July 16, 2019 by Peter B. Laird
Prescription Abuse: Dangers & Solutions
The U.S. Centers for Disease Control and Prevention (CDC) estimates that about 100 people die each day from drug overdose, primarily from prescription drugs. That’s more than from car accidents, gun violence and several other types of fatalities. This means that the U.S. is in the midst of a prescription drug epidemic, according to the CDC, the National Institute on Drug Abuse (NIDA) and other government agencies.
A CDC report released earlier this year, found that a fatal overdose from opiates or painkillers claims the life of 46 people every day, more than one person per hour. The most commonly misused drugs are opiates (OxyContin, Vicodin and Percoset), drugs used to treat depression and anxiety (such as Xanax), and stimulants prescribed for ADHD and narcolepsy.
What is often missing from debates about epidemics and treatment approaches is the medical reality of addiction as a brain disease regardless of the drug – prescription drug, alcohol or illegal drugs, said John Eustace, M.D., medical director of South Miami Hospital Addiction Treatment & Recovery Center.
In about 10 percent of people, drugs and alcohol affect the brain to such an extent that the use of a substance increases the desire to continue using. The remaining 90 percent of the population will not become addicted to alcohol or drug use, and may even have the opposite reaction. The different brain and body responses, he said, do not make one person good or another bad. It is rather, a function of the disease.
Also, missing from the debate is the difference between people who become dependent on a drug after legitimate treatment for pain from surgery or a serious fracture, and those who are addicted to the drug following recreational use.
“The confusion is the difference between primary addiction, which is craving, compulsion, loss of control, as opposed to physiologic dependence, where the person took the medication for a bonafide physical reason — surgery or fracture pain — but the chemical created a neurochemical change so that the patient needed the drug to function,” Dr. Eustace said.
This type of dependence after surgery or treatment may happen when long-term use of a prescription drug to treat pain is not properly monitored, he said. In that scenario, the user does not experience the intense “high” of the person who is addicted.
“It’s not a party; it’s not euphoric; it’s not criminal,” Dr. Eustace said. “It’s neuro-physiological, and as time goes on, that same dose doesn’t work. The patient may think: ‘If I don’t take a higher dose, I am not going to function. I’m going to be in more pain, more anxiety.’ If the physician doesn’t understand that process, if the patient doesn’t understand that and if the intervention isn’t done humanely, compassionately with the proper treatment, everybody’s going to suffer.”
Treatment for that patient would be different than for someone whose primary diagnosis is addiction, he said. Without a proper diagnosis, that patient’s problems could be exacerbated.
“The patient’s going to have to steal, trade, cross over to another drug, or go to heroin use. That’s what happened with the pill mills. It just became a place where people were coming to get the drug and misusing the prescription,” Dr. Eustace said.
Ultimately, he said, the epidemic, like the problem of drug abuse and fatal overdoses, is made up of the interaction of three components: the drug being used, the host or user and the environment.
With more than enough contributors to the problem, Dr. Eustace said, the solution involves greater focus on treatment and increased funding for treatment and recovery programs, combined with a compassionate medical approach to addiction and drug dependence – minus shame, guilt and other stigmas that discourage people from seeking help.