PRESCRIPTION DRUG ABUSE

Lucy, a 35-year old mother of two, seems like a typical suburban homemaker.  She attends church regularly, belongs to the PTA, and volunteers at the local battered women’s shelter.  Her husband is well respected businessman, and her children are honor students at the local high school.  Life seems perfect for Lucy and her family, at least on the outside.  But Lucy has a secret that few outside her family know about.

Lucy’s children and her husband regularly come home to a disheveled household, finding Lucy passed out somewhere in the house or on the back porch.  Lucy’s mood swings are unpredictable.  One day, she will be a loving, devoted wife and mother; the next, she will talk rapidly and endlessly to whomever she can get to listen; sometimes, her speech will slur and she seem incoherent.  All this usually occurs whenever a stressful or unpleasant situation comes up in her life with which she cannot cope.  Lucy’s family never knows what to expect from one day to the next.  The children has moved in and out of the home to live with their grandparents dozens of times over the past several years, and Lucy’s husband has threatened her with divorce.  Lucy has been to inpatient detoxification programs three times, only to “fall off the wagon” whenever a stressful event occurs.

You would probably guess that Lucy is an alcoholic or an illegal drug addict; however, Lucy’s drugs of choice are all legal and all readily available to her from any one of a number of reputable physicians she visits.  She uses a combination of drugs that range from sedatives to tranquillizers to antidepressants.  Lucy is a prescription drug addict.  Her suppliers are unwitting physicians who have no idea that she is seeing other doctors.

In 1999, an estimated 9 million people (12 and older) are using prescription drug for nonmedical reasons.  Prescription drug misuse and abuse is common in older adults.  This population is given prescription medications three times more frequently than the general population.  According to the Prescription Drug Research Report, it is estimated that 17% of adults (60 and older) are abusing prescription medications.

According to the Drug Enforcement Administration, 12 of the top 20 most abused controlled substances are prescription drugs.  These drugs fall into the following categories:

·         Opioids.  These drugs are narcotics typically prescribed to relieve acute or chronic pain.  Common prescription drugs include Demerol, Darvocet, Vicodin, and drugs with codeine.

·         Stimulants.  These drugs affect the central nervous system and increase mental alertness, decrease fatigue, and produce a sense of well-being.  They are usually prescribed for appetite suppression, attention deficit disorder, and narcolepsy.  Common prescription drugs include Dexedrine, Ritalin, Fastin, and Cyclert.

·         Sedative.  These drugs depress the central nervous system and are frequently used to treat anxiety, panic disorder, and insomnia.  Some are dispensed for either daytime or nighttime use.  Common prescription drugs include Xanax, Valium, Ativan, Dalmane, and Ambien.

Under certain conditions, nearly anybody could wind up abusing a prescription drug, but there are particular groups of people who are at high risk for prescription drug abuse.  People with a family history of depression, smokers, and excessive drinkers are more likely to become addicted to prescription drugs, as are those with a history of abusing illegal drugs.  Stress from traumatic experiences  can also make a person more likely to abuse prescription drugs, and people who are hyperactive, obese, or who suffer from chronic pain are also at risk.  Health care professionals are considered to be a high risk group, and older people have a greater tendency to abuse prescription drugs.

A patient can become physiologically dependent on a drug, which is considered to be a more manageable condition than addiction.  Physiological dependence, involving the body’s adaptation to a drug over time, is considered a temporary, benign condition.  Physiological dependence is usually treated by gradual reductions in use of the drug, and although there may be withdrawal symptoms during this period, there is not normally a relapse afterward.  The gradual reduction in dosage can be handled with medical supervision, and the patient does not normally need to enter a substance abuse program.  Addiction involves a continued need to use a drug for psychological effects or mood alteration, and the patient goes to great lengths to obtain the drug even if its effects become harmful.  Addiction is considered a chronic, complex problem and is usually handled with specific chemical dependence treatment.

Abuse is often caused or continued because of deliberate deception on the part of the patient, but misuse of a prescription drug can start innocently enough.  A patient may receiving several prescription that have the same effect, or a patient may have several doctors prescribing the same medication.  Prescription drugs may react with each other and cause different effects than intended.  Sometimes communication problems between patient and physician cause errors in prescription dispensation.  The patient may unintentionally use the prescription incorrectly.  One of these situations or a combination of factors can start prescription drug abuse.  Often a single prescription drug, such as a painkiller or sedative, is enough to start the process of dependence.

Older people are considered at high risk for prescription drug abuse for several reasons.  The process of aging or transition to retirement can leave a person with symptoms of depression or anxiety, and illnesses can also increase as a person gets older.  Many people see multiple doctors as they get older and thus may wind up getting several prescriptions for the same drug under different brand names without realizing it.  Sometimes physicians give older patients the same dosages as younger patients.  Body function slow and change with age, and when this occurs, the duration and intensity of drug effect can change as well.  Such condition can increase the risk of drug abuse among the elderly.

If addiction starts, older people may then resort to the same tactics as any prescription drug addict.  They may begin to “doctor-hop” (moving from one doctor to the next without informing the doctors) to get multiple prescriptions, or they may go to an emergency room to get a quick fix of a particular drug.  Patients may also hoard pills with friends to cut costs and ensure availability of their drug of choice.

Health care professionals are also at high risk for prescription drug abuse.  Physicians are five times more likely than the general population to take sedatives or tranquilizers without another doctor’s supervision.  The high stress of the job and the availability of drugs are both believing to be contributing factors to abuse among health care professionals.  However, studies suggest that those physicians who are psychologically sound had little problem handling the stress of their jobs and generally resisted the temptation of readily available drugs.  Those physicians considered to have psychological problems were more likely to be abusers.

Effects of Abuse

As abuse of a drug continues, the tolerance of the body to that drug increases, which can lead to stronger self-dosing.  As use increases, the detoxification process can become more difficult.  In some cases, people refuse to believe they are addicted, and older people who are isolated from others do not even realize they are hooked.  Physicians may inadvertently promote the abuse by failing or refusing to acknowledge the signs of addiction in a patient.

If a person admits he or she has a problem with a drug, the recovery process can begin.  Trying to kick the habit without professional help may only make things worse.  If the person tries to cut back or stop use of the drug, withdrawal symptoms may occur.  These symptoms include pain, nausea, sleeplessness, nervousness, irritability, hallucinations, and confusion, and can be quite severe.  In short, recovery from prescription drug abuse becomes as difficult as recovery from abuse of illegal drugs.  For these reasons, professional help is usually necessary for a full recovery from prescription drug abuse.

If you or someone you know is abusing prescription drugs, help is available.  Many hospitals that sponsor detoxification programs for alcoholics and illegal drug addicts also have programs for individuals who are addicted to prescription drugs.  Often, insurance will cover the costs of these programs.  After detoxification the individual will need to continue recovery through a program such as Alcoholics Anonymous (the principles used for recovery from alcoholism are also applicable to recovery from drug addiction) or Narcotics Anonymous.  These organizations can be found in the white pages of the phone book.

If the addicted person has family or close friends who being seriously affected by addiction issues, they may want to try Al-Anon, Alateen, or Adult Children of Alcoholics support groups.  Finally, individual or family counseling may be of value in helping to sort out emotional issues that lie behind the addiction.  A certified addictions counselor may be the most helpful person to an addict, or the family may choose a psychiatrist, psychologist, or social worker who has knowledge of addiction issues.

You also might wish to get additional information by going on-line to www.prescriptionabuse.org.  this website was created by a man whose wife was a former prescription drug addict.  The site offers education, hope, and recovery approaches for abusers and their families.

Although prescription drug addicts will always be “recovering” rather than “recovered,” they can still lead relatively normal lives with proper physical and psychological treatment.  However, there are no quick fixes or easy answers.  Recovery is an ongoing process for both the addict and his or her family.