An Invisible Epidemic
A great deal has been written about alcoholism and drug addiction over the last two decades. However, information regarding prescription drug abuse and addiction only seems to surface when someone famous has a problem and needs treatment or dies.
Historically, prescription drug addiction has been the most underreported drug abuse problem in the nation( National Institute of Drug Abuse). It is also the least understood. Addiction to and withdrawal from prescription drugs can be more dangerous than other substances because of the insidious nature of these drugs.
Two types of the most commonly abused drugs are opioids and benzodiazepines. Opioids are generally used to control pain. Benzodiazepines, or tranquilizers, are used to manage anxiety. These drugs are prescribed for short-term use such as acute pain and anxiety that is in reaction to a specific event. They may also be prescribed for chronic pain or generalized anxiety.
Like many other people, Sylvia’s doctor put her on Vicodin because she suffered from chronic migraines. The pills worked effectively. They took away her headaches and allowed her to live her life. But, like other narcotics, Vicodin lost its effectiveness over time. Sylvia began to increase her dosage. She had built up a tolerance to the medication. She was physically dependent on Vicodin.
Fearing that her doctor would stop prescribing the medication if she told him that she had increased the dosage, she kept it a secret. She did not believe that she would be able to function without the pills. She began to change the numbers on the prescriptions so that she would get more pills, with more refills.
Over the next two years, she went from a physical dependence to a physical and psychological addiction. She had to continue to take this drug in increasing dosages in order to feel “normal.” She went from taking the medication as prescribed to a drug habit of 30 pills a day. She started to “doctor shop” in order to obtain several prescriptions at a time. She would make appointments with a number of doctors to get what she needed. She switched pharmacies often so that she could drop off each prescription at a different one. She went to a number of pharmacies in different neighborhoods so that no one would become suspicious.
She could not use her insurance since she was buying several prescriptions of Vicodin at one time. She used different names at each pharmacy. She spent hundreds of dollars a month. She kept a careful record of who she was at every one. As her habit increased, she had to find new ways of getting pills. She stole a prescription pad from one of her doctors and began to forge her own prescriptions. One day, she made the mistake of writing a date on the forged prescription that happened to be a Sunday. The pharmacist became suspicious and confronted her about it. She quickly left the store. He called the police.
By the time the police raided her house, she had hundreds of pills hidden in the bathroom, the kitchen, and bedroom. The police thought she was selling them. They had no idea that the amount she had wouldn’t even last her two weeks.
This may seem like an unbelievable story, detailing extreme measures to obtain narcotics. Unfortunately, Sylvia’s story is not unusual or unique. The National Clearinghouse for Alcohol and Drug Information reported in May of 2001 that approximately four million people aged twelve and up misuse prescription drugs. That is roughly 2-4% of the population, four times the amount it was in 1980. Prescription drug addiction accounts for roughly a third of all drug abuse problems in the United States.
Donna, a 34 year old lawyer suffered from extreme anxiety, coupled with panic attacks. She sought the help of a psychiatrist who put her on Xanax. It helped with the symptoms for a little over a year. She then noticed she was beginning to feel more and more anxious in between doses. In addition, the dose she was taking barely helped anymore. She reported this to her psychiatrist and he responded by increasing her dosage. In less than three years, he had increased the dose to five times the amount she was first prescribed.
She was honest with her psychiatrist and he increased the dose to what she said she needed. She had convinced herself that prescription drugs were safe. She rationalized this by saying to herself, “if her psychiatrist prescribed them, they must be okay. And besides, a reputable drug company developed the pills in a nice clean laboratory, so how could they be dangerous?”
She began to feel increasingly depressed. She dreaded leaving the house. Her panic attacks increased in frequency whenever she did venture out. She did not want to see her friends. She did not answer the phone. Her world was becoming smaller and smaller.
Donna called her doctor and told him she wanted to get off the pills. He suggested a slow tapering off process and they decided that her partner, Beth, would give her the agreed upon dose each day.
She really wanted the tapering off to work, but she began to feel sick in between doses. She tried to follow the schedule, but she couldn’t tolerate the withdrawal symptoms. She would wait until Beth left for work in the morning and then tear the house apart looking for the pills. When she found them, she “stole” a few and put the vial back where Beth hid it. She pretended to continue the agreed upon tapering off process.
Donna panicked when she realized she was taking more than twice the amount she was supposed to take. Feeling like a failure and filled with shame, she did not tell her doctor. She went to another psychiatrist to get another prescription. Her partner begged her to get help. Donna didn’t feel that she could live without her pills. Her life had become completely controlled by Xanax. She would panic when she was beginning to run out.
Donna’s world was now focused on conning, getting, and taking the pills. She would count them over and over again when she picked up a new prescription. One night, several months later, Beth found Donna unconscious on the floor by the bed. She was rushed to the emergency room. When she regained consciousness, the resident informed her that the Xanax had become toxic in her bloodstream and that she would not have lived more than two weeks had she continued taking them. She had no choice but to stop. She was medically detoxed in the hospital and sent to a treatment facility to continue the process and begin to learn to live drug-free.
What leads a person to become addicted to prescription drugs?
Prescription drug addiction is no different from alcoholism or an addiction to any other substance. However, no one is prescribed alcohol or cocaine for medical reasons. People who suffer from chronic pain are in a very difficult position. Painkillers do relieve pain. For people who suffer from constant and chronic pain, narcotics may be necessary to allow them to have any quality of life. The downside is becoming physically dependent and risking the possibility of addiction.
While it is true that the drugs themselves are highly addictive, not everyone who takes painkillers becomes an addict. The statistics of those suffering from chronic pain who become addicted to these drugs are actually pretty low according to the Chronic Pain Advocacy League, a grass roots organization dedicated to helping those who suffer the debilitating effects of chronic pain. However, this is not to say that those who suffer with chronic pain are not at increased risk of prescription drug addiction.
A recent survey by the National Institute on Drug Abuse at Columbia University indicated that approximately 50% of primary care physicians have difficulty speaking with their patients about substance abuse ( FDA Consumer Magazine, Sept.- Oct., 2001).
Drug tolerance is basically the body’s ability to adapt to the presence of a drug. When narcotic substances are taken regularly for a length of time, the body does not respond to them as well. Tolerance then becomes defined as a state of progressively decreased responsiveness to a drug as a result of which a larger dose of the drug is needed to achieve the effect originally obtained by a smaller dose.
Dependence or Addiction
There is a difference between dependence and addiction. Dependence occurs when tolerance builds up and the body needs the drug in order to function. Withdrawal symptoms will begin if the drug is stopped abruptly. On the other hand, when a person turns to the regular use of a drug to satisfy emotional, and psychological needs, they are addicted to that substance. Physical dependence exists as well, but the drug has become a way to cope with (or avoid) all kinds of uncomfortable feelings.
Many prescription drug addicts do begin by needing the drug they are prescribed for medical reasons. Somewhere along the line, however, the drug begins to take over their lives and becomes more important than anything else. Nothing will stop them from getting their drug of choice.
It may be difficult to understand how someone could let this happen. How could someone who is reasonably intelligent and sophisticated in regards to drug addiction become an addict? Addiction has nothing to do with intelligence. And addiction to prescription drugs is no different than any other substance abuse problem. Many people in the medical profession abuse prescription drugs. Health care providers may have a slightly higher rate of addiction due to both the stressful nature of the work and their relatively easy access to supplies of narcotics. Clearly, the potential risks and dangers involved with taking narcotics are not unknown among health care providers. This, however, doesn’t stop someone from becoming an addict. Some 12-step members have described addiction as a disease of the emotions.
Along with addiction, there are addictive behaviors that are quite common among addicts. Lying, keeping secrets, hiding pills and obsessively counting them, making unnecessary emergency room visits and constantly “doctor shopping.” As the addiction escalates, engaging in such illegal activities as stealing prescription pads, committing forgery, and buying drugs off the street is also quite common behavior.
These behaviors usually stem from the desperation an addict feels regarding getting, securing, and taking their drug of choice. Under other circumstances, the individual would probably not engage in the behaviors listed above, unless they were previously part of his/her personality structure. In other words, addictive behaviors are limited to the addiction itself and are generally dissonant with the person’s beliefs and values in any other area of their life.