Prescription for Addiction: Epidemic of Prescription Drug Abuse Touches Unexpected Lives

“I think it all started when I had my second child,” says Joan, recalling her long spiral into addiction to prescription drugs. “I had a C-section and was given Percodan for the pain. I really liked it -- I could go for days without sleep and I never forgot that feeling. It kind of progressed from there -- for years after that I was given narcotics for different things -- migraine headaches, foot and knee problems -- it got to the point where I would lie to get drugs.”

Joan, 55, is a petite, pleasant-looking middle-aged woman who doesn’t look anything like the stereotypical drug addict. She’s a wife, mother and an office employee with a health organization in Traverse City, and she looks that part to the T.
But at one time, Joan did as many as 30 prescription drug pills per day -- Percodan, Davocet, Vicodin, Tylenol 3 -- plunging her into a hellish Valley of the Dolls that nearly cost her her career, her family and her life.
“It was truly a lonely place to be,” she says, her face reflecting a deep sadness. “I felt real suicidal and a lot of depression. Even my husband didn’t know what I was going through. I had the pills hidden so well -- everything he saw he thought was the first sign of depression. He didn’t know about the drugs.”

AN EPIDEMIC
Prescription drug abuse jumped into the headlines last fall with the revelation that talk radio king Rush Limbaugh has been hooked on chemical cocktails of pain pills for years.
The news wasn’t much of a surprise to family practitioner William Smith, M.D., who serves as the medical director of substance abuse treatment services at Munson Medical Center. He says that out of approximately 1,000 patients who pass through the Alcohol and Drug Treatment Center at Munson each year, “close to 50% would have prescription drug issues, either alone or mixed with drugs and alcohol.”
Many prescription painkillers contain oxycodone or hydrocodone compounded with acetaminophen -- opiate derivatives which produce a sense of euphoria. Dr. Smith has seen patients hooked on 30-40 Vicodins per day -- a substance which can result in severe liver and kidney damage along with its high.
He notes that narcotic prescription drugs aren’t hard to find, even in Northern Michigan.
“People get it on the streets pretty easily. Sometimes, people get prescriptions and save some of their pills and decide to sell them. We live in a community with a lot of doctors offices and it’s pretty easy to go from one office to another. Patients can receive drugs from a number of places.”
Theft is also a problem, as evidenced by a wave of drugstore robberies in Northern Michigan, starting in the late ‘90s. Often, the target of robberies has been OxyContin, a high-level painkiller prescribed for chronic pain sufferers such as cancer patients. OxyContin comes in time-release tablets packed with several opium derivatives that provide the kick of high-quality heroin; it can be chewed, ground down and snorted, or dissolved and injected. Anecdotally, several deaths in Northern Michigan have been linked to OxyContin overdoses over the past few years.

ON LINE
Then too, as noted in an Oct. 2003 article in the Village Voice by Bill Landis, there’s also a flourishing internet drug scene of “ops” (online pharmacies) which pander to an upper socioeconomic clientele that doesn’t connect with the street drug culture. Their come-ons are easily noted in the day-to-day spam coming to you via email along with penis stretching pitches, Nigerian con artist scams and peddlers of Viagra.
“What people seek from ops is controlled-substance painkillers or tranquilizers in the Schedule III-V categories (Vicodin, Lorcet, Lortab, Norco) -- not Schedule II narcotics like OxyContin, morphine, or Dilaudid,” Landis writes.
Many of the prescription drugs obtained on the internet contain hydrocodone opiates. “In addition to relieving pain, hydrocodone can cause euphoria in sufficient doses, providing an “awake” feeling like that of a heroin-cocaine speedball. It has a longer half-life than many painkillers and is highly addictive,” Landis notes.

NATIONAL PROBLEM
Coincidentally, many of these online pharmacies operate out of Florida, a state with vague laws governing their existence which is also the home of America’s most notorious prescription drug addict. Rush Limbaugh of Palm Beach County was reportedly hooked on OxyContin, Lorcet and other hydrocodone drugs. His housekeeper testified that she purchased 4,350 pills for him during one 47-day period.
As evidenced by Limbaugh, prescription drug abuse is a national problem that reaches every level of society. One study claims that nine million Americans aged 12 and older were abusing prescription drugs in 1999, with nearly half that number taking pills for non-medical reasons. From 1990 to ‘98, researchers found a 100% increase in the number of people using pain killers in the U.S., with a 130% increase in those using sedatives and a 165% increase in those using stimulants.
Compounding the problem, another study showed that 45% of doctors feel uncomfortable talking about drug abuse issues with their patients. Physicians can be easily manipulated into writing prescriptions for narcotic pain relievers. “People who are addicted to prescription drugs can be very skilled at getting what they want,” Dr. Smith says. “So the drugs are there, and if you’re motivated you can get them.”

BRAIN CHEMISTRY
What would lead someone -- including solid citizen types like Joan -- to become hooked on prescription drugs?
Some people are simply more susceptible to addiction, Dr. Smith says, getting hooked quickly on substances which most patients use with impunity.
“A lot of it has to do with brain chemistry,” he says. “We’re learning that certain areas of the brain aren’t functioning properly for people who are addictive, and certain substances just take over that area of the brain. It’s different for each person, whether it’s narcotics for one person, or alcohol for someone else, and marijuana for the third person. Then there are those who have problems with multiple substances.
“I think if you use the theory that there is a problem with brain chemistry and the right person has exposure to that particular substance, then it becomes fairly easy to become addicted,” he adds. “For others who don’t have that problem with brain chemistry, they can use these drugs without any problems.”
The studies are borne out by other evidence. For instance, many persons who take narcotics for chronic pain conditions such as Chron’s disease, cancer or severe arthritis never become addicted.
“It’s pretty uncommon for people with acute pain to become addicted,” Dr. Smith says. “One study showed that only about four out of 12,000 chronic pain patients became addicted.”
He adds that another study followed 38 chronic pain patients for a period of four-to-seven years and found that only two became addicted during that time, despite constant narcotic use.
“For most folks who become addicted, it’s a means to kind of protect themselves and clearly not deal with some of the pains of everyday living. When you’re in a drug stupor, obviously you don’t make clear decisions. It’s a way of avoiding the discomfort that all of us have trying to deal with everyday issues walking this earth.”

PROGRESSIVE DISEASE
Joan grew up without any involvement in the street drug culture of heroin, cocaine, LSD or Ecstasy, but was immediately charmed by the effects of Percodan.
“I just liked the numbing feeling,” she recalls. “It feels like you don’t have any worries, but it’s a real lonesome place to be. I did it by myself and stayed by myself, but I missed a big part of my kids growing up. I slept a lot, but I couldn’t stop it. It got to the point where I stole medication.”
Fears of getting caught intruded on her daze. “I know one girl who went to prison -- she got caught stealing and writing her own prescriptions. Once, I changed one of my own prescriptions and got really scared that I’d get caught.”
She also increasingly faced the problem of blackouts.
“Blackouts are a period of time that you can’t remember, and I had a lot of them,” she recalls. “I was a working drug addict and I don’t know how I did it at the time.”
Inevitably, her friends sensed that something was wrong and urged her to seek treatment.
“When I went to the treatment center, I had been using prescription drugs for some time, and it got to the point where I couldn’t stop. I was using more and more of them. How I got there I don’t know. I don’t remember because I was in a blackout at the time.”
Joan spent a month at the clinic, hallucinating through the detox process. “I was really sick to my stomach, vomiting, real cold and shaking.”
Like other recovering patients, her care included heavy group and individual therapy and outpatient care, followed by weekly Alcoholics Anonymous meetings.
“I pray every day and do the AA readings and I never let myself get the point where I have the attitude that I don’t care. If I did that, it would drive me to use again.”

TOUGH ROAD
Joan has had relapses, but has been drug-free for three years.
“I feel that I’m on a good path now, but there’s never a day when I don’t think about it,” she says. “But I know in my heart that I’ve used for the last time -- I don’t feel that I have another recovery in me -- I feel it would kill me if I used again.”
Eventually, advances in human knowledge could turn the tide of addiction.
“There’s a lot of work being done to study transmitters in the brain and neuropharmacology, trying to identify different pathways for almost every drug,” Dr. Smith says. “Once we have those things identified, we’ll be able to see what we can do for specific treatments.”
For the present, however, conquering prescription drug addiction often involves a titanic personal battle, bolstered by the help of others. Typically at Munson, an intensive two-week outpatient program with housing is followed by a heavy dose of therapy and a lifetime of AA meetings.
“We have the stance that if you complete treatment and aftercare therapy and Narcotics Anonymous or AA meetings, you have a 90% chance of sobriety,” Dr. Smith says. “But they have to do all of those things -- there are no shortcuts. A lot of people come back after a year and are drug or alcohol-free, but it’s a chronic illness and there are relapses.”

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