Baxter, Butterfield, Cheney, Europa, Evans 1

Baxter, Butterfield, Cheney, Europa, Evans

English 1010-91
4/29/2015

Trading One Pain for Another

There is something about a prescription drug that makes you feel safe. You have
just seen a doctor who has prescribed you Lortab for your chronic pain. You didnt buy it
from someone on the street. Typically doctors know when its appropriate to write a
prescription. They just spent a decade in school and have been practicing for 20 years.
The real issue starts after the drugs have made their way home. Finding a way to reduce
prescription drug availability at home will help minimize rates of addiction.
On average 24% of teens have admitted to abusing or misusing a prescription.
(Goldberg paragraph 3) Although, misusing and or abusing medication does not always
lead to addiction or dependency, that is how it begins. Commonly abused prescription
drugs generally fall into three categories. Opioids such as codeine, hydrocodone and
oxycodone reduce pain signals being sent to the brain, and are used to treat moderate to
severe pain that other kinds of painkiller cant easily treat. CNS (central-nervous-system)
depressants like Xanax, Klonopin and Valium are used to treat anxiety and sleep
disorders, and trigger a relaxing effect in the body. Stimulants like Adderall use
amphetamines to treat ADHD and sleep disorders, giving the user and awake, focused
feeling. While all of these drugs treat very different conditions, they all trigger a euphoric
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feeling that can result in recreational use. Whether you begin using a controlled
substance when prescribed by a doctor or not, the moment your purpose for taking a
prescription is not for managing pain or a condition the drug becomes misused. Even
when taking a prescription as prescribed by a doctor, you may become dependent on that
drug to manage your everyday life. When that dependency becomes a compulsive need,
despite negative consequences, it can be defined as an addiction.
Using controlled substances even when prescribed by a doctor, can lead to several
side effects. Some may be common such as gastrointestinal issues, dizziness, and skin
reactions. While other side effects may be more serious such as, Physical debilitation,
strokes, & death. (Prescription Drug Side Effects) According to a report by the Trust
for Americas Health, In 29 states drug overdose is now the leading cause of preventable
death, overtaking motor-vehicle accident deaths. Within this figure, prescription drug
overdoses exceed heroin and cocaine. (Trust for Americas Health) This shows that
prescription drugs have become a sizeable part of a worsening drug epidemic, claiming
more and more lives. Utah in particular has become the 8th in the nation for prescription
drug overdoses, while being near the bottom of the list for all other drugs. On average
21 Utahns die each month due to prescription drug abuse. That is a 400 percent increase
in the last decade.
The significant health risks associated with prescription drug abuse are only a
small part of the problem. The costs to society, and to the personal lives of addicts can be
far more damaging. In a landmark study it was found that the total costs
associated with

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just opioid prescription abuse were, $55.7 billion in 2007 (in 2009 USD).
Workplace costs accounted for a majority of total costs, followed by health
care costs, and criminal justice costs. (Meyer) . Addiction is defined as an

uncontrollable, compulsive dependence on a drug despite the negative consequences.

Addicts experience depression, anxiety, loss of motivation, and sometimes psychotic
episodes. Addiction is like having a constant, obsessive hunger. Your entire life revolves
around your addiction and how youll feed it. Nothing matters except that drug. It
becomes impossible to prioritize your work, your schooling, even family and friends. Its
very rare for a drug addict to maintain their life when battling addiction. Those who seek
help often end up in rehabilitation programs for years, often with accompanying legal
problems. Prescription drug abuse is one of the most rapidly growing pieces of the drug
epidemic, especially amongst young adults. the National Institute on Drug Abuse's
(NIDA) Monitoring the Future (MTF) survey found that about 1 in 12 high school seniors
reported non-medical use of prescription opioids in the same year.
When getting a prescription written or filled, several people play a specific role
in the process. The patient who is seeking pain relief needs to be seen by a doctor. If the
patient is successful in getting a prescription, oftentimes they need to go to a pharmacy to
retrieve their pills. When this chain of events is manipulated to acquire drugs for
recreational use, its called drug diversion. This can mean doctors over prescribing
medication, or not reporting where prescribed medication is going, or it can be the patient
dishonestly acquiring drugs. Patients looking to get large amounts of prescription drugs
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try and get multiple prescriptions. Some go Doctor-shopping to get multiple

prescriptions filled from different doctors, and some outright forge their prescriptions.
Getting a prescription filled can be disturbingly easy. Ive been to a Rehab Facility
twice and Ive been using for over seven years now. All it would take for me to get pills
from a doctor would be a phone call to set up an appointment. Ive been doing it since I
was 17 years old. (anonymous drug user 3) Many addicts dont get their drugs through
overtly illegal means like doctor-shopping, almost 50% claim the got their drugs from
family members who legally got their prescriptions through one doctor. When
interviewed, four out of five people with prescription drug abuse history commented that
the first time they abused these substances occurred after finding a family members
outdated prescription in their home. Because some of the most common paths to
obtaining prescription drugs illegally are hard to monitor, battling addiction is a
complicated problem.
Combating prescription drug abuse is one of the governments top priorities in the
War on Drugs. Many states have imposed harsher penalties on those found guilty of drug
diversion, and have expanded their efforts to catch those offenders. In 2010 Utah
expanded their drug laws to treat the sale of prescription drugs the same as they would
street drugs like heroin, cocaine and methamphetamine (Thalman). They wish to
eliminate barriers to investigating prescribers who are prescribing too much medication.
While getting harder on offenders will put a dent in the street availability, this does little
to affect the demand for drugs.
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Most states have implemented a prescription drug monitoring program (PDMP) to

collect data on the prescribing and dispensing of controlled substances. All prescribers
and pharmacists are required to report on the dispensation of medication within a week to
a month. When these programs were first implemented in the 90s they were specific to
each state, but in recent years these programs have been expanded to include multiple
states to prevent doctor-shopping across state lines. Reports can be solicited from PDMPs
from doctors, pharmacies and law enforcement, but many studies suggest that unsolicited
reporting is one of their most powerful uses. When a prescriber or patient reaches a
predetermined threshold on prescribing behavior, the PDMP sends out a report alerting
possible illegal behavior. A report from the PMP Center for Excellence reports Analyses
of Nevada PDMP data from 1997 to 2002 indicate that individuals for whom unsolicited
reports were sent exhibited declines in the average number of dosage units and numbers
of pharmacies and prescribers visited subsequent to the reports (PDMP Center for
Excellence 5). These figures encouraged the successful adoption of PDMPs with
unsolicited reporting in many states. Unfortunately unsolicited reporting is still limited.
According to surveys conducted by the PDMP Training and Technical Assistance Center
in 2012, 38 of the 49 existing PDMPs were authorized to provide unsolicited reports or
alerts to one or more categories of end users, and 26 (53 percent) were actually doing so.
Of the PDMPs providing reports in 2012, 20 were sending them to prescribers, 10 to
dispensers, 12 to law enforcement, and 13 to health professional licensing boards
(PDMP Center for Excellence 6) This is a significant increase in PDMP effectiveness
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since the 2000s, but clearly there is still a long way to go before we have fully effective
PDMPs.
However there are many barriers to expanding these programs. Some states have
laws restricting unsolicited reporting to one or more end-users. Finding policymakers
who understand the need for amending legislation can be difficult, especially due to the
resources required to update PDMPs. Many PDMPs are under-resourced on staff, funding
and reporting ability. Any initiatives taken to update PDMPs would require additional
funding, which can be extremely difficult to find.
Originally our solution to decrease prescription drug recreational use was to
require doctors to use Dopple, or other prescription drug tracking databases before seeing
a patient. However, after interviewing several doctors we were able to see that although
our solution may be the most effective, it may not be the most realistic. Dr. Jonathan
Campbell In some respects there would probably be good reason to check a patient's
dopple every time you prescribe a controlled substance, just to make sure you are not
facilitating to the problem I think the system is just cumbersome enough that that isnt
going to happen. But I also think thats good because maybe you shouldnt be suspicious
of everyone who comes in to your office. Maybe you should just buy the fact that a
patient is in pain and not let that influence your decision.

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After interviewing the prescribing doctors and prescription abusers, we realized

that a lot of the stories we hear of prescription drug abuse come from leftover
medications. Friends or family may have expired medications that arent being used and
that makes them accessible. Say your brother broke his arm and had a prescription for
oxycodone, he doesn't need it anymore and has extra pills. Those leftover medications are
susceptible for anyone to use and become addicted. When interviewing Dr. Lamont
Hesslegesser he was asked if he ever goes over proper disposal when writing a
prescription for a narcotic. No, because I dont always know how to. 3 out of the
doctors who were interviewed all said the never go over proper disposal of leftover pills.
There is a huge lack of educating on drug disposal and drug take back programs. On both
the doctors and patient's end. We could improve education and awareness that these
programs exist, and that there are proper ways to dispose unused prescriptions.
Knowing how many extra medications are floating around, we decided that proper
drug disposal is key in bringing down the abuse rate. There needs to be more education in
this area and it is so simple! I interviewed my friend Spencer, who is a pharmacist, and he
said they only go over drug disposal on very rare occasions and it is only when they are
notified to do so. He mentioned he has only talked to one person is his career about
disposal and that was only because they asked. He has also handed out pamphlets on
proper disposal a few times but that was only when they had been given the go ahead by
the company. So nationwide you could implement a mandatory disposal pamphlet with
every medication, just so everyone is educated at the least. Have you ever heard about the
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drug take back program? If youre anything like the majority of Americans, you havent.
National drug take back to officially dispose of your expired or unused medication is
Septemer 27 their website, http://www.takebackyourmeds.org has a plethora of useful
information and lists of places that hold events to dispose of your medication. The FDAs
goal is this Protect our kids, families and environment by properly disposing of your
unwanted and expired medicines. Medicines in the home are a leading cause of accidental
poisoning and flushed or trashed medicines can end up polluting our waters. Rates of
prescription drug abuse are alarmingly high - over half of teens abusing medicines get
them from a family member or friend, including the home medicine cabinet, and often
without their knowledge. I think this is a very accurate, and realistic goal to shoot for.
We can promote these events and get rid of unused medications in the home to improve
our situation.
In my interview with Spencer he had a lot more to say about prescription abuse.
He has recently moved from working with Walgreens where it is policy to contact the
police if anyone is trying to get prescription under fraudulent causes. They have even
tried to keep people in the store until the police arrive. He is now at Walmart where their
only policy when someone is falsifying a prescription is to deny them the prescription
without contacting the police. And it is up to them to contact the physician and let them
know, and if the physician chooses to pursue legal action then the pharmacy is there to
back them up. This upset Spencer, he mentioned that it is a ridiculous policy and that
there should be immediate legal action taken on people who are falsifying information to
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get prescriptions. So the policy is really up to the individual business. If there was a
nationwide policy on what legal action is taken on these individuals then we would have
less people getting away with abusing pills. If they know they are going to be punished
for getting caught the likelihood they are going to try it in the first place is slim.
The Utah Controlled Substance Database (UCSD) is a database where you can
look up anyones past prescriptions in that state. In almost every pharmacy they only use it
when people are picking up high strength of oxycodone, methadone, or hydromorphone.
Spencer mentioned that at Walmart they use it even less due to the lack of staff and how
busy they are. Spencer directly said There should be a National Database that is
accessible through every state. In my years of pharmacy I always wish I had this because
you can look up their whole history and not just in the state. He said it would help to
know all the pills theyve received in the past because people move around a lot and
when abusers get into a new state its just a clean slate of prescriptions. We need a
national database inside of every pharmacy and a job specifically built for that. We could
create more jobs and be keeping track of all prescriptions being received and not just
really high strength ones because they are not the only ones being abused.

Works Cited:

 "U.S. Food and Drug Administration." How to Dispose of Unused Medicines. FDA, 18
Feb. 2015. Web. 29 Apr. 2015.
<http://www.fda.gov/forconsumers/consumerupdates/ucm101653.htm>.

Rettner, Rachael. "Prescription Drug Problem Sparks Debate Over

Solutions."LiveScience.com. 21 June 2012. Web. 29 Apr. 2015.
<http://m.livescience.com/36486-prescription-drug-abuse-solutions.html>

"DEA Event." Take Back Your Meds. 27 Sept. 2010. Web. 29 Apr. 2015.

<http://www.takebackyourmeds.org/dea-events>.
Prescription Control Personal interview. 22 Apr. 2015.1
Anonymous drug user Personal interview April 10, 2015
Campbell, Jonathan personal interview April 15, 2015
Goldberg, Cassie National Study: Teen Misuse and Abuse of
Prescription Drug Up
33% Since 2008, Stimulants Contributing to Sustained RX
epidemic
drugfree.org, April 22, 2013. web. April 14,
2015.http://www.drugfree.org/newsroom/national-study-teenmisuse-and-abuse-of-prescription-drugs-up-33-percent-since2008-stimulants-contributing-to-sustained-rx-epidemic/

Hesslegesser, Lamont personal interview April 15, 2015

Thalman, James. "Herbert Signs Prescription Drug Abuse Bills." Deseret News 3 May
2010. Church of Jesus Christ of Latter-day Saints. Web. 23 Apr. 2015.
<http://www.deseretnews.com/article/700028113/Herbert-signs-prescription-drugabuse-prevention-bills.html?pg=all>.

Unknown Author. Prescription Drug Side Effects drugwatch.com, May 14, 2014. web.
April 10, 2015. http://www.drugwatch.com/side-effects/
Wright, Dean, Taya Fernandes, Christina Morris, David Hopkins, John Lipovsky, Leonard
Young, Adele Audet, Deborah Brown, Eric Rosen, James Mielo, William Bronson, Sonya

Brown, John Womble, Andrew Holt, Sherry Wright, Christopher Baumgartner, and David
Wills. "Guidance on PDMP Practices, Options for Unsolicted Reporting."
Http://www.pdmpexcellence.org. PDMP Center for Excellence at Brandeis University, 1
Jan. 2014. Web. 22 Apr. 2015.
<http://www.pdmpexcellence.org/sites/all/pdfs/Brandeis_COE_Guidance_on_Unsolicited
_Reporting_final.pdf>.