Commentary: Danger in your pill bottle

Commentary: Danger in your pill bottle

Editor's note: Marvin Seppala, MD, is chief medical officer at Hazelden, a national nonprofit organization that has been treating addiction for 60 years. He is co-author of two Hazelden books: "When Painkillers Become Dangerous" and "Pain-Free Living for Drug-Free People: A Guide for Pain Management in Recovery."
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Marvin Seppala says opioid painkillers are highly addictive and in the same class of drugs as heroin.


CENTER CITY, Minnesota (CNN) -- Prescribed opioids -- pain medication -- have become the fastest-growing addiction problem in the United States. They are second to marijuana as the most commonly used illicit substances.

Vicodin and OxyContin lead the way among our youth; the 2008 "Monitoring the Future Study" by the National Institute on Drug Abuse found that 9.7 percent of high school seniors have misused Vicodin and 4.7 percent OxyContin.

There is a naïve consensus that these are safe medications because they are prescribed by physicians. However, they are extremely reinforcing, highly addictive and in the same class of drugs as heroin.

Opioid prescriptions have skyrocketed since the mid '90s and with this we have seen dramatic increases in illicit diversion of the drugs, addiction treatment admissions, emergency room visits for opioid overdoses and deaths.

Historically, pain has been inadequately treated by physicians, so there is good reason for the increased medical use of opioid pain medications. However, inadequate safeguards are in place and no one was prepared for the dramatic increase in addiction to these medications.

Some have argued that the addiction-related problems are a small price to pay for the relief of pain for the masses, but the parents of a 17-year-old girl who died of an OxyContin overdose in Portland, Oregon, last year would most certainly disagree.

Most often people obtain these medications by prescription; usually by "doctor shopping" -- going to multiple doctors for prescriptions. They are also purchased at "pill mills" from unscrupulous physicians, from dealers and on the Internet. Young people often obtain them from their parents' and grandparents' medicine cabinets. They are very easy to obtain.

Heroin is actually cheaper than these medications, resulting in another problem; once addicted, requiring high doses of opioids due to rapid buildup of tolerance, people look for less expensive alternatives.

Heroin use rapidly escalates, increasing the potential for IV use and the associated risk of hepatitis C, HIV and other infections. I worked with a 23-year-old who, as a senior in high school, used Vicodin that was legitimately obtained due to a football injury.

He and four friends were experimenting with other drugs and overused it. They all started to obtain opioids from physicians because of various real and fake injuries. Over time they became opioid addicts and three of them moved on to heroin. None of them went on to college and they were all caught in the vicious cycle of opioid addiction; using high doses every few hours, engaging in crime to support their addiction.

This is not a problem limited to our youth. The "boomers" are aging and developing aches and pains. Pain is the most common problem bringing people to the doctor, and opioid pain medications are frequently prescribed for even minor pain.

It's quick and easy for the physician to write a prescription for these medications and move on to the next patient. The patient is satisfied and the pain is often relieved. Unfortunately, some of these prescriptions will go to those already addicted and some will initiate an addictive cycle.

A 54-year-old woman came to see me for detoxification from opioids. She had obtained five prescriptions per month from five physicians. None were aware of her problem, nor suspected addiction. She was never seeking more, never tried to fill prescriptions early and appeared to be using them as prescribed.

Her husband had divorced her, she could not work and her home was going into foreclosure. She was caring for her two teenagers, but was barely able to care for herself.

These stories and many, many more illustrate our need for a national response to this crisis. If any other "legitimate" illness was killing hundreds of thousands of people per year, we would have outrage, government intervention and establish a directed response. Unfortunately, this is a disease of great stigma, and easy to neglect. We must begin to address this issue.

How can we do so?

• NIDA, the National Institute on Drug Abuse, and the ONDCP, the Office of National Drug Control Policy, should establish a task force to examine and implement a national response.

• A state or national computerized pharmacy record should be maintained and examined for overuse of prescribed medications.

• Law enforcement needs new laws, and resources to effectively shut down "pill mills," Internet prescribers and unscrupulous physicians. State medical boards need to examine over-prescribing and strip some physicians of their license to practice medicine, as well as offer training about addiction and appropriate prescribing of pain medications.

• Most states, especially in this economy, are in dire need of increased resources for addiction treatment. Effective treatments for opioid addiction exist.

• We need to provide training for medical students, nursing students, psychologists and social workers in the identification, evaluation and treatment of addiction as well as identifying drug-seeking behavior. We barely provide any training to our health care professionals about addiction in spite of the fact that 25 percent of the national health care budget goes to addiction-related illness.

• Chronic pain is commonly treated with opioids, but alternatives exist and in many cases are better. Among the alternatives are nonsteroidal anti-inflammatory drugs like ibuprofen, physical therapy, massage, acupuncture, nonaddicting pain mediations and exercise. Cognitive behavioral therapies can also be very effective for chronic pain. Insurance companies need to fund the alternative treatments.

• Our physicians, other prescribers and caregivers need to pay more attention to the risks associated with prescribing these medications. Appropriate prescribing, ongoing monitoring and educating patients about the risks are essential to good practice.

Addiction is an equal opportunity disease. It doesn't care about your age, race, gender and socioeconomic status -- which is why nearly 24 million Americans are dependent on -- or abuse -- alcohol or other drugs.

Treatment works and there is hope for lifelong recovery.

The opinions expressed in this commentary are solely those of Marvin D. Seppala.
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Just thought I'd copy and paste it out for you. Try remember to do this in future ;)
Good post :)
 
I think I read that overall, opiates cause few deaths compared to other drugs, even otc drugs. Anyone have any numbers on this?
 
this is like my parents telling me to exercise/diet (i do) and try counseling (i do) a third time instead of taking a small amount of a benzo each day for anxiety. drugs are the devil, even if all other methods fail, dont do quote unquote """"DRUGS""""! they ONLY have negative attributes, zero positives!

the older generation will die off soon enough...
 
yea, Fuckin exercise, chiropractic, advil...These all work GREAT when you have a serious back injury that needed multiple surgeries, rods, bone fusions, etc. I cant fucking STAND when people recommend this shit. maybe to someone who got a "achy back" and is gettin low dose vicodin, doin those things will help. When your pain hurts so bad you cant even MOVE at all, cant bend over, cant sit, cant stand or barely do nothing at all then you aint gonna be doin fuckin stretching exercises or wat the fuck ever they reccommend. There was times when i was in so much pain all i could do was cry and cry, could not barely even move at all, had spasms of pain shootin up and down my back makin me constantly twitch and shake, and i could not even GET any medication for this even with MRIs and xrays, and that was only a pretty MINOR injury....Imagine to ppl with severe serious injuries...

Its so fuckin offensive for these goddamn cocksucking asshole who never spent a day in the body of a suffering injured person to suggest these shit-ass excuses for treatment. Dont you think we TRIED those already? Dont you think that maybe becuz we are COMING to a doctor, that its becuz everything else DONT WORK??I tried advil motrin tylenol aleve bayer aspirin, prescription strenth ibuprofen, and so on...everything over the counter, i tried it, even herbal supplement type shit , chiropractic which put me in alot of pain half the time becuz i was so jacked up.....And you kno wat, fuck those parents who "beg to differ" they are fuckin assholes. If they aint able to tell the difference between their kid using recreational drugs to get fuckin high, and a person suffering in misery gettin the relief they need, then they shouldnt be openin their goddamn mouths.

Its pieces of shit like this that crusade their entire lives acting liek they are workin in the best interest of "the children" when really it is THEIR CHILD that they are doin this for and nothin more. THEY are upset that THEIR child died from illegally using drugs, so they open their fat ass mouths to spew out bullshit to influence law makers and community "do gooder" type ppl and just cry about their kid til they get wat they want. Its selfishness. no matter wat they do, their kid aint gonna come back from the dead because they make it even harder and harder and harder for ppl with legitimate pain to get prescribed the medication that will make their life livable, and thats exactly wat they are doin. its incredibly selfish and hurts way more than it could ever help. Fuck them.
 
Drugs should be cheaper so people wouldn't have to steal to buy them. Adults should be able to take any drug (without prescription). Let doctors give advice and educate people, but you should be the one to decide. It's your body and your reasons for taking your drug of choice are your own private concern.

End prohibition. People got to be free.
 
Yay Lacey! You vehemently stated exactly what I was thinking.

It really pisses me off when these parents try to get legitimate medications banned because their kid was irresponsible or just plain stupid and OD'd. Um, excuse me, you are supposed to be the parent, so please parent your kid, don't expect the world to remove all the dangers and cater to your startling lack of ability to raise your kid to have some common sense. These are parents who probably never had an honest drug discussion with their kids, just kept pushing the "Just Say No" philosophy of FAIL. It all begins at home, people. I am a parent to a 12-year-old, and his daddy and I have been upfront and honest with him about our experiences with drugs, both the positive and the negative. And, we know our kid. If he were to start using, we would be the first to pick up on the signs because we know him, and we pay attention, and we communicate.

And, it seems like it's usually stupid suburban white people! (I'm a suburban white person myself, but I really don't fit in, LOL.) They live in this clueless, sheltered cocoon and are just *shocked* when they discover little Justin or Tiffany has been using drugs! Check your own medicine cabinets, ya morons. Your kids are dying because you just don't wanna see what is happening!

OK, I will step down off my soapbox now...
 
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