Tuesday, March 27, 2012

The Growing Problem Of Prescription Drug Abuse

Behind the everyday activities of life in America—going to work, socializing with friends and family, running errands, etc.—lies the untold story of prescription drug abuse. For many, the use of a powerful pain reliever (Vicodin, Percocet, morphine, etc.) happens only on a rare occasion that usually after a trip to the dentist to get a root canal or a bad accident ending in a broken bone. But for others, it's a daily struggle as these same drugs have taken over their lives causing both physical dependency and addictive behaviors that they can no longer control. In short, narcotic drug abuse can turn into a disease just like any other disease.

Opioids - Overview And Background

Opioids are the strongest of all pain relievers. They include a number of different products including both prescription and illicit drugs. They can be classified into 3 main types[1]:

1)  Natural Opioids - Extracted from the poppy seed plant Papaver somniferum. Common products are opium and the primary active component of opium—morphine.

2)  Semi-synthetic Opioids - The chemical synthesis of compounds naturally found in plants (alkaloid substances derived from opium). These include heroin, oxycodone (Percocet, Roxicet), oxymorphone, hydrocodone (Vicodin, Lortab).

3) Synthetic Opioids - This class of opioids is created using completely unnatural substances (petrochemicals) to create a number of different opioid products. Common items include methadone, buprenorphine (Subutex), fentanyl (Duragesic), codeine, meperidine (Demerol), propoxyphene (Darvocet and Darvon - recently withdrawn from the U.S. market).

Many will refer to all of the above medications as narcotics which is only partially true. The term narcotic originated from the ancient Greek words ναρκῶ narkō  which means "numbness" or "stupor". Narcotics have been associated with any psychoactive compound that dulled one's senses, relieves pain, and has sleep-inducing properties.

Narcotics have been widely used without a prescription for thousands of years all over the world for their pain relieving properties, but the U.S in 1915 made these drugs available via prescription only due to the potential for serious consequences if used inappropriately. Stricter regulations have been put in place over the years to try and reduce the amount of harm or even death that occurs from misusing these powerful drugs.

Opioid Use And Abuse By The Numbers

Opioid use certiainly provides many much needed benefits in terms of pain relief when helping those who need it to get through their difficult illness or distressing medical condition—cancer, acute traumatic injury, post-op surgery, etc. But in some of these individuals it can turn into a lifelong battle of addiction and dependency issues if not used properly. Opioid use is also becoming more common amongst recreational drug users and is even being used as a "gateway" drug to more powerful, harder substances like cocaine and heroin.

Narcotic drug abuse is now a serious problem and becoming more so with the increasing prescribing practices seen in today's medical community. These prescribing practices can turn deadly too in some cases as patients prescribed higher amounts of opioid doses have an increased risk of opioid overdose death[2].

The numbers below from the 2008 National Survey on Drug Use and Health (NSDUH) help put in perspective the growing problem of narcotic drug abuse[3]:

  • First time users (ages 12 or older) of prescription pain relievers for non-medical uses numbered 2.17 million second only to the 2.2 million first time users of marijuana. In comparison, there were a mere 114,000 first time users of heroin.
  • First time non-medical users (ages 12 and older) of Oxycontin totaled 478,000 or approximately 1,310 new users a day.
  • Persons (ages 12 or older) classified with dependent on or abuse of prescription pain relievers totaled 1.72 million people. This is an increase of 300,000 people from the 1.4 million individuals dependent on or abusing prescription pain relievers in 2004.
  • Those seeking treatment for the abuse of prescription pain relievers has nearly doubled from 2002 to 2008 from 360,000 to more than 601,000 individuals.
  • 55.9% of non-medical users (ages 12 or older) of prescription pain relievers obtained the drug from a family member or friend and 18% got it from their doctor while only 4.3% obtained it from a drug dealer or stranger. Surprisingly, only another 0.4% bought them off the internet.
  • Among those reportedly getting pain medications from a relative or friend, 81.7% said their friend or relative received the drugs from just one doctor.

In 2009, an article in the Pain Physician Journal stated the following - "Americans, who constitute 4.6% of the world's population, consume approximately 80% of the global supply of opioids. Between 1997 and 2006, retail sales of methadone have increased by 933%, and sales of oxycodone have increased by 58%... A number of studies have looked at the concurrent prevalence of abuse and prescription medications, and a consensus is that it is well above 20%."[4]

Data below from the Drug Enforcement Agency (DEA) show just how big of a problem prescription painkillers have become with rates of sales, deaths, and treatment due to these medications all skyrocketing in the last decade.

SOURCES: National Vital Statistics System, 1999-2008; Automation of Reports and Consolidated Orders System (ARCOS) of the Drug Enforcement Administration (DEA), 1999-2010; Treatment Episode Data Set, 1999-2009 

Pill Mills - A Growing Problem

Pill Mills are basically a legalized front for an illicit drug trafficking center. They come in the form of a doctor's office or pain management clinic as well as the pharmacies who cater to their "patients" handing out hundreds upon hundreds of powerful narcotic drugs for cash money. Most of the time the "patients" or clients that use these clinics are either drug addicts themselves or dealers looking to purchase some easy loot. A CBS News article states that pill mills share the following characteristics:

  • No physical exam is conducted
  • No medical record or other diagnostic tests are required to obtain medications
  • Have on sight dispensaries/pharmacies or patients are referred to specific pharmacies
  • Treat pain only with pills and offer no alternative treatments
  • Patient can pick their own drug of choice, no questions asked
  • Patient gets a set amount of pills and is told when they can come back for more
  • Accept cash only
  • Have large crowds of people waiting in line to see the doctor
  • Have security guards and security cameras
  • Accept cash only, no insurances

One can typically purchase most narcotic drugs for $1 a pill at these clinic with a street value of $4-$10 per pill. Oxy's (oxycodone) and Bars (Xanax) are two of the most popular medicines "prescribed" at these clinics. Together this combination can be deadly. This is especially so if multiple pain relieving drugs and/or alcohol is combined with these drugs. A recent article in the Orlando Sentinel stated how as many as 7 people die each day in the state of Florida due to prescription drug abuse. To put it bluntly, these pill mills are nothing more than potential "death clinics" to those who use them only succeeding in generating huge profits for the owners and doctors who run.

Many states have implemented Prescription Monitoring Programs (PMPs) to collect, monitor, and analyze the prescribing and dispensing of controlled substances. By doing this it should better allow for practitioners and pharmacists to "red flag" potential abusers of the system. There are currently 40 states with operational PMPs. However, each state sets up its own laws regarding which drugs are monitored and how the program is to be run. Since there is no national database and no standard set up these programs can only do so much to avert potential drug trafficking. The DEA (agency in charge of enforcing our nation's controlled substance laws) do not have oversight nor jurisdiction over any of these state run PMPs. The result is several holes and cracks in the system.

I currently live in the state of Florida which is considered to be one of the worst states in the U.S. for the trafficking of "legal" prescription drugs. Even though Florida just implemented a PMP program in the fall of 2011 the central and south regions of the state are still littered with "pain clinics". The problem is so big that out of state individuals have been coming to Florida for years in order to get a piece of the action. The take down of one of these clinics was recently featured in an Orlando newspaper article. A single doctor working at the clinic had prescribed more oxycodone in a 3 month period (Oct-Dec 2010) than all the doctors in the state of California combined. It equaled out to over 8,400 prescriptions filled at 446 pharmacies for a total of 506,126 oxycodone pills! This is not medicine folks. This is downright criminal.

To learn more about these clinics and the problems with prescription drug abuse in the state of Florida watch the documentary at the end of this article called The Oxycontin Express.

The Road To Recovery

The amount of damage both in terms of people's lives and financially that prescription drug abuse creates is almost unimaginable. According to a CDC report, in 2008 there were a total of 36,450 drug overdose deaths in the United States. This averages out to a little over 4 deaths every hour[5]. The social impact of drug dependence costs the U.S. approximately $67 billion annually in crime, lost work productivity, foster care, and other social problems[6].

Treating this disease is very difficult to say the least and usually requires multiple modalities with the primary focus in the short term focusing in on reversing the chemical processes taking place on a cellular basis in the body. To do this, there are two commonly used opioid agonist drugs (methadone and buprenorphine) and one opioid antagonist (naltrexone) which act to satisfy the body's need for the drug of abuse while suppressing withdrawal symptoms and cravings. Detoxing in this manner requires medical treatment and the expertise of a physician specifically trained to perform such work.

Relapse rates are quite high for substance abusers reaching anywhere from 40%-60% going back to their old habits within one year of being treated for them. One study even found that 59% of patients relapsed within a week of receiving inpatient treatment for their opiate dependency[7].

For this reason psychosocial therapy is also recommended in addition to the pharmacological treatment being administered. By doing so it increases the completion rates of treatment programs and reduces opioid use during such programs and at follow-up time[8]. Group therapy (Narcotics Anonymous), family therapy, and cognitive behavioral therapy are just some of the psychosocial therapies offered to accomplish this.

Below are some resources for those looking for help with a substance abuse problem:

-  National Institute On Drug Abuse
-  Substance Abuse and Mental Health Services Administration
-  The Partnership at Drugfree.org

With a lot of dedication, hard work, and support from all involved (drug abuser, family and friends, counselors, medical practitioners, state and local government officials, etc.) prescription drug abuse can be apreciably reduced in our communities improving the lives of not only the people it directly affects but also of our nation as a whole.

The Oxycontin Express Documentary

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by Dustin Rudolph, PharmD
Clinical Pharmacist

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Photo credit: 51fifty (Wikimedia)

1 Preda A. Opioid Abuse. Medscape reference. Updated 29 Feb 2012. Available: http://emedicine.medscape.com/article/287790-overview. Accessed 10 Mar 2012.
2 Bohnert AS, Valenstein M, Bair MJ, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011;305(13):1315-1321.
3 Substance Abuse and Mental Health Services Administration. (2009). Results from the 2008 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434). Rockville, MD.
4 Wang J, Christo PJ. The influence of prescription monitoring programs on chronic pain management. Pain Physician. 2009;12:507-515.
5 Community-based opioid overdose prevention programs providing naloxone - United States, 2010. MMWR Morb Mortal Wkly Rep. Feb 17 2012;61:101-5.
6 McLellan AT, Lewis DC, O'Brien CP, et al. Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evalulation. JAMA. 2000;284(13):1689-1695.
7 Smyth BP, Barry J, Keenan E, Ducray K. Lapse and relapse following inpatient treatment of opiate dependence. Ir Med J. 2010 Jun;103(6):176-9.
8 Amato L, Minozzi S, Davoli M, Vecchi S. Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Database Syst Rev. Sep 7 2011;9:CD005031.


  1. Wow, scary stats! And didnt know about the "Pill Mills"! Eek! Awful! It's all very worriesome.

  2. This is good information that should be made known among general populations. The rise of addiction to opioids is a very serious matter, and though treatments are available which include buprenorphine and Methadone, prevention should always be the goal.


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