Thursday, November 15, 2012

Prescription painkillers ‘like loaded guns’ for teens

By Mary Winter
Andrea was 15 when she started abusing prescription painkillers.
As an adolescent, the Denver woman, now 31, dabbled in alcohol and marijuana with friends, but it wasn’t until she had her wisdom teeth pulled and was prescribed Percocet that “I found what I’d been searching for, where my body felt like it was in a comfortable space in life.”
Andrea remained high on opioids for the next 12 years of her life.  She agreed to talk to Solutions about her addiction if we didn’t use her last name, a tradition of Narcotics Anonymous, which arranged our interview.
For about five years, in her late teens and early 20s, Andrea took 30 Percocet a day, which she obtained mainly from street dealers. She graduated to OxyContin, a more powerful painkiller she first obtained from a doctor in Hawaii whom she’d found in the Yellow Pages. She convinced him over the phone that she needed the drug for pain, and he mailed her OxyContin.
Andrea became good at manipulating doctors, as well as herself.  “Between accidents and strenuous work, you can THINK you have a lot more pain that you really do.”
Gradually, her tolerance to painkillers increased and “the same amount of drugs no longer worked. I was working to feed my habit. “
If she didn’t pop more pills within eight to 16 hours after her last ones, she’d get severely ill. Her stomach would ache, her legs and hands and fingers would swell, and she’d get extreme cold and hot flashes.  “You can’t even move or take a shower.”
It all came crashing down four years ago, when Andrea was fired, broke up with her boyfriend and was forced to move in with her parents. “I was already as sick as I could be, and that desperation just brought me to my knees.”

Prescription drug abuse epidemic
She tried on her own to quit using drugs, but failed repeatedly.  “The only way I could do it was going through NA and talking to other addicts and seeing there was a solution and that I never had to use again. They kept me accountable, and I still go (to NA meetings) to this day.”
Andrea is the face of what a University of Colorado Denver sociology professor has called an epidemic of prescription drug abuse among young people.

Richard Miech
A recent study by Richard Miech, Ph.D., indicates young people ages 12 to roughly 30 are abusing prescription pain medications like Vicodin, Valium and OxyContin at a rate 40 percent higher than previous generations.
Drug deaths, propelled by an increase in prescription narcotic overdoses, now outnumber traffic fatalities in the United States, the Los Angeles Times reported in September 2011.
“Drugs exceeded motor vehicle accidents as a cause of death in 2009, killing at least 37,485 people nationwide, according to preliminary data from the U.S. Centers for Disease Control and Prevention,” the Times wrote.
For young people, the dangers are several-fold.
Because of the varying strength of pills, it’s easy to accidentally overdose, or take a dangerous combination of pills and alcohol, which can lead to convulsions, coma and respiratory arrest, which can be fatal.
Like any mind-altering substance, prescription drugs can impair judgment and reasoning, inducing reckless driving and other dangerous behaviors.
Finally, some scientists believe immature brains are especially vulnerable to chemicals, and that exposure to prescription drugs at a young age can trigger lifelong addictions.
Statistics from the Narcotics Overdose Prevention and Education Task Force:
  • Every day 2,500 teens in the United States try prescription drugs to get high for the first time. (Source: Partnership for a Drug Free America)
  • Nearly half (49 percent) of all college students either binge drink, use illicit drugs or misuse prescription drugs. (Source: Center for Addiction and Substance Abuse at Columbia University)
  • Every day 2,500 teens in the United States try prescription drugs to get high for the first time. (Source: Partnership for a Drug Free America)
  • 60 percent of teens who have abused prescription painkillers did so before age 15. (Source: Partnership for a Drug Free America
  • 45 percent of those who use prior to the age of 15 will later develop an addiction. (Source: Misuse of Prescription Drugs. National Surveys on Drug Use and Health, Substance Abuse and Mental Health Services Administration. 2006)
  • 12- to 17-year-olds abuse prescription drugs more than they abuse ecstasy, crack/cocaine, heroin and methamphetamine combined. (Source: Partnership for a Drug Free America)
  • There are as many new abusers age 12 to 17 of prescription drugs as there are of marijuana. (Source: Partnership for a Drug Free America)

How can I keep my child from abusing prescription medications?
  • Safeguard all drugs at home. Monitor quantities and control access. Take note of how many pills are in a bottle or pill packet and keep track of refills. This goes for your own medication as well as for your teen and other members of your household.
  • If you find you have to refill medication more often than expected, there could be a real problem-someone may be taking your medication without your knowledge.
  • If your teen has been prescribed a drug, be sure you control the medication and monitor dosages and refills.
  • Set clear rules for teens about all drug use, including not sharing medicine and always following the medical provider’s advice and dosages.
  • Make sure your teen uses prescription drugs only as directed by a medical provider and follows instructions for over-the-counter (OTC) products carefully. This includes taking the proper dosage and not using with other substances without a medical provider’s approval.
  • Teens should never take prescription or OTC drugs with street drugs or alcohol. If you have any questions about how to take a drug, call your family physician or pharmacist.
  • Be a good role model by following these same rules with your own medicines. Examine your own behavior to ensure you set a good example. If you misuse your prescription drugs, such as share them with your kids, or abuse them, your teen will take notice. Avoid sharing your drugs and always follow your medical provider’s instructions.
Miech’s findings are based on 1985-2009 data from the National Survey on Drug Use and Health, a representative sampling of some 60,000 respondents.
“Prescription drug abuse has become an epidemic in the past 10 to 15 years,” not just among youth, but among adults as well, said Miech.
But people born in 1985 or later have rates that are much higher than any other cohort when they were the same age, Miech found. One of the main reasons, he believes, is the explosion in the availability of the drugs.
“From 1997 to today, legal prescriptions for painkillers increased from 20 million to 160 million a year – a fourfold increase.”
Because so many people “have them lying around the house, it’s easy for kids to procure prescription pain meds,” Miech said.   According to his findings,  “friends and family” are the No. 1 source of prescription painkillers for youth.
The fact that doctors are issuing the prescriptions may give the public a false sense of safety and an aura of legitimacy, Miech added.
That view is widely held.  As Andrea said: “For young people who are addicts, the best access to drugs is through a doctor, because it’s legal” and seemingly sanctioned.
Miech’s numbers indicate “prescription drug abuse is definitely concentrated among people of low education and low income.”
He said celebrities whose deaths are in part attributed to painkiller overdoses, including Heath Ledger and Whitney Houston, are the exceptions.
Others in the field say abusers come from all socio-economic groups.
“They come from good families, often with good educations,” said Robert Johnson, a licensed addiction counselor in metro Denver. “They just get mixed up in the wrong crowd, and they’re off to their addiction. Their family doesn’t know what to do. We start with individual and sometimes family therapy and a 12-step program. We try to get them connected to a strong support group.”
Dr. Comilla Sasson, an emergency room physician at the University of Colorado Hospital in Aurora, agreed.  “It’s not really any certain kind of kid; it’s an any and all kinds and that’s what makes it difficult.  Any child who has got access to their parents’ drugs at home has the potential to be drug abuser.”

Comilla Sasson
For Miech, the biggest surprise of the study was the finding that baby boomers aren’t driving the trends in prescription drug abuse, as they always have with marijuana use.  “As it turns out, it’s today’s youth that really seem to be taking to (prescription drug abuse.)”
In 2009, of all age groups, people aged 25-34 made the most emergency department visits involving non-medical use of pharmaceuticals in the Denver-Aurora Metropolitan Statistical Area.  This group made 1,607 visits, or 22.4 percent of all such visits, according to the Drug Abuse Warning Network.
People 18 to 24 had the highest rate of such visits — 465.6 visits per 100,000 population — and 54.5 percent of emergency department visits for pharmaceuticals were made by female patients, according to DAWN.
Prescribing culture has changedOn the other hand, people aged 55 to 64 made 791 visits, or 11 percent of the total visits.
Miech traces the roots of today’s liberal prescription trends to the 1980s and ’90s, when two U.S. medical-expert panels issued guidelines that “encouraged expanded use of opioid pain medications after careful patient evaluation and counseling when other treatments are inadequate,” as reported in a Dec. 10, 2008 article in Journal of the American Medical Association.
The article states that the “Federation of State Medical Boards has encouraged adoption of model policies to promote more compassionate pain management by clinicians.  States have increasingly complied by enacting new regulations or issuing guidelines or policy statements promoting improved pain management.”
But the increase in compassionate pain management has led to an increase in abuse, the article states.
“In the 10 years (1997-2007) since the guidelines were first published, per capita retail purchases of methadone, hydrocodone and oxycodone in the United States increased 13-fold, four-fold and nine-fold, respectively.  Concurrent with the increase in legitimate sales of opioids, diversion of these drugs to non-medical uses has also increased, “ the JAMA article states.
In an August 1999 article,  “A Shift in the Treatment of Chronic Pain,” the New York Times describes how many states had begun to shield doctors from prosecution for over-prescribing painkillers on the widely held belief that alleviating “intractable pain” should the medical profession’s higher priority.
According to a 2009 report on opioid drug abuse by the Center for Health Law, Politics and Policy at Temple University Beasley School of Law:
“The growth in prescription of therapeutic opioids had several causes. The most important were incontrovertible empirical evidence of high levels of untreated pain among patients in the U.S. and elsewhere, and a general consensus within the medical community that chronic pain needed to be more aggressively treated. The availability of new drug formulations and vigorous pharmaceutical marketing efforts also contributed to wider use of effective pain medicine.”
Like other experts interviewed for this story, Miech said doctors today have a difficult job striking the right balance between helping patients manage their pain and over-prescribing pain killers.
Sasson, the emergency room physician at the University of Colorado Hospital, remembers that as recently as 2003, when she entered the medical profession, “it was a big (deal) to give a patient Vicodin.
“Nine years later, I’m handing it out to patients much more rapidly,” she said. “The prescribing culture has changed.”
Patients want and expect drugs, Sasson said. “You say ‘no’ and you become the ‘bad doctor’ who doesn’t care.  But we have to manage those expectations.”
Other experts say pharmaceutical makers have no incentive to want a reduction in prescriptions, and that insurance company policies may add to the problem. Robert Johnson, the counselor with A New Outlook Counseling in Denver and Lakewood said a client who had hurt her back shared this story with him:
“The doctor, instead of giving her a week’s worth of pain pills, said, ‘Your insurance will pay for 100, so here’s 100.’ ”
Johnson estimated that 50 percent of his patients were prescription-drug or opioid dependent in 2006-08, when he worked at CeDAR, a Colorado addiction treatment center.
His own off-the-cuff theory about the cause of the increase in prescription drug abuse among young people is that  “Today’s youth feel entitled to do whatever they want.”
“I’m one of ‘em,” said Johnson, who’s been in addiction recovery for 12 years.
Prescription drugs like loaded guns
At the University Hospital emergency room, “We get at least one (prescription drug) OD a shift,” said Sasson.
Many are young people, although the hospital has not broken down the numbers by age, she said.
In many cases, paramedics will have responded to a 911 call by the victim’s friends, who report he or she has stopped breathing.  Symptoms also include drowsiness, confusion, nausea and seizures.
Paramedics will administer an antidote to restart breathing.
“But it’s a fine line,” said Sasson.  “If their friends had waited just a few more minutes to call 911, they’d be dead, or if our paramedics weren’t as good as they are, many, many more would be dying every year.
“We get used to it, but it’s scary.”
Like Miech, Sasson said parents need to treat prescription drugs like loaded guns, and keep them locked up at home. Even if your own kids aren’t snooping around in your medicine cabinet, there’s a good chance their friends are, they said.
“Parents cover electrical outlets when their kids are toddlers,” Sasson said, but it’s not on their radar to take similar precautions when their children are teens.
“Young brains are more susceptible and so much more vulnerable; the potential for addiction is much higher,” she said.

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