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Prescription Drug Abuse Is an American Crisis
By Nancy Kennedy

Neil Capretto, DO, Medical Director of Gateway Rehabilitation Center

Baseball, hot dogs, apple pie and – opioid addiction? Unfortunately, yes, opioid addiction now belongs in that group. It has become as American as our favorite pastime and most popular foods. Addiction to prescription opioid drugs has skyrocketed in the U.S., permeating every socioeconomic group and geographic region, and growing every year. According to the Centers for Disease Control and Prevention, two million Americans are addicted to powerful painkillers like Vicodin and Oxycontin, the two most misused prescription drugs – more than the number addicted to the illegal drugs heroin and cocaine combined. And most tragically, many of those people - 15,000 per year - will die by overdosing on prescribed opioids. The deaths of celebrities such as Whitney Houston from prescription drug overdoses bring a media spotlight to the issue, but give false assurance that this tragedy only happens to the rich and famous. Conversely, many believe stereotypes that paint addiction as a problem exclusive to the inner city. Both perceptions are false.

In Allegheny County, drug overdose is the leading cause of accidental death, ahead of homicide or traffic accidents. Most of those overdose deaths involve prescription drugs. Not heroin, not cocaine, not methamphetamine – but drugs that you most likely have, or have had, in your very own medicine cabinet.

"This is a problem that potentially affects any and all families," warns Neil Capretto, DO, Medical Director of Gateway Rehabilitation Center and a nationally recognized expert in the specialty of addiction medicine. "No family can afford to be complacent about prescription drug abuse. It's everywhere, and it's getting worse, especially among teens and young adults."



Practical Tips for Preventing Prescription Drug Abuse:

1. Keep all drugs locked up, out of sight. If you have prescription pain medications in your home, do not keep them in your medicine cabinet or on your dresser where anyone will have access. Do not keep them in the kitchen cabinets – this is one of the first places addicts will look. Keep them in a lockbox. Addicts will steal from family members, friends and neighbors.
2. If you are no longer taking the medication, discard it but do so safely. See instructions below.
3. Addicts go to great lengths to get drugs. Some go through trash, or go to real estate showings in order to find drugs in the home. Others get jobs that take them into residences, such as contracting or house cleaning.
4. Pay attention to where money goes in your home. If your children are spending large amounts of money but cannot account for it, or if money or valuables are missing, these things are red flags. Trust your gut.
5. Examine your own behavior regarding drug use. Do you take a pill for everything? Do you misuse alcohol? What are you modeling to your children?
6. Teens in our region are known to have "pharm parties," which require everyone to bring a drug from home to share. Know where your children spend their time away from home, and most importantly, pay attention to who their friends are.
7. Never share prescription drugs with others. This is dangerous and you don't know where they may end up. Safe Disposal of Prescription Medications: Some medications have disposal instructions on the label.

If not, you can throw the drugs in your regular trash, but first take these steps:

1. Scratch out the label so it is unreadable and there is no information about the drug or your identity.
2. Take the medication out of the container. Throw away the container, and mix the medication with an undesirable substance such as used cat litter. Put into an empty can or re-sealable bag so it does not break out of the trash bag if an animal should get to it or it breaks.
3. When in doubt about proper disposal, talk to your pharmacist. Many pharmacies provide ways for people to drop off unused prescription drugs.
4. The Drug Enforcement Administration has occasional prescription "Take-Back" events which are advertised in local newspapers.


Rooted in Good Intentions
Prescription drug misuse/abuse is a multifaceted problem that confronts the nation with daunting challenges. "A number of factors converged to create this crisis," Capretto explains. "It began in the early 90's with a shift in how doctors approached pain. Before then, opioid drugs – drugs derived from morphine - were used to treat acute, short term pain, such as post-op pain or pain from severe injury, but they were not prescribed for chronic pain. Doctors were reluctant to do that because of the risk of addiction and the development of tolerance that would mean increasing the dose to get the same effect."

But that changed with a new emphasis on pain management in the 90's. Pain medicine became a sub-specialty and healthcare professionals began to speak of pain as "the fifth vital sign." According to Capretto, this arose from a genuine desire to help patients. "Doctors were accused of under-treating pain, and recognized that this was true. They realized that people were suffering unnecessarily with chronic pain and it was wreaking havoc with their lives. At the same time, pain specialists were presenting convincing arguments that the risk of addiction had been blown out of proportion. Then Oxycontin came out and was marketed to doctors as safe, non-addictive and effective."

Cultural change also contributed to the demand for pain medications. Pharmaceutical companies marketed directly to consumers, touting the wonders of new drugs through the mass media. People were told that there were drugs for anything that ailed them, from pain to insomnia to disorganization, and they wanted them.

Becoming Addicted
Used appropriately, Vicodin and Oxycontin are effective medications for pain relief. But they create feelings of euphoria that the brain begins to crave, and that is how addiction begins. Anyone can become addicted to a pain medication that has been legitimately prescribed; the risk is even greater if there is a history, or a family history, of drug or alcohol abuse. Before long, the person wants the drug even as the pain lessens. "Drugs hijack the brain," says Capretto. "They're exremely powerful and work in a deep, primitive part of the brain. There's nothing rational about becoming addicted."

The desire for opioids crosses the line from treatment to misuse when a person begins to take it for reasons other than pain relief. Capretto says that patients will go to great lengths to obtain drugs – exaggerating their pain, fabricating symptoms or "doctor shopping" – finding new doctors to obtain prescriptions. Despite negative consequences, such as impaired thinking, the craving continues, the person keeps using and gradually loses control of their use – and that is the essence of addiction.

Prescription drug abuse has fueled a heroin epidemic, Capretto says. "People get addicted but the drugs are expensive and eventually they run out of resources. They learn that they can get a similar euphoria from heroin for less cost. Heroin has been around for a long time, and the use of it decreased in the 80's when AIDS emerged and people were afraid to use needles; cocaine became popular. But now, heroin can be smoked or snorted because they made it stronger and more pure so you can get high without needles. The abuse of prescription drugs and the availability of heroin are a 'perfect storm' and the risks are enormous. Addicts become enslaved by these drugs."

Change on many levels is needed to combat the prescription pain medicine epidemic, Capretto believes. Physicians, the government and individual citizens all have roles to play. Doctors, he says, need to have two skill sets – one to manage pain, and one to prevent and manage addiction. "Chronic pain and addiction are complex problems. My mentor, Dr. Abraham Twerski, calls them 'biophysical-social-spiritual diseases.' Writing a prescription is easy, but understanding human beings is far more difficult. Doctors need greater awareness of the risk of addiction; we need collaboration between pain medicine and addiction medicine, and things are moving in that direction."

Pennsylvania should create a prescription drug monitoring system that will enable doctors to find out if a patient already has prescribed opioids, Capretto says. "The states that surround Pennsylvania have this in place, which is good but it drives people into Pennsylvania to 'doctor shop' and find 'pill mills.' Research has shown that when doctors have this option, they change their decision about prescribing opioids 42% of the time. Fortunately, our state legislature is considering this."

Most important of all, Capretto says, is public awareness of the opioid problem. Those with chronic pain should seek pain management physicians who offer a comprehensive, holistic approach beyond drugs. Parents need to educate themselves, be vigilant about protecting their families and rid themselves of the naïve idea that they are immune because they live in a safe neighborhood. Awareness of the problem is the first step to preventing it in your own family. Opioid pain medicines offer genuine relief to those who are suffering from pain but when misused, they deliver many new kinds of suffering. Every year, 15,000 people die from prescription opioid overdoses, and 13,000 infants are born addicted. People who are addicted to opioids can be helped to survive, by getting them into rehab where they can receive treatment of both their pain and their addiction. Opioid addiction can be prevented, through awareness, education, legislative action and individual responsibility.

For more information, call 800-472-1177 or visit Gateway on the Web at www.gatewayrehab.org.

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