Monday, April 15, 2013

The Drug Addict Next Door

They were a nice young couple with small children. I was called to serve as their home teacher. They were trying to live their faith. The husband was congenial and hard working. The wife was dealing with the kinds of things that most mothers of young children deal with. But I sensed that she harbored some kind of underlying pain. It was never mentioned to me and I didn't pry.

I would be surprised years later to hear those that had known the wife during her school days describe her energetic vivaciousness and leadership skills. I would never have guessed it from my interactions with her. Her friends and family talked about how much she had changed since her school days.

One of our children occasionally played with one of their children. So it was not uncommon for our wives to visit each others' homes. After a few years the family moved up the hill to a nicer home. We still occasionally had some interaction because our children continued to hang out together from time to time.

We were surprised when the wife of this family came to my wife begging our forgiveness. She admitted to rifling through our medicine cabinet in search of prescription painkillers while visiting our home.

Our friend's story of prescription drug addiction is repeated frequently throughout the country and especially in Utah (see CDC report). The story unfolds when patients are legitimately prescribed strong painkillers to deal with the immediate aftermath of surgery or injury. Some end up with strong addictions to these medications.

 It is not unusual for a painkiller prescription to include many more dosages than necessary. For example, my wife was recently prescribed a huge bottle of Lortab (which contains an addictive opiate derivative) for post surgery pain control. After taking two doses my wife reverted to over-the-counter acetaminophen because she disliked the way the drug made her feel.

Most people that receive prescriptions for painkillers don't become addicted. They take the drug only as long as needed or maybe a bit longer, and then they put the bottle away and often forget about it. Then one day the drug goes missing from their cabinet following a friend's visit. Or maybe they give the leftover drug to a friend or family member that claims to need it.

That recipient may be among the 5-10% of people that are predisposed to drug addiction. This WebMD article explains that these drugs "stimulate the areas of the brain that perceive pleasure. This results in the initial euphoria or sense of well being...."
"As an addiction-susceptible person uses opioids again and again, the reward system begins to wrongly learn these drugs are as essential to survival as food or water. Experts believe that the nerve cells of the brain actually undergo a change."
Eventually addicts can reach a point where they feel that they will literally die without the drug. With perceived survival at stake, addicts will often let everything else in life—job, family, friends, even food—slide to a lower priority. Sometimes the drug that they feel is necessary for their survival ends up killing them instead.

Our friend was one of the lucky ones. Or so we thought. Unlike many that find themselves trapped in prescription drug addiction, she finally got help. Her apology to us was part of her therapy. We were glad she was getting the help she needed.

But addictions can be very persistent. WebMD notes that "Even after breaking free from physical dependence through a detox program, most people with opioid addiction relapse." In the prime of her life our friend departed this life following an unintentional overdose, widowing her husband and leaving her children motherless.

Governments and health organizations have implemented prevention measures as awareness of prescription drug abuse has increased. Tracking systems make it more difficult for addicts to game the system to get prescriptions from multiple practitioners and vendors.

A police detective recently told me that the resulting difficulty in obtaining prescription drugs is causing increasing numbers of addicts to turn to cheap illicit heroin instead. "We are arresting soccer moms and businessmen buying dope. We've never seen anything like this before," he said.

You might be surprised to discover that you may have enabled an addict. After all, prescription drug addicts get their hits via their own prescriptions only 17.3% of the time. They occasionally steal (4.8%) or buy (11.4%) the drugs from friends or relatives. Most of the time (55%) a friend or relative congenially gives them the drugs.

Of course, you wouldn't have the drugs to give away if your original prescription contained fewer doses. Doctors clearly prescribe too many painkillers. This CDC report states that "Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month."

But doctors prescribe the number of doses they do for your convenience and theirs. They don't want to be bugged if you run out after three days and need more. They also want to save you extra insurance co-pays and trips to the pharmacy.

Although doctors know about prescription drug abuse, no feedback mechanism exists that would let them know when a prescription they have written has gone to an addict or has been used in an overdose case. (The pills have usually been separated from prescribing info by then anyway.) Doctors know that over-prescription is an industry problem but they have no way of personalizing it to see how their own prescription patterns contribute to real life problems.

A family practice doctor told me that his job nowadays boils down to two things: 1) give the patient a pill, or 2) send the patient to a specialist. "That's what I get paid to do by the [insurance company owned] corporation," he said. His nurse's main job, he glumly noted, was to make sure that he spent less than 8½ minutes with each patient. Is it any wonder that harried doctors don't take time to tightly tailor prescriptions?

I believe that the medical industry could do much more to prevent undesired cases of prescription drug abuse. After all, most prescription drug addicts never wanted to end up that way. (You will never be able to stop those that DO want to end up that way from getting the drugs they want.) This is clearly an area that is open to innovation.

Hopefully it's wise innovation. Too many people are prone to whining for the government to solve every problem. Unfortunately, the government-centric approach to problem solving usually translates into making life more difficult for those with legitimate needs without significantly improving problems among those that don't, while rewarding politically connected cronies along the way.

In the meantime, there are some simple common sense measures we can take in our own homes to reduce opportunities for prescription drug abuse and for the enabling of such. I shouldn't have to spell these out. Think about it and take care of your own home.

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