Prescription drugs: 'The new killer for young and middle-aged people'
For the first time in history, more people died last year from prescription drug overdose than from accidental overdose of illegal drugs, according to the federal Centers for Disease Control and Prevention.
The CDC reports that overdose deaths have "skyrocketed" in the past decade, largely because of prescription painkillers. Most of these pills are prescribed for a medical purpose, but many end up in the hands of people who misuse or abuse them.
"Prescription drug abuse is the new killer for young and middle-aged people," said Dr. Christopher Boe, emergency room physician and medical director of the Emergency Department at Altru Health System in Grand Forks.
"We have seen a rise" in prescription drug abuse, he said. "We are still experiencing that rise that we started seeing a couple years ago. It's an ongoing problem."
According to the CDC, emergency department visits for prescription painkiller abuse or misuse have doubled in the past five years to nearly a half million. About 12 million American teens and adults reported using prescription painkillers to get "high" or other non-medical reasons.
For kids, these drugs are temptingly easy to get -- and free for the taking -- in the medicine cabinet at home.
But not just in the home. "If you ask any kid, say, in 12th grade or college, the majority seem to know where you can get drugs," Boe said.
Rise in use by younger kids
Prescription drug use is the most rapidly increasing type of drug abuse among teens, according to a recent survey by the National Center for Addiction and Substance Abuse at Columbia University. Since 1992, the number of teen illegal drug users has more than doubled to 2.6 million in 2005, the survey found.
In Grand Forks, a survey conducted by the school district last spring shows that prescription drug use, for the purpose of getting high, has dropped among students in 10th through 12th grade but is up in sixth- through ninth-graders this year compared to 2010.
Twenty percent of students in seventh through 12th grades reported consuming alcohol, and 13 percent said they used marijuana in the past 30 days, the survey revealed. Both percentages are higher than 2010 responses.
"The drugs that are killing the most young adults -- and adults -- are extended-release opioids, like Oxycontin," said Robert Stutman, a former federal drug enforcement agent who visited Grand Forks recently. He met with high school students, faculty and administrators, parents and the public, to discuss substance use and abuse.
After a presentation at a high school, he said, a student athlete confided that she had had knee surgery. "She said she had no problem getting through the surgery, but she was deluged with texts from other students, asking if she would share her 'stash' with them," he said, referring to pain pills she received to aid her recovery. She was so bothered by the barrage of text messages, she had to turn off her phone.
Must be safe
Kids mistakenly believe that because these drugs are prescribed by a doctor, they must be safe, Stutman said.
What makes drugs like oxycodone (Oxycontin) and hydrocodone (Vicodin) so dangerous is their addictive potential, said Boe. "Some of the more powerful drugs are designed to treat terminal conditions. They are powerful medications that people can't control."
He cites a 2010 survey by the National Institute of Drug Abuse which shows that 2.7 percent of eighth-graders, 7.7 percent of 10th-graders and 8 percent of 12th-graders had abused Vicodin at least once in the year before taking the survey.
Further, the same study revealed that 2.1 percent of eighth-graders, 4.6 percent of 10th-graders and 5.1 percent of 12th-graders had abused Oxycontin in the year before taking the survey. "That's a fairly startling statistic if you think about it," he said.
Parents should be concerned about early experimentation with drugs because "age of first use" is the best prognosticator of addiction, Stutman said. The earlier a child begins consuming drugs, the more likely that addiction will result.
"Kids who have problems with drugs all say they started drinking at age 11." The average age of first use of alcohol used to be around 15, he said. "Now 12 years 3 months is the average age of first use of drugs." Students in 4th grade are the most at-risk to try alcohol or drugs, he said.
Boe said people who abuse drugs come to the emergency room with symptoms such as an altered mental state, confusion, slurred speech and euphoria. They may be unable to breathe on their own.
In severe cases, patients present with excited delirium or agitated delirium, he said. "They're sweating, extremely excited and out of control. They are 'wired.'" Hospitalization may be needed.
Boe is also worried about abuse of synthetic marijuana or designer drugs such as "K2," "Spice" and "bath salts," which cause "significant harm." "It's basically taking a drug that hasn't been tested or approved, and experimentation on your own body at your own risk." In the ER, the youngest drug-abuse patient he can recall was "in the 14- to 15-year-old range," he said.
On average, 30,000 young people a month visit the emergency room with a prescription drug overdose, according to the website, www.TheStutmanGroup.com.
The prevailing culture in the United States encourages prescription drug use -- and abuse, Stutman said. While the U.S. is home to only 4 percent of the world's population, Americans consume 60 percent of the world's drugs. Intense desire for drugs may account for certain crimes in this region.
Theft of prescription drugs has been linked to the case of two teenagers, Nick Brady and Haile Kifer, who were shot and killed during an alleged break-in of a home in Little Falls, Minn. Police found pill bottles from an earlier burglary in Brady's car.
Sergeant Travis Jacobson of the Grand Forks Police Department said, "A lot of people commit theft in order to pawn or sell things on the black market to get money to feed their drug habit...
"Young people will lie, steal and cheat to get their fix." He said the rise in the prescription drug abuse problem "boils down to, it's so easy to get -- it's in the medicine cabinet or the kitchen cupboard."
He cautioned parents and grandparents to lock up their medications, especially if their kids' friends or babysitters are coming in and out of the home. "Lock them up because they are very dangerous," he said, referring to pain pills such as Percodan, Percocet, oxycodone, hyrocodone, Tylenol 3, Demerol, depressants and stimulants.
Jacobson said he has seen firearms and other valuables bypassed by thieves looking for prescription drugs. Stutman recommends, "Take any bottle that has 'caution, do not drive' on its label and lock it up in a handgun locker. You'll save kids' lives."
He also urges parents to read "How to Raise Drug-free Kids," by Joseph Califano, chairman emeritus of the National Center on Addiction and Substance Abuse at Columbia University and former U.S. secretary of health and human services.
It's important for parents "to think about how to talk to kids, and when to start talking to them," Stutman said, but not preach. "It's important that we always listen to kids. Often adults don't listen." Parents will be most persuasive if they "are knowledgeable and kids perceive that you're being honest with them...
"I have found that kids' perceptions are very often wrong, but if it's their perception it is oftentimes their reality."
Pressure on doctors
Emergency room health professionals have seen a rise in drug-seeking behavior by patients. "We're continuing to see that serge in the population that is frequenting the ER for medications only," Boe said.
Sometime people come in with "bogus claims or minor complaints that are blown out of proportion, used to obtain medications or access those drugs," he said.
When he and his colleagues notice someone returning often to the ER, a red flag goes up. "They say they're allergic to every other medication except the ones they're seeking," he said, such as Percocet, oxycodone and hydrocodone.
Doctors not only get pressure from patients but also health-system administrators, who "grade" doctors based on patient satisfaction, said Dr. Matt Stayman, who practices family medicine at a Sanford Health clinic in East Grand Forks.
At a presentation that Stutman gave for parents Dec. 5 at Red River High School, he said physicians take a hit from patients who claim "'they are not treating my pain appropriately.'"
Too many negative responses from patients could result in a "consequence." He has decided to limit the number of strong pain-killers in each prescription and require patients to come in to see him for a refill every two weeks. Despite angry responses from patients, he said, "That's my rule."
Development of centralized electronic medical records, too, will make it easier for the medical community to watch for and prevent drug abuse, he said.
The North Dakota Board of Pharmacy also maintains a statewide prescription drug monitoring program for the same purpose. "Prescription drug abuse is a problem that health care providers are going to have to tackle," Boe said. "And I think we are tackling it."
He and other doctors are encouraging patients to use medications such as Tylenol and Motrin "that don't have addictive qualities" but are effective for pain management.
Further, they recommend that people see one provider if they have chronic pain, he said. "We'd want them to go to a primary care doctor or a single-source provider, so they're not 'doctor-shopping.'"
The emergency department "is happy to treat people when indicated, but maybe we've been 'over-willing,'" he said. "We want to keep patients happy, but that has led -- to some degree -- to a situation where we've been taken advantage of."
Changing face of drug abuse
"There used to be a very clear separation between users and others, between the 'druggies' and everybody else," Stutman said.
"Twenty-five years ago, almost the only kids that abused drugs were kids with a fairly low sense of self-esteem. Now, kids with almost no emotional or psychological problems, and are otherwise well-adjusted," are abusing.
"Yes, there are some things missing in their lives, but they are not things most parents think about." What kids who get in trouble with drugs have in common, he said, is "they perceive they are no longer the priority of their parents."
One lesson he's learned from decades of combating drug abuse is, "We'll never make drugs unavailable to kids," he said. "But we can stop kids wanting these drugs."