[Noozhawk’s note: This article is part of Day 2 in Noozhawk’s 12-day, six-week special investigative series, Prescription for Abuse. Related links are below.]
Unlike methamphetamines or heroin, which could have been made in a stranger’s garage, a uniformly manufactured pill from a pharmacy is considered a paragon of safety.
“The public has to realize this is a very serious problem; this is not something that is superfluous.”
The fact is that medical professionals regularly prescribe drugs that can — and do — become addictive.
Addiction can be caused by taking prescription medications recreationally, taking more than the prescribed dosage, or following every direction given by a physician. Treatment for an injury or attempts to get high can lead to complete dependence.
More than 7 million Americans report using prescription drugs nonmedically within the past month, according to the Health and Human Services Department.
Pain is perceived differently by different people, explained Dr. Chris Lambert, who worked as a full-time emergency department physician from 1977 to 2010. He now heads Cottage Health System’s Frequent Opiate User Program, which monitors patient prescription histories to determine if they’re seeking additional drugs.
“Until there’s clearly a flagrant example that I’m getting worked, so to speak, I treat them,” he said.
Lambert teaches doctors in residency the same thing — to treat first and later deal with any problems that are identified.
At Santa Barbara Cottage Hospital, triage nurses assess patients so they don’t have to be in agony while waiting for an hour in the emergency room, Lambert added.
He said he has treated many close calls related to prescription drug overdoses, especially when patients take a mixture of narcotics about which they know nothing.
Opioids include natural opium poppy products (opiates), like morphine and codeine, and semi-synthetic products hydrocodone, hydromorphone and oxycodone. The products are often used as painkillers because of their effects to decrease the reaction to and perception of pain.
Alicia, 31, only stopped abusing prescription drugs when Santa Barbara County took away her two children. It took her nine months of treatment and drug court to get them back.
“I never tested positive for drugs ever again,” the woman told Noozhawk on condition of anonymity. “It’s sad, but I needed my kids taken from me to (give up drugs).”
A Vicodin prescription after a car accident started her 10-year problem.
“I discovered pills at 20 and fell in love with them because they were legal,” she said. “You didn’t have to feel guilty about it.”
Alicia’s habit grew when she discovered how easy and inexpensive it was to make online purchases of pain, sleep and muscle-relaxant drugs.
“I used to be so envious of people who could go through their day-to-day life without being on something,” she said. “But I didn’t have the willpower to stop.”
Benzodiazepines and psychotherapeutic drugs are also commonly abused.
Informally called “Benzos,” benzodiazepines act as sedatives in low doses, affect the central nervous system and are widely prescribed to help relieve anxiety or insomnia and to prevent seizures. Some name-brand products include Xanax, Valium and Klonopin.
Psychotherapeutic drugs like antidepressants are commonly taken without a prescription as people self-medicate, said sheriff’s Sgt. Sandra Brown, supervisor of the county Coroner’s Office, a division of the Sheriff’s Department.
The National Institute on Drug Abuse defines addiction as a chronic, relapsing brain disease characterized by compulsive drug seeking and use, despite harmful consequences. Drugs can change the structure of the brain and how it works, which is why addiction is considered a brain disease.
There are many origins to abuse, from people taking medications as prescribed to experimenters whose only interest in the drug is getting high. But there are serious physical and mental effects from long-term drug abuse and addiction, and recovery is a lifelong ordeal.
One effect Lambert has observed in abusers is a change in mental status, which causes their perception of reality to suffer while also damaging family relationships. These psychosocial consequences are in addition to the risks of driving under the influence or an accidental overdose, he said.
Lynn, a UCSB student who had to leave school to seek treatment for her drug abuse with the Santa Barbara Council on Alcoholism & Drug Abuse’s Project Recovery, said the drugs are so strong that people can get addicted even when taking them just as prescribed. Even among people who were abusing them intentionally, some didn’t realize drugs had a time-release formula, which increased the risk of overdose, she said.
“If that’s an issue for people who don’t mentally crave this, it’s going to be that much more of an issue for people who do,” she told Noozhawk, also on the condition of anonymity.
Now 21, Lynn said she abused OxyContin for two years before switching to heroin after the formula changed and the anti-crushable tablets made it too difficult to freebase them — that is, melt them on a piece of foil and then smoke it.
She bought the pills on the street, mostly.
“If you’re into a certain thing, I feel like you will always find it because you work to find it, whether that way is sketchy or not,” she said. “People are very clever.”
Lynn’s story is not uncommon. Within the past two decades, the statistics are staggering: Both prescription and abuse rates have skyrocketed, resulting in hundreds of thousands of overdose cases annually. The number of patients treated in emergency rooms for prescription drug overdoses doubled between 2004 and 2008, to 305,885, and death rates have risen astronomically since the late 1990s.
Prescription drug abuse is not one county’s problem; it ranges across socio-economic and geographical lines.
The number of unintentional opioid painkiller deaths in the United States nearly quadrupled over the last decade, to 11,499 in 2007, according to the Centers for Disease Control and Prevention’s National Vital Statistics System. That same year, there were 38,371 total drug-induced deaths involving illegal and/or prescription drugs.
Santa Barbara County’s Premature Death and Preventable Illness Report in 2008 noted that accidental drug overdose death is the third leading cause of premature death in the county, with males accounting for two-thirds of the deaths and whites accounting for 81.6 percent.
Hundreds of people visit local emergency rooms and get admitted because of unintentional and self-inflicted/suicidal poisonings every year.
In 2009, Santa Barbara County reported 143 unintentional poisonings, making it the third cause of nonfatal hospitalizations, and there were 485 emergency department visits for poisonings. There were 226 and 189 self-inflicted/suicide poisonings in 2009 and 2008, respectively, statistics show.
This year, the three Cottage Health System emergency departments — in Santa Barbara, the Goleta Valley and the Santa Ynez Valley — reported 117 accidental poisonings between Jan. 1 and June 30, although there is no further breakdown into type of substance, according to the California Office of Statewide Health Planning and Development.
Prescription drugs are involved in more U.S. overdose deaths than heroin and cocaine combined, according to the CDC.
The Santa Barbara County Coroner’s Office sees dozens of alcohol- and drug-related overdose deaths every year, and its records list the drugs found in each deceased person’s system; the cause of death is either a lethal amount or lethal mixture of drugs and/or alcohol.
The drugs found most often in fatal overdose cases between 2005 and 2009 are methamphetamine, morphine, hydrocodone, methadone, the benzodiazepine diazepam, cocaine, nordazepam, marijuana, codeine and hydrocodol.
Overdose risk is closely tied to the method of delivery, and combining drugs with each other or alcohol often results in death, said Sgt. Brown of the Coroner’s Office.
In the county’s 2009 coroner reports, there are people with 15 different drugs in their system at the time of death. In fact, it’s extremely rare to only have one drug present, she said.
Getting access to these medications is relatively easy, with or without a prescription. Sgt. Brown knows the seven ways people have been getting drugs in Santa Barbara County from her background in narcotics: prescriptions, prescription fraud, doctor shopping, Internet sales, street sales, theft and from a family or friend.
The 2009 National Survey on Drug Use & Health, compiled by the Health and Human Services Department’s Substance Abuse & Mental Health Services Administration, noted that more than 70 percent of people who abused prescription painkillers reported getting them from friends or relatives.
If people don’t monitor their own medicine cabinets, it’s easy enough for someone — really, anyone using the bathroom — to take the drugs. Drugs are stolen from pharmacies, in home burglaries and even during real estate open houses, often with a two-person team with one acting as a distraction for the agent, authorities say.
Young people frequently abuse over-the-counter cold and cough medicines, which many of them steal if they are under the age limit to purchase them, law enforcement officials said.
Access also increases every year as more prescriptions get handed out by doctors.
The number of prescriptions filled for opioid painkiller increased 402 percent between 1997 and 2007, according to industry statistics reported by SDI’s Vector One in the Modern Medicine network.
Meanwhile, 257 million total prescriptions were dispensed by retail pharmacies in 2009, up 48 percent from 2000.
In 2010, hydrocodone — a component in Vicodin — topped the lists for most prescriptions written and retail dollars spent, with both categories showing increases from the previous year. There were 122.8 million prescriptions written in 2010, bringing pharmaceutical companies $1.9 billion in revenue, according to data analyzed by SDI’s Vector One.
Oxycodone, a component in OxyContin, is in the top five in terms of retail dollars at $1.26 billion, and a 95.8 percent jump from 2009.
With the increase in accessibility, health-care practitioners, law enforcement and treatment personnel say they see the need for changes in the way prescription drugs are handled.
“Times are stressful and a lot of people seek and get drugs prescribed as coping mechanisms to help them sleep or help them with their anxiety, help them with chronic pain or their stress level,” Sheriff Brown said. “It’s that, seeing drugs as the answer to the problem instead of making some other lifestyle changes or healthier practices, that’s the hard part.
“We’re Americans, we want things now — you know, instantly. We’d much rather have the instant fix than the long-term fix that’s better.”
While researching this project, Noozhawk repeatedly has heard sources proclaim the need for change. Among the suggested remedies: comprehensive prescription history databases, increased prevention and enforcement by law enforcement, and widespread public education about the risks, signs of abuse and proper disposal and prevention.
Most people say they would never abuse drugs, but anyone can come in to a home and take medication from a medicine cabinet, Sheriff Brown said.
“So you have to recognize if you no longer have any need for those medications, the best thing you can do is properly dispose of them,” he said, putting in a plug for the Sheriff’s Department’s Operation Medicine Cabinet, which provides secure drop-boxes for residents to get rid of all types of unwanted medications.
“We couldn’t make it any easier: drive to the nearest sheriff’s station and drop them off in a box. We’ll take it from there.”