New Leading Cause of Accidental Death

Prescription Drug Abuse

The overall point of conversation when speaking of prescription drugs in the public and political sphere has usually focused on cost and/or ease of access among all Americans. The overall points of conversation relating to drug has often centered on drugs like heroin, cocaine, crack and marijuana. However, as time and trends have shifted, the primary focus of both overall topics has centered on the use and abuse of prescription drugs, usually certain classes of drugs such as sedatives, opiates and anti-anxiety drugs. Common drugs focused on include Xanax, any narcotic-based painkiller such as Oxycontin and sedatives or muscle relaxers such as Valium and Soma. While prescription drugs are very important to have at the ready, the likelihood and propensity towards abuse of the drugs and other legal behavior is significant and this is even true among people who obtain the drugs legally at the onset.

Analysis

As noted in the introduction, much of the "War on Drugs" debate has centered on drugs that are never legal, or at least not legal in the form in which they are produced and sold. After all, there is not a whole lot of difference between the street drug methamphetamine and drugs like Ritalin nor is there a ton of difference between heroin and Oxycontin in terms of the base components and effects of the drug. However, of those combinations, one is produced in filthy to dangerous ways and the other has a legitimate use with certain kinds of medical patients and in certain situations.

However, the lines have become blurred because now prescription drugs are being used by people to get their proverbial fix. It can be as simple as someone giving a friend a pill such as an Adderall or a Xanax to supposedly give them focus or calm their anxiety, just as two example. It can mushroom to something such as someone filling their legal prescription and then selling some or all of the pills. It can get even worse when a person gets multiple prescriptions from different doctors for drugs such as Xanax or any opiate painkiller. The way in which the drugs are used changes with the day as well. Some people just take one or more pills in a regular fashion but some people go to the lengths of crushing and snorting the pills or shooting them using a syringe after submerging the drug in a liquid. This report looks at this ever-growing problem that knows no racial lines and is affecting a lot of people from all walks of life. While the drugs in question are a lot safer than common street drugs, the manner and quantity in which they are being taken is not remotely safe and the laws that make the simple mislabeling, incorrect carrying or distribution of one bill alone a felony is not deterring people that are seeking their fix.

The problem of prescription drug abuse is a wide-spread problem that touches all demographics but focus can also be put on specific demographics within society such as women and teenagers. As far as looking at things from a high-level standpoint, the drug problem is especially strong in the state of Ohio. The state of Ohio ranks among the highest in terms of overdose rates in the United States and unintentional drug poisoning in general has risen by nearly four times over just from 1999 to 2010. This has cost the state nearly $4 billion in budget money and this amount alone is half of the state's budget deficit. Part of the problem, at least in the eyes as many, is the areas that are dispensing of millions of ostensibly legal doses in such a small geographical area. One such example was Scioto County in Ohio. That county alone dispensed nearly ten million doses of pain medication in just 2009 alone. Such a pervasive amount of "legal" drugs being present in such a small area no doubt leads to the fact that more than a fifth of all children born in Scioto County have tested positive for opioids at birth (Winstanley et al., 2012).

Drug overdoses overall account for about 100 deaths a day in the United States as of 2007. This is triple the rate of the same metric in 1991. In 2009, there was 1.2 million visits to the emergency room for drug overdoses and this was a doubling of th e rate from 2004. Those visits were specifically for the misuse of pharmaceuticals and this number actually exceeded, although not by much, the amount of ER visits for street drugs such as heroin and cocaine. To paint an even more sober picture, in 2010 there were enough opioid drugs prescribed to give every single person in the United States a 5 milligram dose every four hours for an entire month. This is a 300% increase in just 11 years. As far as an impact on women, deaths are more common with men but visits to the ER and/or hospital are higher with women when looking at the same event (Vital Signs, 2013).

When looking at teenagers, the picture is dire as well. Every day, more than two thousand kids from age 12 to 17 take a prescription painkiller for the first time. The aforementioned instance of unintentional drug poisoning is now the second-leading cause of death in the United States and this is true among all age groups. When looking at teens in particular, prescription drugs are second only to marijuana when looking at the drugs that are used and abused the most. The notable rub as far as prescription drugs go is that many of them have legitimate uses and there are obviously instances where a drug is used legitimately at least initially but is later abused. Even over-the-counter drugs like dextromethorphan, normally just used as a cough suppressant, are subject to being abused when the wrong knowledge and wrong intentions are involved. At least when dealing with teenagers, the use of youth-based interventions and community groups plays a huge part in eliminating or at least reducing drug abuse amongst teens. Teens that are involved in such groups are 81% more likely to be aware of the dangers of prescription drug abuse, are 87% more likely to not shrae prescription drugs, are 89% less likely to use drugs that are not prescribe to them and are 90% more likely to understand that using the drugs of others is not right or safe for them. The same approach can also make it more than 90% likely that the children are more knowledgeable about the dangers of abusing prescription drugs, are more likely to store their drugs in a secure and safe location, will dispose of their unneeded or expired prescription drugs in a safe way and that they will connect with a professional or trusted person if they feel they are abusing prescription drugs (Wade-Mdivanian, 2012).

As far as other and more general ways to address and quantify the issue, the research undertaken by this author found some other points of action and thought that can and should be undertaken. The Centers for Disease Control, contrary to the verbiage and summaries above, has stated that they feel that non-medical use of powerful drugs could very well be the leading cause of death in the United States, rather than just being the second-worse. Car accidents could very well still be in the lead but drug-related deaths are at least catching up and could have surpassed car-related incidents already. The CDC had a survey done in 2010 that found that sixteen million people in this country, about four percent of the overall United States population, have used psychotherapeutic drugs for non-prescription and/or non-medical reasons in the past year. Of those, more than half got the drug they used from a friend or relative, nearly a fifth said they got it from a doctor and less than five percent got it from an actual drug dealer. Of those drugs obtained from a relative or friend, those drugs were typically only obtained from one doctor. In other words, the people that are using drugs for non-medical reasons are typically not getting the drug from drug dealers or other expected sources of illicit drugs or illicitly-used drugs in general. Indeed, most of them are coming from legitimate doctors and are just being used for non-medical purposes and/or they are coming from family and friends a good portion of the time. This fact makes enforcement and prevention of misuse exceedingly difficult to police and prevent except through means such as education and information-spreading (Kirschner, 2014).

The problem that is easy to see in the above is the fact that there is a thin line between using drugs as intended to cure maladies and abusing them. Since the frequenting of a drug dealer or other illegal distributor of drugs is often not needed and since the drugs are often legally prescribed, the question becomes how it can be stopped without hurting people who legitimately need the drugs. Measures that have been undertaken thus far are the aforementioned laws banning not having a drug in the bottle it was issued in, making giving out of drugs a felony and so forth. Other drugs, including many over-the-counter drugs are tracked and must be sold, literally, over the counter by a pharmacist even though a prescription is not required (such as any drug with pseudoephedrine) and those purchase are often tracked by the state to ensure that too much of that drug or other precursors for methamphetamine or other drugs are not bought abusively. Age restrictions on over-the-counter medications are used as well (Garcia, 2013).

Another step that has been taken is the more heavy regulation and control of pain-management clinics that have been seen as a rubber-stamp way for people to get painkillers from "legal" sources. States that have been focused on the most are Kentucky, Massachusetts, New York, Tennessee and West Virginia. Clinics in those states are required to maintain databases and make sure that a patient has not gotten similar or the same drug at another clinic in too short a time period. Limitations on the dosage and frequency of prescriptions being renewed is another tactic that has been used, such as in the state of Washington. Since the epidemic of the pill abuse epidemic is still in some ways in its nascent stages and the reactionary countermeasures are evne more so, it will take some time to see what effects, good or bad, these efforts will have on preventing the over-use and abuse of prescription drugs (Garcia, 2013).

As noted earlier, the use of public outreach and educational campaigns has worked wonders with teenagers and the same could and should be said of the same efforts with adults. Much like similar campaigns for things like battling obesity, it should be laid bare that the use of prescription drugs in non-medical applications can kill and/or ruin lives due to things like felony convictions and other extremely bad outcomes. Child custody can be stripped, people can go to jail and people can become junkies overnight given the wrong circumstances and outcomes. There is some good news, however. The use of pill identifier phone numbers and websites has encountered extremely heavy use and this is a good thing. Social workers fielded a total of more than 17,000 calls over a twenty month period. The average caller was 33 years old and Caucasian but the overall pool of people calling spanned all races and from the age of 18 to 93. More than a third of the calls helped to identify and prevent problems with drug overdoses or interactions due to poly-drug use. Resources for obtaining treatment of any source were delivered to just over a fifth of the callers. However, the battle is still in full swing and the drug use is currently winning as the amount of fatal drug overdoses jumped from 4000 in 1999 to 13,800 in 2006. However, the fact that were over a million calls to United States poison control centers in 2009 is a good thing as it is clear that people are indeed trying to make a strong effort overall to remain safe while still using their drugs as needed and with the proper amount of care and foresight (Doyon et al., 2013).

However, other research lays bare that may patients are not trying to be careful and are lying in a brazen fashion to doctors and other health professionals as a means to get multiple prescriptions for their drug of choice. The aforementioned use of databases can be used to fetter out whether a prospective or current patient is lying. The state-wide or even nation-wide tracking of what drugs a person has gotten and when can make it clear when a patient is trying to game the system and get drugs for abuse-related purposes. However, it is not just patients that are part of the problem as many doctors either do not do enough investigation before prescribing drugs and/or they are basically a rubber stamp that people use to get drugs when they really do not need them and a quick investigation of the patient's symptoms and drug history would easily disqualify them from getting more drugs. The main tactic to undertake is to use records and databases to trip up a patient that is clearly using deceit and deception to get more drugs through ostensibly legal means. One of the major tools used to combat this abuse are prescription drug monitoring programs, often referred to as PDMP's. The drugs are tracked based on what "schedule" they are with schedule five being the least risky and schedule one being very rife with potential abuse. However, schedule one drugs would always be illegal drugs such as heroin, ecstasy and LSD. The highest legal drugs on the scale would be schedule two drugs like stimulants (Adderall, Ritalin, etc.) and pain killers such as Oxycontin. Dilaudid and Demerol are also on the list. Schedule three drugs include Vicodin, Tylenol with Codeine, Suboxone, steroids and such. Drugs such as lorazepam, diazepam sleeping pills and cough suppressants are actually pretty far down the list but are possible sources of abuse as well (Worley, 2012).

The presence of "data silos" is a condition where the data to prevent abuse if were simply organized and/or shared is quite common. Basically, all of the information necessary to stay ahead of drug peddlers and abusers is out there but it is often not made available to practitioners and/or is not required to be used. As such, doctors that are not required to be more dililgent and careful are not doing so and/or they are not allowed/permitted to do so. Either way, drugs end up getting to people that should nto be getting them either because they do not have a condition that requires the drug and/or they are using the drug or drugs in an unapproved way. However, efforts are getting better. The Drug Enforcement Agency (DEA) reports that they have a database called ARCOS that has 30 million transactions running through it every year, with a focus being applied to schedule I and II drugs in particular being the main things tracked and schedule I always being illegal (Traynor, 2012)(Schacther, 2012).

Reaction

Striking a balance between allowing people to get the treatment they need while at the same preventing abuse is often pretty clear-cut. However, there definitely shades of gray that have to be known and respected. For example, a person who comes home from war with a damaged spine may very well get patched enough to walk and function but they will be in some amount of pain, if not a lot of pain, all of their life. As such, narcotic pain killers are necessary or at least optimal to care for that. However, the problem with that is that narcotic painkillers users often build up a resistance over time and getting them off that high and onto a drug that actually takes effect well can be difficult to impossible and the patient suffers when a switch is made. It is not all that different from an alcohol user that has to drink more and more to get the same effect but the difference with a painkiller is that the drug is necessary on some level at least some of the time. As such, while cutting someone off cold turkey is not an option, it is also not wise just let them have what they want. A moderate and varied approach is necessary to keep pain to a minimum while not allowing addiction and over-use to take hold.