The need for these tests has grown in proportion to the skyrocketing epidemic of substance abuse.
In 2007, the U.S. Department of Justice's Drug Enforcement Administration (DEA) reported that for the first time since drug use has been tracked, sales of prescription painkillers like Vicodin and OxyContin have surpassed the revenue from marijuana, the long-time champ and favorite of the American public.
“People in the United States are living in a world of pain, and they are popping pills at an alarming rate to cope with it. The amount of five major painkillers sold at [pharmacies] rose 90 percent between 1997 and 2005,” according to the DEA.
There must be a lot of pain out there. And the 90 percent jump in painkiller sales doesn’t include prescription drugs sold illegally, another growth industry.
“The only way to cure an illness is to diagnose it.” – Barack Obama
Anecdotal evidence suggests that the burgeoning abuse of painkillers is due to the recession. Terrified of losing their jobs or their homes, people use prescription medications, according to this theory, in order to cope with the economic downturn by anesthetizing themselves with painkillers, which not only kill physical pain but emotional pain as well. Addictionologists call the phenomenon "self-medicating."
That theory is problematic, however, because prescription drugs became the No. 1 abused substance in 2007 – before the nation descended into the worst recession since the Great Depression. The current epidemic can’t be blamed on economic anxiety and fear. Whatever accounts for the epidemic, it is so severe that the crisis has led to a 20 percent jump in calls to the National Suicide Prevention Lifeline (800-273-TALK) between January 2008 and January 2009.
Despite the statistical increase, The American Association of Suicidology released a statement in 2009 dismissing any connection between hard times and the increase in suicides..
David Lisonbee, who operates several rehabilitation centers in Southern California, believes that teens have also contributed to the rise in substance abuse. “More adolescents than ever are abusing narcotics, which are as close as the family medicine cabinet and their parents’ painkiller prescriptions,” says Lisonbee.
He also blames the Internet and mail-order companies for making drugs more available without a prescription or a physician’s oversight.
Addictionologist Lawrence S. Glass, DO, cites another cause. The diseases of old age and work-place injuries have begun to afflict baby boomers, who have a legitimate need for pain relief.
Age has forced into “retirement” many abusers of street drugs. They lack the stamina to score in dangerous neighborhoods where drugs are sold, so addicts access prescription drugs easily available from a cooperative doctor of an entrepreneurial street dealer.
“I don’t see a lot of older heroin addicts,” Dr. Glass says. There’s no need to bother with dirty syringes and “cooking” heroin in a spoon with a cigarette lighter. No risk from AIDS-infected needles. Relief comes in a little amber bottle. Prescription drugs often require less of a financial outlay when supplied by a physician because insurance may cover most of the cost.
Parents should be concerned and disturbed by another 2007 DEA survey that reported 15 percent of high school seniors abuse either Vicodin or OxyContin. Impoverished senior citizens do a brisk if painful business reselling their prescriptions to younger customers, a third-degree, first-offense felony called “diversion,” which carries a maximum sentence of 10 years in federal prison, which does not grant parole. Half of all painkiller prescriptions end up in the black market.
Two case histories embody two inarguable facts about addiction.
Cindy McCain, above, wife of presidential contender Sen. John McCain, has a personal fortune of $100 million but stole prescription narcotics to alleviate pain after back surgery.
Mug shot of Rush Limbaugh, above, after his arrest by Palm Beach sheriff's deputies on charges of "doctor-shopping" for massive amounts of painkillers. The billionaire radio commentator blamed post-surgical pain and self-loathing for his drug use.
Substance abuse does not recognize or respect socio-economic status. The CEO of a Fortune 500 company and a homeless street person can both share the craving for drugs that is one of the identifying signs of substance abuse.
Addiction can ensnare anyone regardless of intelligence, education, experience, religious faith, willpower or strength of character. The epidemic is not a snob but an equal opportunity destroyer that knows no class distinctions.
Second: No one is immune to the ugly consequences of addiction. To maintain their inventory of drugs, licit or illicit, and to prevent the agonizing symptoms of withdrawal from narcotics, addicts who are otherwise law-abiding citizens with no criminal record will steal, lie, forge prescriptions and commit other crimes they wouldn’t consider under any other circumstances.
The case histories of two famous prescription painkiller users who made the covers of Newsweek and the Sunday New York Times Magazine in 2008 prove that anyone can succumb to the insidious influence of drugs.
A medical school professor and addictionologist likes to wake up dozing students by saying, “Give me Mother Teresa for 30 days, and I’ll turn her into a crack w****.”
Reviving old news on front pages: Mrs. John McCain, felony pill-popper
Although Cindy McCain’s story is literally “old news,” dating back to 1989, it was considered timely enough to make the cover of Newsweek and generate an enormous, 3000-word piece in the Washington Post, both in 2008.
As the wife of Sen. John McCain, the Republican presidential nominee that year, Mrs. McCain had become an object of obsessive interest, with no elements of her life considered off limits.
Newsweek dredged up her 1989 arrest for helping herself painkillers prescribed for others, the felony crime of diversion.
The Washington Post report was even more scathing.
In 1989, while lifting her son Jimmy, Mrs. McCain ruptured two discs which required several back surgeries. Although the operations were successful, she continued to suffer intractable pain and became dependent on narcotics.
The distinction between dependence and addiction is crucial, not semantic. After about 30 days on painkillers prescribed for post-op discomfort or for chronic conditions like rheumatoid arthritis and low back pain, the patient will develop cravings and experience excruciating withdrawal if analgesia is abruptly terminated. The patient is said to be dependent, not addicted to drugs.
Drug addiction is simpler to define. Recreational use of opioids can lead to addiction. Pain-free consumers of narcotics in search of a good time may become addicts. Patients on narcotics to treat pain may become dependent on them.
The distinction between addiction and dependence may seem negligible since both cause withdrawal, but the motivations for drug use are legitimate and indisputable: cheap entertainment vs. relief from the surgeon’s scalpel or from fractures due to osteoporosis.
Social stigma also differentiates between the two kinds of use. No one condemns a cancer patient for taking painkillers. A judge condemns recreational users to prison.
Although Mrs. McCain sought pain relief rather than entertainment, at the height (or depth) of her dependence she was consuming 20 tables of Vicodin and a related opioid, Percocet. The recommended daily dosage is two to four tablets.
After she was arrested for stealing painkillers from the medical charity she had founded and operated to supply the Third World with inexpensive drugs, her attorney plea-bargained her felony offense (diversion) down to a misdemeanor and instead of hard time she was sentenced to community service, drug rehab and restitution. She was also forced to resign from the charity she founded.
Another Poster Child for Opioid Abuse – Rush Limbaugh
Radio commentator and zero tolerance advocate, Rush “Lock ‘em up & throw away the key” Limbaugh was arrested in 2006 after a disgruntled ex-employee he had fired – his maid – turned him in after he asked her to fill a prescription for opioids with the maid’s name on the label, another case of diversion and a potential felony. After his arrest, critics called him a hypocrite for his past support of incarceration with no rehabilitation.
Ironically, it was rehab that kept him out of a vacation in Super-Max. Criminal charges were dismissed after Limbaugh agreed to in-patient rehab and psychotherapy.
Household names such as Marilyn Monroe, Judy Garland, Heath Ledger, River Phoenix, Lenny Bruce, and Janis Joplin remain permanently lodged in the nation’s, indeed, the world’s collective memory as grim object lessons of the perils of drug addiction. The list of celebrity casualties is encyclopedic, a Who’s Who of ODs.
Some celebrities perish from drug-induced causes which somehow manage to escape media attention. One of these casualties was singer-turned-U.S. Congressman Sonny Bono, who died on January 5, 1998, at the age of 62, after colliding with a tree while skiing near Lake Tahoe.
Although the coroner’s autopsy said that Bono’s death was not due to drug or alcohol abuse, his widow Mary contradicted the coroner. Her husband, she said, took 15 to 20 painkillers a day, a potentially lethal dose that can lead to overdose or injury-related death. “I am 100 percent convinced that is why he died. What he did showed absolute lack of judgment. That’s what these pills do. They take away your thought process,” she said.
What to do about the epidemic of painkiller abuse unlikely to end after the current recession does?
Zero tolerance advocates urge tougher sentences although the construction of more prisons to house offenders has paralleled rather than diminished the epidemic while enriching the prison construction industry, its lobbyists, and corrupt politicians.
Rehab supporters call for more drug “education,” which is a misnomer. Since childhood, we have been educated that drugs are a one-way ticket to, in the phrase of 12-step programs, “incarceration, institutionalization, or death.” The short answer for solving a complicated public health menace involves reframing the problem as a lack of indoctrination rather than education.
Public service announcements, celebrity spokesperson, famous and obscure survivors of substance abuse need to bang the public over the head repeatedly and loudly without resorting to Reefer Madness-style exaggeration that undercuts the credibility of the genuine message: “Do not operate the machinery of life while under the influence or risk losing that life.”
“The bestselling drug in Baghdad is Valium.” — the New York Times, 2009
Another message that requires benign but vigorous brainwashing emphasizes that painkillers may seem like a panacea for all ailments, physical and psychological, but there is no free lunch.
Eventually, tolerance of narcotics requires higher and higher doses that no longer provide euphoria or banish the blues. At some point, the euphoric effects disappear, replaced by drug cravings and withdrawal. The antidote for what street junkies call “dope sickness” is more drugs. But by now, drugs no longer make the abuser feel ecstatic, merely “normal.”
The remission or so-called “cure” rate for drug addiction is at best 11 percent
In or out of prison, addiction can end up a life-sentence with death the only parole. Alcoholics Anonymous rarely mentions its own estimate of the remission rate (long-term abstinence) for substance abuse — a disheartening 11 percent. AA’s reticence may be a well-meaning attempt to avoid discouraging addicts with the near hopelessness of their problem.
Thomas Newton, MD, a former professor of psychiatry and medical director of UCLA’s Substance Abuse Inpatient Service, offers an even less optimistic prognosis for those who enter the death camp of drug abuse with a sign over the front gate that warns, “Abandon hope all ye who enter here.”
Or as Dr. Newton explains using clinical terms:
“Once somebody gets into narcotics, they’re just going to go down the toilet.”
(Excerpted from The Addict Next Door: The Epidemic of Prescription Painkiller Abuse and Other Contemporary Plagues by Jayson A. Hymes, M.D., M.P.H., and Frank Sanello. Genesee Avenue Books, 2011)
Jayson A. Hymes, M.D.
Causes Frank Sanello Supports
ACLU, ASPCA, Amnesty International, Doctors Without Borders