Introduction to Prescription Drug Abuse
Who’s Really to Blame for Prescription Drug Abuse?
Written by Liz F.
Do you remember your first opioid experience? I do. My first hydrocodone prescription came when I got my wisdom teeth pulled. I was out for one day with actual pain– the rest of the month I was happy and high, for the first time at 16. It was a thrill when I could go back for a refill! It was a treat, like when I was prescribed unlimited ice cream and jello after I had my tonsils taken out. I didn’t become addicted then, but I had tasted euphoria for the first time. And you better believe it was on my radar ever after.
When we talk about prescription drug abuse, opiates are always at the center of it. In our not-too-distant history, there were myriad misconceptions about pain medicines and their potential for addiction. Doctors and patients alike held beliefs that it wasn’t possible to become addicted after only 14 to 30 days of taking opiates. They thought that you wouldn’t become addicted if you took the medications as prescribed or especially if they were medically indicated.
Can we just make a blanket assessment at this point that any drug derived from the opium plant is potentially addictive? Heroin, morphine, hydrocodone, oxycodone, Dilaudid, fentanyl… I don’t have the science to back that up right now, but my common sense tells me there isn’t an opioid that can’t be abused.
The Slow but Steady Progression of Prescription Drug Abuse
We didn’t come to the heroin epidemic by a direct route. Good luck convincing a group of student-athletes in their teens with their lives ahead of them to try injecting a drug that will lead to a life of abscessed arms, crime, violence, homelessness, overdoses, psych wards, and very likely prostitution. No, actually, heroin piggybacked its way into our communities from the doctor’s office. People just like me who had a simple surgery found their euphoria in the aftercare and wanted more.
A country preacher I used to know would always say how people don’t dive headfirst into, well, “sin” in the church context, but let’s relate it to addiction here. He said it’s more like how cows end up in the middle of a pond in summer: they ease on in, one step at a time until they’re up to their necks in water.
As I’ve mentioned before in a previous blog post, within my 36-year lifespan, I have personally witnessed the introduction, growth, and expansion of certain types of opioid and amphetamine pharmaceuticals. I’ve observed their devastating effects. The effects often lead to either addiction, overdose, or illicit drug use. In my youth, they called marijuana the “gateway” drug, but that’s not the case in this generation. Pills and prescriptions, which can be legally prescribed and apparently medically necessary, are given to ever younger age-groups. It’s introducing a new generation to the altered state of consciousness before even a teenage rebellion has taken root.
If you want to get the full, in-depth story of the history of the opioid epidemic, I suggest getting a copy of Beth Macy’s new novel Dopesick: Dealers, Doctors, and the Drug Company That Addicted America. Macy does an incredible job of tracing the history through Appalachia, the epicenter of the opioid outbreak.
What is the History of Prescription Drug Abuse?
To understand the pill epidemic of prescription drug abuse, we need to look back to the mid-90s. A couple of turning points happened in the 1990s that paved the way for the proliferation of painkillers. In the 90s, doctors were encouraged to treat pain as this “undertreated illness”. It was viewed as this fifth vital sign, along with blood pressure, heart rate, respiration, and temperature. Hydrocodone was then a Schedule III drug. Patients could go home with months’ worth of pain medicines. Pain pills were seen as the first line of defense, superseding more patient approaches like physical therapy and acupuncture. They weren’t seen as the lurking threat that they prove to be today.
Also from the 90s, we see the normalizing of the idea that there is a quick fix in pill form for any ailment. How many prescriptions are in your cabinet right now? Of those, how many do you take on a daily basis? What level of comfort do you have walking into your doctor’s office with an ache or illness, either physical or mental, and asking for a pill to make it go away? It’s not an uncommon practice. Additionally, when the FDA allowed for direct-to-consumer advertising on TV, branded medications became household names. We were encouraged to “ask your doctor about X Brand Medication.” “Healthcare consumers,” are how patients began to be seen.
How Pharmaceutical Companies Promote Prescription Drug Abuse
Through the early aughts, pain medications were not highly regulated. One pharmaceutical company took full advantage of the free reign: Purdue Frederick, makers of OxyContin. OxyContin was approved for use by the FDA in 1995. In 1997 it was on the market.
OxyContin is a synthetic opioid with a potency similar to heroin. It has a street value of $1 per milligram, so an 80mg pill would bring in $80 on the streets. It was pitched as superior to pain pills previously on the market because of its delayed time-release, offering 12 hours of pain relief as compared to 4 hours. This time release coating was pitched by Purdue as a deterrent to abuse. When in practice, however, it was a simple coating that could be removed with a bit of saliva. Purdue also falsely claimed that OxyContin was only addictive in less than 1% of the population when taken as prescribed.
Purdue Pharma, the marketing arm of Purdue Frederick, unleashed on small-town doctors an incredibly lucrative direct-to-doctor marketing blitz. Armed with shoddy, biased research and an arsenal of kickbacks, sales reps set out to woo family doctors and get their pill into communities across America. They succeeded to the tune of billions of dollars.
Prescription Drug Increase through Illegal Incentives?
Purdue targeted doctors who were already in the habit of prescribing pain meds and offered them all sorts of incentives to prescribe their drug. Incentives such as Christmas hams, branded office supplies, free trips to resort locations for “educational seminars” hosted by Purdue. Sales reps made commissions on how many milligrams doctors prescribed, which encouraged the overmedicating of patients. Purdue insisted that the risk of addiction was negligible but that chronic pain was vastly undertreated. They repackaged the idea of “drug-seeking behavior,” which would usually alert doctors to patients who were abusing their medications, as “relief-seeking behavior.” By 2000, family doctors were the number one prescriber of OxyContin.
While Purdue was bringing in billions of dollars in profits, its sales reps were making millions. And as any good multibillion dollar company would do, they went to work on charming the FDA and manipulating regulation for their benefit. Since 2002, Big Pharma and the FDA held private meetings each year, where they developed standards and practices such as the aptly titled “enriched enrollment.” The enrollment allowed drug companies to manipulate drug trials by filtering out test subjects who did not respond well to the drug.
I once did a drug trial for a new arthritis medication and I saw this practice of “enriched enrollment” firsthand. My arthritis actually worsened while taking the medication, yet the doctor refused to record my results. Towards the end, he told me if I didn’t report a better response he would drop me from the study. Needless to say, I left the study and my participation in the study was likely erased. It makes you wonder what the point of a drug trial is if only the positive results matter. It’s like saying, “This drug works well for people in whom this drug works well.”
Big Pharma also bought allies with the American Pain Society and the American Academy of Pain who promoted the use of opioid treatment for chronic pain while pocketing millions of dollars from drug companies.
The behavior of Purdue is indistinguishable from any drug pusher pattern. They performed a market analysis to find the vulnerable population, targeted trusted distributors, offered bribes and incentives, and sold lies or “alternative facts.” They essentially encouraged prescription drug abuse in the interest of one thing: Profits. Where money is a motive, there follows corruption. From there, “pill mills” began to crop up, where the unethical medical professionals would prescribe practically unlimited amounts of pain medicines to patients. Many of these patients were on Medicare and could get hundreds of high power pain pills for dollars, then turn around to sell their script for thousands of dollars. The money brought them enough to live and support their own habits.
Growing Statistics of Opiates & Prescription Drug Abuse
Between 1998 and 2005 prescription drug abuse rose 76%. By 2010, so many painkillers had been prescribed in America that every American could have one full month of round-the-clock pain medication. When regulations finally showed up to reveal the number of pain meds being prescribed, addiction already had its foothold. All opioid medicines were switched to Schedule II drugs. Schedule II means that no more than 30 days can be prescribed at a time and refills require a visit to the doctor. Furthermore, OxyContin faced (and lost) a major lawsuit for its unethical practices. They were forced to reformulate its pills into a form that couldn’t be crushed up and snorted or injected. There was a vacancy for the cheaper and easier to procure opiate to step in: heroin.
Now, this is where the personal stories get really dark. The honor roll athlete who sustained a sports injury was prescribed painkillers, who then found pills through contacts at school. But as his tolerance increased, he was turned to dealers who could supply his growing habit. He was then turned onto something that would get him higher for cheaper– the dreaded heroin. Soon he is found unconscious in his parents’ house with a needle stuck in his arm.
Why is Opioid Addiction so Difficult?
Opioid addiction is different than other forms of addiction because of the way the opiates actually alter the brain. To learn more, check out this new documentary on addiction from NOVA that goes in depth into the effects of opiates and addiction on the brain. We are learning that recovery from opioid addiction is often times a losing battle because current methods of treatment do not address the science behind opiate addiction.
Is there Treatment for Prescription Drug Abuse?
As with many substances, like alcohol and methamphetamine, abstinence-based recovery can be effective. Although, with opioid addiction, everything I see and read suggests that suboxone and methadone treatments vastly improve the chances of long-term recovery. Yes, unquestionably, suboxone and methadone can both be abused. As I said, I don’t know of an opiate that can’t be. Because of this, the medicated treatment option has been largely stigmatized and dismissed. NOVA cites statistics like that the success rate in abstinence-based recovery models for opiate addiction is around 10-20%, while medically assisted treatment options see success rates above 50%.
I will admit, before doing this research, I was dismissive of suboxone and methadone, too.
However, when we consider the intensity of the addiction and the enormity of the epidemic, it seems dangerous to dismiss the most effective treatment option because of the few who abuse it.
Opioid-based prescriptions are not the only drug susceptible to abuse. Stimulants, like Adderall, Vyvanse and Ritalin, and benzodiazepines, like Xanax, lorazepam, and Klonopin, are also popularly misused. These drugs do not operate on the brain the same way as opiates. They don’t become as compulsively addictive and the withdrawals are not nearly as devastating.
What are the Dangers of Prescription Drugs?
Stimulants enhance your natural abilities, enabling people to achieve more, work harder and longer, to focus for hours on a single topic. Uppers are a perfectionist’s best friend because they enable people to achieve to a higher standard than they could on their own efforts alone. In a highly competitive academic and work culture, who wouldn’t want a boost to their own abilities? The pressure to perform at that higher standard can pave the way for addiction. And then in order to come down from the stimulant high, many people turn to benzos or alcohol.
Side Effects of Mixing Substances
Both benzos and stimulants can be companion pills to other intoxicants. They allow people to drink longer without getting sick, giving those on opiates the energy to do what they have to do to get more drugs or helping people to come down from an amphetamine binge. When it comes to prescription drug abuse, it is not limited to just one prescription at a time.
Drugs and Denial among Children and Families
One of the major dangers of ADHD medications is that it is prescribed to children. Taking a high powered stimulant at young ages is a risk factor for later addiction. It also normalizes the idea of taking pills to change how you feel and who you are.
Another danger of prescription drug abuse is that it is easier to deny to one’s self that there is a problem. The side effects are milder than with illicit drugs. One may have a prescription that qualifies his or her need for them. They’re only pills, right?
It is because of the justifications that they are so insidious. Sometimes a person’s addiction leads them to street drugs, but that’s not always the case. I’ve known mothers who used their children’s prescriptions to get high and then justified that they were doing their child a favor by not giving them their meds on the weekends. In Dopesick, Macy shares stories of parents who get their children diagnosed with ADHD in preparation for qualifying for social security disability when they become adults.
Why Does Prescription Drug Abuse Matter?
I believe it is worthwhile to know the history behind the prescription drug epidemic because it has been too easy to dismiss addicts as immoral, degenerate drug addicts with no conscience. When the actual story shows that the immoral, degenerate and conscience-less behavior is on the part of the drug companies who manipulated and exploited vulnerable populations. Also to blame are the regulators who turned a blind eye.
A drug is a drug. A pusher is a pusher. It is important to remember that prescription medications are as dangerous as, and as potentially addictive as, any other drug. A part of their true threat is that they come from people we trust: our doctors. That is why we must remain vigilant against the influence of Big Pharma. We need to know the facts about prescription medications before we take them and we need to take seriously their potential for addiction and abuse.
If you need help getting over an addiction, reach out for help. Call our Addiction Helpline to learn why and how to recover from Prescription Drug Abuse. We can help you or your loved one find the necessary treatment and support in order to live a drug-free, healthy life again.