Prescription drug abuse and 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).

What Can be Done to Help Resolve the problem of Opiate Abuse

It may be unrealistic to expect to wean people from opiates, as for a particular group of people, no matter what their moral character or plans - the pull of opiate addiction may prove too strong for them to withdraw without help (McKnelly, as cited in Weslander, 2007, Biological dependency section, ¶ 4). The death of the Daniel, the 20-year-old son of the former Playboy model, Anna Nichole Smith, shocked those who knew this family, as well as many throughout the world, who avidly followed Smith's tumultuous life. Dr. Joshua Perper, Broward County medical examiner, reported in regard to Daniel's death: "The cause of death was combined drug intoxication with chloral hydrate being the major component and the other drugs being contributory....the infection in the buttock and also a viral flu were contributory causes (Miami Herald, 2007; Perper, as cited in Anna Nicole, 2007, ¶ 9). Less than five months after Daniel's death, when Smith also died prematurely from a lethal combination of an accidental overdose of sleeping medication, combined with other prescription drugs, suspicions of opiates contributing to her death arose. Perper, however, argued that Smith's overdose was accidental, and noted a number of reasons suicide had been ruled out. "Although Smith had been severely depressed following Daniel's death, which came just three days after the birth of her daughter Dannielynn, she had recently been happier, Dr. Perper said" (Perper, as cited in Anna Nicole, 2007, ¶ 9). The amount of chloral hydrate Smith had ingested was not necessarily lethal, and a person attempting to kill him/herself would not likely have left a half-full bottle of this particular medication. However, suspicions regarding that prescription goods contributed to Smith's death continues, as the medical examiner's report specifically stated: "Miss Smith had a long history of prescription drug use and over- self-medicating" (Perper, as cited in Anna Nicole, 2007, ¶ 11). At the time of Smith's death, she had prescriptions for eleven drugs, a mix of chloral hydrate (a colorless crystalline solid; soluble in water' used as a sedative and hypnotic) a powerful depressant.. Taken individually, these drugs may help one sleep, relieve anxiety and pain, and decrease symptoms of attention-deficit disorders. Drugs in Smith's possession, however, combined and ingested, could have lead to her untimely demise

In "Attorney General Curran releases report: "Prescription for Disaster: The Growing Problem of Prescription Drug Abuse in Maryland"; Calls for electronic prescription monitoring program and increased penalties for pharmaceutical diversion," the Attorney General pleads for government officials' help incorporate Maryland into an electronic monitoring program for prescription drugs, which 21 other states currently participate in. Attorney General Curran contends this practice would end the incidences of increasing a prescription drug abuse, currently on the rise. The electronic prescription monitoring program, containing a central database of all prescriptions written and dispensed in the State, would help detect abuse and diversion. This program would additionally help counter doctor shopping, which would in turn, help doctors, pharmacists and law enforcement officials identify individuals, abusing medications, who need treatment ("Attorney General," 2005). Curran cautioned, however, that a prescription monitoring program must be designed carefully, and draw upon the input and expertise of pain management specialists, pharmacists, law enforcement, patient advocates and others. Already discussing options with medical and pharmaceutical experts, Curran emphasized it is vital to ensure the program protects patient privacy, and does not interfere with the legitimate use of pain relievers and other drugs. The purpose of the program, according to Curran, is to ensure the people who truly need prescription medications continue to obtain them, but keep the legal drugs out of the wrong hands, and off of the black market (Curran, as cited in "Attorney General," 2005). Crackdown on Prescription Abuse Government officials stress that statistics confirmed that even though illicit drug use may be declining overall, the abuse of prescription drugs is increasing. Due to the contemporary increase in prescription drug abuse, the DEA, is currently requesting help to counter this critical problem. During 2005, John P. Walters, director of the White House Office of National Drug Control Policy, asked President Bush to increase funds for the 2005 budget to attack such illicit use of prescription drugs, projected to increase by $20 million, to $138 million. Most of this funding was to reportedly be directed at reducing the abuse of opium, and morphine-based painkillers (Kaufman, 2004). In addition, the DEA is trying to also stop the abuse by eradicating online abuse by perpetrators. During a one-week analysis of online sales of prescription drugs, reports indicated that approximately 495 Web sites advertised controlled prescription drugs, with 157 of those online sites selling opiate-based drugs. Of the 495 Web sites selling the highly addictive drugs, such as, OxyContin, Percocet and Darvon, only 6% required a verifiable prescription for the order to the field (Kaufman, 2004). A completely appalling, component of the scenario is the fact that none of these Websites take any measurements to avoid children or youth obtaining these highly lethal drugs.

The Pain Relief Network, albeit, challenges DEA concerns in this area. The Pain Relief Network argues that the Government is trying to make the process for those individuals who rightfully need their medications even more difficult.

The Pain Relief Network stresses is that many individuals who for the medications online need the drugs, as they are still in pain (Kaufman, 2004).

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).