The personal and social costs of prescription opioid addiction

¶ … Abusing Opiates

Cost associated with Abuse

At times, the cost associated with abusing prescription pain killers, such as opiates, may seem minimal, as having a prescription filled in the quest to secure relief from pain may be small in the cost of dollars. When an individual becomes addicted to opiates, however, the associated cost dramatically increases. At times, along with being dishonest and denying the fact that one may in fact be addicted to opiates may cost much more than the addictive individual ever intended to pay. Abusing opiates may at times cost an individual his/her life - figuratively, or literally, as in the case of Anna Nichole Smith, when abusing opiates ultimately ended in premature death. In "As painkiller, methadone proves deadly," Eric Weslander (2007) reports concerns regarding opiate addiction, related by Dr. William McKnelly, of the Kansas City Metro Methadone Program. The current increase in legitimate use of these pain medications, according to McKnelly, "has paralleled... A rise in abuse of these drugs" (McKnelly, as cited in Weslander, 2007, Deaths rising section ¶ 7).

In "Drug Testing. In Drug Treatment: What Works?," J.A. Carver (2004) presents numerous considerations relating to attempt to answer the question "what works" in the battle against addiction, as "mind-altering substances have the ability to elevate the level of a substance known as dopamine in the brain, which produces a sense of intense pleasure" (Carver, p. 146). In its quest to enhance the understanding of the cost relating to the addiction of opiates, this paper also addresses a number of considerations that accompanying the process when an addicted person's brain is "programmed to repeat pleasurable experiences and avoid unpleasant ones" (Carver, p. 146).

The researcher contends that when a person becomes addicted to prescription painkillers, such as opiates, the related ramifications of abusing prescription drugs may not only drain him/her biological, psychological, and socially, but also adversely, often painfully affects those he/she interacts with during his/her time of addiction.

At times, even when an addicted individual may realize that his/her ingestion of opiates and/or other drugs may cost him/his/her life, the immediate pleasure or "necessary" relief from pain that the prescription painkiller provides may attribute to the user insisting that he/she is not addicted. he/she may even "convince" him/her self that his/her abuse of prescription painkillers, such as opiates, does not constitute a "real" problem. Prescription painkiller abusers may even initially believe they can abuse opiates without causing harm to him/her self. "As a result of the effect on the brain produced by drugs, [however,] the compulsion to repeat intensely pleasurable experiences, and the inherent denial of addicts that their drug use is causing problems, the lives of drug abusers tend to spiral out of control" (Carver, 2004, p. 146). Eventually, individuals who abuse opiates may reach a point in their lives when they "hit bottom." At this time, the opiate abuser may begin to realize that he/she cannot continue to "live" such a self-destructive lifestyle. Reaching this point frequently, albeit, comes with a high price. The opiate abuser's family may issue him/her an ultimatum; he/she may lose his/her job, or he/she may be arrested and incarcerated for a time. Each of these incidences, particularly an arrest, proffers an opportunity for the opiate abuser to begin to establish a framework of honesty and begin to be accountable, not only for his/her abuse, but for him/her self.

At this time, the healing process; the process of recovery may begin (Carver, 2004, p. 146).

The Start of Addiction

Weslander (2007) reports that between 1999 and 2002, Oxycodone prescriptions increased 50%, while physicians wrote approximately 60% more morphine prescriptions " the single-most prescribed drug nationwide is the painkiller hydrocodone, with more than 100 million prescriptions in 2005" (Journal of the American Medical Association, as cited in Weslander, 2007, Deaths rising section ¶ 5). Recently, in light of concerns related to methadone treatments, doctors have begun to shift from methadone as an addiction-treatment drug to an analgesic, or painkiller. Weslander stresses, however, in some incidences, methadone is included as one of a number of opiates increasingly being prescribed. Consequently, it needs to be determined "why the use of prescription opioids has increased so markedly over the course of the last several years (Deaths rising section ¶ 4). According to the American Medical Association, the increase of opiate prescriptions evolves from the increasing emphasis on pain treatment of pain. This trend is expected to continue as the age and population will suffer from more pain related to arthritis, cancer and back problems in future years (American Medical Association, as cited in Weslander, 2007, Deaths rising section ¶ 6). Toxicologists currently report the rapid increase of prescription drug abuse; which increased 21% from 2004 to 2005. The National Institute on Drug Abuse contends most misuse occurs in the following three classes of prescription drugs (Miami Herald, 2007):

Opioids, prescribed for pain, such as Vicodin.

Central nervous system depressants, prescribed to treat anxiety and sleeplessness, such as Valium. (Miami Herald, 2007)

Stimulants, prescribed to fight attention-deficit disorder, such as Ritalin.

A reported, contemporary alarming trend reveals young kids and teenagers are turning away from street drugs, such as cocaine and heroin, and replacing them with prescription drug use. One survey, noted by the Miami Herald (2007) found that during 2006, abuse of the painkiller, Vicodin, totaled 3% among eighth-graders, 7% among 10th-graders, and 9.7% among 12th-graders. Misuse of Ritalin, a stimulant with the proper target of attention-deficit disorder, remains steady, at 5% among 12th-graders. Of the 1.4 million trips to U.S. emergency rooms in 2005, approximately 27% of these related to drug overdoses. Despite the fact that most people taking prescription drugs, legally prescribed for them, may not believe that these drugs possess the potential to harm them, E.R. records confirm the contrary to be true. When the amount of a particular drug ceases to revive the same amount of relief as previously received, some individuals tend to increase the doses they'd take, without the consent of their doctors. This, in turn, frequently increases a person's chances of misuse, and to potentially overdose, a common story of the start of addiction (Miami Herald, 2007).

How Addicts Feel "It's hell" (McKnelly, as cited in Weslander, 2007, Biological dependency section, ¶ 2), Kerry McLay, a Lawrence substance-abuse counselor, states, regarding the process of being addicted to opiates. Trying to get off any opiates proves to be a horrific process, McKnelly stresses. The addicted individuals experiences extreme body aches and nausea. A majority of individuals have to be admitted to the hospital to be medically detoxed (Ibid.). McKnelly and his staff members report they have witnessed an increasing number of patients in recent years come to the methadone clinic hooked on prescription pills. According to McKnelly, "OxyContin -- which is often crushed into powder and snorted to bypass its time-release feature - [is] "the worst thing in the world" (Mcknelly, even Weslander. Deaths rising section ¶ 8).

As opiate addiction is a biological dependency, one cannot talk an addicted person out of his/her addiction. It would not matter if he/she were "MotherTeresa, or Rush Limbaugh or a junkie down here by the mission," McKnelly stresses. Other members of the community may do a number of things to help person withdrawing from opiates, however, one person cannot help another out of a biological dependency. (McKnelly, as cited in Weslander, 2007, Biological dependency section, ¶ 5).

Maintaining the Habit

The following writing: "The Psalm of the Addict," anonymously written anonymously, and recorded in the Congressional Record, July 31, 1971, could also depict the habit of opiate addiction:

King at Heroin [Opiate] is my shepherd, I shall always want.

He maketh me to lie down in the gutters.

He leadeth me beside the troubled waters.

He destroyeth my soul.

He leadeth me in the paths of wickedness for the effort's sake.

Yea, I shall walk through the valley of poverty and will fear all evil for thou, Heroin [Opiate], art with me.

Thy Needle and capsule try to comfort me.

Thou strippest the table of groceries in the presence of my family.

Thou robbest my head of reason.

My cup of sorrow runneth over.

Surely heroin [Opiate] addiction shall stalk me all the days of my life and will dwell in the House of the Damned forever. (Respectfully Quoted, 2003)

Getting Free

While the withdrawal from opiates may be an agonizing matter for some abusers, it does not prove to be an excruciating painful case for all. At its worst, opiate withdrawal may include a number of days when the abuser vomits, experiences diarrhea, shivers, sweats, has muscular twitches and suffers with severe cramp-like pains in both his/her abdomen and limbs. The rule for those withdrawing from opiates, however is severe insomnia. Insomnia is such that "there is no relief even at night" (Carver, 2004, p. 102). Even though drugs as clonidine or lofexidine may provide some relief during the withdrawal phase, many clinics only offer aspirin to the individual experiencing withdrawal from opiates. No known drug, however, proves universally effective, or shortens the duration of discomfort. Because numerous clinics decline to offer sleeping medication to the individual withdrawing from opiates, many addicts discharge themselves early from the treatment process (Carver). In regard to treatment, Carver notes:

Detoxification technology is being transformed in an increasing number of countries by the introduction of rapid opiate detoxification (ROD) techniques. Instead of discontinuing opiates abruptly or over a few days and allowing withdrawal symptoms to develop (a technique which adds the stress of anticipation to the actual pains of withdrawal), an alternative technique is to precipitate acute withdrawal over a space of three to four hours by administering opiate antagonists. These drive all opiates off the opiate receptors but also start the process of normalising the receptors so that the worst symptoms of withdrawal are over in two to three days rather than the two to three weeks which is typical in conventional programmes for most patients (Brewer 1997). Naltrexone is the usual opiate antagonist used. As well as being more efficient and humane, these techniques are also more cost-effective than conventional methods. (Lahej et al. 2000; Carreno et al. 2002, as cited in Carver, 2004, p. 102)

Starting Over Grace Rountree, 18-years old, Paul S. Martinez (2007) reports in "Former pill addict gets a new lease on life," comes from a "good Christian family." As she was home schooled, Rountree was not routinely exposed to drugs as many youth who attend public school may be. At the age of sixteen, however a friend, at Rountree's local church, and a relative introduced her to prescription drugs. In time, she not only began to abuse the prescription drugs, she also started selling them after she learned she could receive four to six dollars a pill (Martinez). To obtain the drugs, Rountree met individuals suffering with real health issues, and subsequently went into pain management clinics to obtain the prescription drugs. From Rountree's prescription drug business, she discovered she can spend $150 on the doctor visits plus the prescription, and then easily transform that amount into $1,500 (Martinez, 2007). Each day, the group Rountree worked with would "visit' several different clinics, as well as routinely travel to Houston to hit more clinics. The cost for the easy profit, however, hit home to Rountree, when she finally got caught. Currently, she is on probation and required to take weekly drug screenings (Martinez, 2007). During the same time frame Rountree was charged with the illegal purchase of prescription drugs from a pharmacy, law enforcement officials in the same area arrested three doctors: Carlos Domingo Cunado, Ramiro Hernandez and Douglas Wayne Wheeler, I for prescribing the same combination of narcotics to every patient without an adequate medical examination. Documents later confirmed that the medical board took away the medical licenses of each of the three physicians (Martinez, 2007).

Rountree stated that getting off of prescription pain pills was one of the hardest things she has ever done. Currently, as she strives to get her life back on the right track, Rountree works at a full time job and plans to enroll in college (Martinez, 2007).

Curbing Drug Abuse

On February 21, 2001, few weeks after Ryan Haights 18th birthday, Francine Haight, Ryan's mother received the phone call parents hope to never receive. Ryan died from overdose of prescription pain pills. At the time, Francine was at a total loss, as she did not even know Ryan had been prescribed any kind of pain medication. When Haight investigated how Ryan obtained the prescription drugs that contributed his death, she learned Ryan did not have a legal prescription for the highly addictive drugs he had ingested; that he had obtained the pills through a Web site. Currently, thousands of Internet pharmacyWeb sites appear to provide, for a reasonable price, highly addictive controlled substances to individuals who would generally not be able to obtain them from a legitimate physician. These Internet pharmacy Web sites exploit a vagueness in the Controlled Substance Act, a law that governs the sale of drugs, albeit still possesses some potential for abuse and addiction. Web site operators create a sham process, which permits customers to fill out a short online questionnaire, which a doctor reportedly uses to verify a prescription for a controlled substance, such as hydrocodone. The "online" physician never sees the patient, and he/she never verifies patient information. Senators Dianne Feinstein and Jeff Sessions introduced legislation to try to help prevent other parents/children from experiencing the same horror as Haight and Ryan. The Online Pharmacy Consumer Protection Act, to be considered by the Senate Judiciary Committee, is expected to regulate the sales and distribution of a controlled substance, and bring the law into the Internet age. The Online Pharmacy Consumer Protection Act addresses the issues of rogue Internet pharmacies in three significant ways:

It eradicates the online questionnaire loophole by requiring at least one "in-person" examination to occur, for a controlled substance prescription to be filled over the Internet, and considered valid;

It creates a registration system for Internet pharmacies; and it increases penalties for trafficking controlled-substance prescription drugs.

These three components appear to constitute plausible fixes that will protect Internet users from prescription drug traffickers, without hindering legitimate medical practices. Even with new precautions put in place and practiced, nevertheless, some will still craft devious ways around the process to obtain prescription drugs. New constraints will hopefully make the illegal processes a bit more laborious (Horton, Remington, 2007).

Many parents in the town of Omaha, Nebraska, Walters reports, were unaware of the grave the situation in their town until the arrests of a number of teens occurred. John P. Walters (2004) recounts details of the major arrest of teens at Millard North High School and Westside High School for the distribution of Adderall in the article, Goal is to halt abuse." Adderall, comparable to Ritalin, is a central nervous system stimulant often prescribed to treat individuals (primarilychildren) diagnosed with ADD (attention deficit disorder), or ADHD (attention deficit hyperactivity disorder). Taken as prescribed, Ritalin or Adderall proves to be an effective medicine. Research reveals that individuals with ADHD do not become addicted to their stimulant medications, when taken at treatment dosages. A person who abuses Adderall, however, may become addicted, and convinced they cannot function without the drug (O'Connor, 2007). One major concern regarding Adderall is that along with using Adderall, a person may also use other drugs such as marijuana, and alcohol. Due to the sobering effects of Adderall, individuals who drink alcohol with this particular drug, do in fact run a high risk of alcohol poisoning. Some youth, nevertheless, like to experience the feeling of energy Adderall produces, possibly because they feel that others in society perceive them to always be on the go (O'Connor, 2007). In the past, in Omaha, as in many towns in the U.S., parents may have exclusively focused on the illicit drugs like meth, coke, and marijuana. After the arrest incident, however, they began to double check their medicine cabinets to ensure that their children were not taking prescriptions - not specifically described for them.

The Second Largest Illicit Drug Problem in America

Prescription drug abuse constitutes the second largest illicit drug problem in America. Only marijuana is reported to be more widely abused. Over six million Americans have reported that they in fact have abused these drugs over the past year. One survey, according to Horton and Remington (2007) asserts that one out of ten high school seniors confessed to using a highly addictive prescription called Vicodin. The number of people abusing OxyContin reportedly increased since the national survey was completed. In response to these staggering results, the government has begun to implement state to state monitoring, and utilizing electronic tracking systems, with the hope this will help warn pharmacies and doctors about persons trying to obtain drugs through deception. Unfortunately, an abundance of "pill mills" operate, with doctors willing to prescribe a myriad of prescription drugs to those willing to pay them. Even with the illegalities being well-known, only a minute percentage of physicians selling drugs in illegal ways face any charges. It was estimated that during 2007, out of approximately one million physicians licensed to prescribe controlled substances, fifty were arrested. These physicians were known to actually be providing prescriptions to individuals for sexual favors; without any monies exchanged. Persons who become addicted, due to the extraordinary noted in this particular scenario were not to be punished, but made to enter a drug rehabilitation facility. In addition, the community was to become educated to this rising problem, so that it may be able to prevent more addiction to prescription drugs (Horton, Remington, 2007).

New drug dealers: Medicine cabinets

In "New drug dealers: Medicine cabinets," Emily Johns (2008) reports that the federal Office of National Drug Control Policy, is running drug awareness ads in its attempt to warn parents about the mounting abuse of prescription drug abuse by youth.

You got kids?" (Johns), a rough looking character in the commercial abruptly asks. "Well, next time something goes south with your kids, don't look at me, man" (Johns, 2008) the character claims. The commercial reminds parents that teens no longer routinely turn to the regular drug dealers, one would find on a street corner. Instead, today's youth are turning to the in-house drug dealers, medicine cabinets of family and friends. It is estimated that nearly 7 million Americans currently abuse prescription drugs, more than the number of individuals who abuse cocaine, heroin, hallucinogens, Ecstasy and inhalants combined. According to federal statistics, prescription drugs have overtaken cocaine and heroin (combined) as the leading cause of lethal drug overdoses. This indicates an 80% increase from 2000 (Johns, 2008). During 2006 in Minnesota, 240 people were arrested in prescription drug cases, an increase up from 193 in 2005, according to the Bureau of Criminal Apprehension. More than 5 million children in the U.S. ingest a pill every day for behavior disorders, so kids learn at a very young age that if you want a mood change, you take a pill," Carol Falkowski, director of the Chemical Health Division of the Minnesota Department of Human Services, asserts (Falkowski, as cited in Johns, 2007)

Falkowski also believes that teens do not realize that taking another person's prescription poses an incredibly dangerous threat. Some teens believe the myth that prescription drugs are safer than street drugs. Though efforts to decrease this percentage are being implemented by methods such as using electronic medical records, requiring tamper-proof prescription pads for Medicaid patients, and creating a Minnesota health-information sharing system that allows hospitals to communicate with one another, the abuse continues to increase (Johns, 2008). The abuse of prescription drugs, such as opiates, does not discriminate against age or social class. Due to the easy accessibility of ways to secure prescription drugs, incidences of abuse are also increasing in the health care profession. One nurse, for example, was charged with forging her own prescriptions for Percocet after she stole prescription pads from several doctors' offices where she worked (Johns, 2008). Although today's technology is frequently used to illegally obtain a prescription drugs, it also proves vital in the fight against the abuse of the drugs. Minnesota plans to unveil a new "electronic superhighway," noted as the Minnesota Health Information Exchange. This system will allow medical organizations across the state to share information about patients who give consent. This electronic highway, designed to aid in the prevention of prescription fraud, identifying what prescriptions patients have filled, could also provide other secondary benefits. Electronic prescriptions may additionally provide pharmacists, on the lookout for fraud, some added protection (Johns, 2008). The U.S. government is also trying to change the fact that most addictive painkillers cannot be prescribed electronically; due to the fact they must have a signature. Since Minnesota has made the transition to electronic medical records, a fewer number of patients have paper prescriptions, which consequence helps decrease the percentage of individuals "doctor shopping," or obtaining multiple prescriptions for the same health problem.

No matter the methods to prevent scenarios of abuse of drugs, the researcher contends, as noted earlier in this paper, somewhere; somehow; some way; someone will find a way around electronic and other safeguards, and illegally obtain prescription drugs. The abuse or prescription drugs, however, the researcher asserts presents only a symptom of an underlying problem that needs to be further addressed. As society addresses the roots of drug abuse, including opiates, perhaps in time, instead of the cost associated with abusing prescription pain killers, such as opiates, continuing to rise, and costing individuals their literal and figurative lives - those addicted will chose instead to live. In turn, as they seek to live, others in their lives will hopefully begin to reach out to help them. Ideally, in time, what today reflects a massive myriad of unanswered questions as to what works to counter abuse of opiates will be answered as lives, once ruined by abuse, become transformed and freed.