicians.
When a physician prescribes a drug for a patient, the patient has no reason to assume that the drug is not safe or that it is being used in a manner other than it’s intended purpose. Unless the patient has studied pharmacology, they truly have no way of rendering a logical verdict as to what drugs are good or bad for them or when a drug has been properly prescribed in terms of dosage or period of usage. In this way, many have abused prescription drugs completely unaware of the fact that they are doing so. Finally, there is a stigma that lies behind the admission of abuse of prescription drugs.
Many find that admitting to misuse of a drug that their doctor has prescribed to them is embarrassing and are unwilling to admit to the fact that they are doing so. Three particular types of drugs now stand out as the most commonly abused drugs. These three drugs are: Opioids, Central Nervous System (CNS) depressants, and Stimulants. Opioids are prescribed for pain relief, CNS depressants are prescribed to treat anxiety and sleep disorders, and stimulants are designed to treat attention deficit disorder and to help a patient to feel more alert and to lose weight.
Opioids act by attaching themselves to specific proteins called opioid receptors. When opioids attach to this specific receptor sites, they block messages of pain that are sent to the brain. Isolated from opium in 1806, opiods quickly became the method of pain relief offered by doctors to their patients. Later in the century, when the hypodermic syringe became available, patients had a way to provide themselves with injections of morphine that would go directly to the brain. This, no doubt, was the quickest way to relieve pain. Doctors could leave their patients morphine along with endless prescriptions at their bedsides.
A patient would own their syringe and when they ran out of morphine, they could easily go back for more. This method of unregulated treatment and administration of morphine led to addiction, forcing the patient to return for stronger and heavier doses of morphine to relieve their pain. Today, we have pain-relieving drugs such as codeine, which must be converted into morphine before it can take effect in the body. Only about 10 percent of the codeine that is taken into the body will actually convert itself into morphine. This makes the drug less powerful and less addicting than morphine.
Currently, the clearest problem with opioid addiction lies in the uprising theft and violence that occurs while trying to obtain an extremely powerful Schedule II pain relieving drug called OxyContin. OxyContin (oxycodene), became a national focus in 1999 when terrorizing armed robbers entered into drug stores across the nation demanding their supplies of OxyContin. In 2000, there was an admission of 5,261 cases of Oxycontin abuse. Disaster struck as OxyContin hit the streets. Uncontrolled and unregulated use led to death from respiratory arrest making it one of the most dangerous prescription drugs to obtain and abuse.
Sadly, once a patient has been given an opioid drug for an extended period of time, withdrawal is so difficult that often it is much easier to continue on the course of self-medication than it is to deal with pain that may occur after discontinuation of use. CNS depressants act upon the neurotransmitter gamma-aminobutyric (GABA). GABA functions by decreasing brain activity. When a CNS depressant is administered, usually orally, GABA activity produces a calming effect and drowsiness. CNS depressants like Xanax, Valium, and Librium have been prescribed to treat anxiety, stress reactions, and panic attacks.
Becoming addicted to CNS depressants and prolonging use after being removed from the medication is not uncommon due to the fact that the user is accustomed to the calming effects and therefore seeks more of the same drug for the same effect. In January 2002, Noelle Bush, niece of President George W. Bush, was arrested in Tallahassee, Florida after attempting to fraudulently obtain Xanax. She had written a prescription for the drug and had taken it to a local Walgreen’s Pharmacy. When she returned to pick-up the Xanax, police were waiting for her. Ms.
Bush admitted that the prescription pad belonged to a doctor that was no longer in practice and that the phone number on the prescription was actually to a second line in her own home. After a troubled past, Ms. Bush was scheduled to start a new job the following day. Would the continuation of the anti-anxiety drug, Xanax, have helped her make it through her “first day” quivers? Because Xanax and other CNS depressants have such a short half- life, the user must overuse repeatedly in search of that good feeling that the drug gives them. Some of the withdrawal symptoms of CNS depressants include insomnia, seizures, and hallucinations.
Like the withdrawal effects of opioids, these uncomfortable and often dangerous symptoms could push any user over the edge into prescription drug abuse. Stimulants are the drugs that make you feel great and lose weight. Amphetamines, classified as stimulants, work to heighten levels of the brains activity by attaching to the cells that produce excitatory effects in some areas of the brain. They also constrict the blood in the gut, giving the user a feeling of satiation so that they will not have to eat. In the twentieth century, stimulants were used to help war soldier improve their concentration and to counteract fatigue.
Stimulants, such as Ritalin, have also been given to children with Attention Deficit Disorder (ADD). Stimulants are great for what they do in a short-term perspective. The problem with stimulants is that they often turn people into “speed freaks”, making them feel that they need the drugs in order to function after treatment at the same levels as they did during treatment. Children, at ages sometimes as young as 13 become drug-pushers in their schools by selling their Ritalin pills to other students who want to feel the same “high”.
“Students are selling their medication to classmates who are crushing and snorting the powder like cocaine” A frightening statement such as that should tell the American public about how dangerous it is to leave patients unattended with their addictive legal prescription drugs? “When does it become dangerous to do the right thing? ” That is a question that many doctors now face as they write prescriptions for opioids, CNS depressants, and stimulants. Because doctors have taken an oath to serve their patients and to help them maintain a certain level of comfort, they often feel obligated to be write prescriptions.
When a patient tells them that they are in pain, feel strung-out, or need a real pick-up to help them concentrate and make it through the day their first solution and simplest solution is to offer a prescription. Because of the awareness of prescription drug abuse, some doctors have now begun to cut back on writing prescriptions. Because of the high demand of opiods for abuse, many orthopedic physicians have gone to the route of ordering physical therapy or suggesting surgery in lieu of medication.
Figuring out if a patient is faking symptoms is often difficult. Physical tests, such as Magnetic Resonance Imaging (MRI) and X-rays can tell a doctor if a bone is broken or fractured, but it cannot areas of strain. Because of this, making a decision in regards to the validity of the complaint is often very difficult for doctors. When a doctor decides to take a patient off of a medication, whether it is for pain, anxiety, or concentration, the patient is left to take matters into their own hands.
Some patients will chose the illegal route and attempt to buy illicit drugs off of the street. Many, however, will at the very least, attempt to obtain the medication in what seems to be a less legally threatening manner. A popular route of getting around the prescription drug abuse safeguards it to go “doctor shopping”. When one physician says “no”, a patient will find a new physician. When they go to the new physician, they will start all over with their symptoms, trying to concentrate on willing the new physician into prescribing the same pills for them.
When the second physician catches on to the game, the patient will leave that physician and go with yet another new physician to continue the process over and over again. Another very similar method of obtaining excessive amounts of prescription drugs is called “prescription doubling”. Prescription doubling is when a patient goes to a new physician within 30 days of their last prescription and does not make the new physician aware of the fact that they has received prescriptions from the previous physician.
The new physician, being unaware of the fact that the patient is already adequately supplied with a medication, will prescribe the medication for them. Because of recent lawsuits for giving too much medication, physicians have had to become more aware of the many signs of a persistent prescription drug abuser. Medicals schools now teach their students too look for the underlying signs of abuse and for clues that someone may be abusing. One way of checking for prescription drug abuse is to survey a patient for a predisposition to abuse. In a patient survey, routine questions about drug abuse are asked.
If the patient notes that they have used addicting drugs in the past or have abused illicit drugs, there is a good chance that the patient will abuse legal prescription drugs and that should be monitored more closely because of this. If the patient calls often to have prescriptions refilled over the phone, physicians are instructed to encourage the patient to come in for a routine follow up. Physicians must also be wary of excuses that a patient can devise. A common excuse for needing more medication is that they lost their previous prescription.
Most of the time, when this happens, the patient will call the office in a hurried flush, demanding a refill in desperation. This trick sets the physician and his/her staff off balance and makes it easier for the abuser to obtain the prescription. So what are we doing about the war on prescription drugs? The first thing that they are doing is tracking those who like to go “doctor shopping”. Lawrence Matheis of the Nevada State Medical Association issued this statement, “By tracking how many doctors a patient visits, it discourages doctor shopping.
So if a patient goes to 10 doctors for narcotic prescriptions, the state sends letters to all of the doctors. ” Although a procedure like that is very intimidating to both the patient and the doctor, it does seem to be a logical way of addressing an issue that may very well be a problem. In this way, the doctors were not limited to providing prescriptions for those who needed them, but they would most certainly be aware of a problem. Keith Macdonald clarified Nevada’s mission by stating that, “A person can get three wheelbarrows of drugs and we don’t care, as long as they go to one doctor.
” In Kentucky, efforts to beef up prescription drug efforts began after several tragedies due to overdoses on the powerful opioid, Oxycontin. Also in the game, Michigan and Virginia now have databases for prescriptions written for any Schedule I or II prescription drug. There are hopes that statewide databases will soon become national databases in order to keep patients from running across the borders to have prescriptions made or filled. The second thing that they are doing to control prescription drug abuse is punishing those who offend.
The government is now cracking down harder on those who abuse and those who provide prescription drugs for abuse. Not more than a few months ago, in February 2002, a Floridian doctor named James Graves was found guilty of four counts of manslaughter and one count of racketeering in an OxyContin case. Because of his careless procedures when delivering prescriptions for OxyContin, the state of Florida charged him with causing the deaths of four people who took the medication. He was charged with racketeering because the prescriptions that he issued were being converted into street drug sales.
Graves is now facing 15 years in life for his mistake. The federal government hopes that this will send a message to the medical community about how careful they must when dealing with prescriptions. For patients, felony convictions can be made if the prosecution feels that they purchased illegal amounts of the drug knowingly or if they purchased or stole the drugs for distribution. Other healthcare workers are under the gun in Traverse City, Michigan where four health care workers, such as nurses and home health aids have had their licenses suspended for improper use of the drugs that have within their access.
In conclusion, prescription drug abuse may not carry the same weight in law enforcement as illicit drug abuse, but the recent focus seems to have turned to those who do not operate below the radar screen. Most cases involve those who abuse drugs in blatant manners such as obtaining fraudulent prescriptions, writing excessive prescriptions, and using drugs in manners other than that for which they are intended. More importantly, the public is now becoming aware of the fact that prescription drug abuse can easily be just as dangerous as the illicit drugs that are bought on the street.
As individual patients become increasingly savvy on ways to obtain excessive prescription drugs, doctors are becoming more educated on ways to prevent this behavior. As doctors glimmer with greed in their eyes while thinking of ways to make money on drugs they prescribe, the federal and state governmental agencies are finding ways to track and prosecute them. Bibliography 1. “Prescription Drug Abuse and Addiction. ” National Institute of Drug Abuse Research Reports, http://www. nida. nih. gov/ResearchReports/Prescription/Prescription. html 2. “Pain Medication and Other Prescription Drugs.
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