While Berry would like to enroll in an inpatient or outpatient drug rehabilitation program, neither is covered by her health insurance – a common predicament with prescription-drug abuse, says Steven Juergens, M.D., an addiction expert at Virginia Mason Medical Center in Seattle. “Prescription-drug withdrawal can take up to three weeks, while withdrawal from alcohol and cocaine can happen in a few days,” says Juergens. “That time difference amounts to a lot of money, and many health-insurance companies won’t pay for it.”
On her own, Berry’s gone from taking six Ativan to half a pill a day. Still, every day is a struggle, and she and her husband are contemplating divorce because of the drug’s impact on her life. “Now my kids take care of me instead of the other was around,” she says. “On my really bad days, I feel like I’ve gone insane and beg ny husband to put me in a mental institution. He tells me it’s the medication’s fault, not mine. I try to keep believing him.”
Health Care in Crisis
At first glance, stories of prescription-drug abuse just don’t add up. How can FDA-approved drugs be ruining so many women’s lives? The main problem, says Miller, is that doctors increasingly use pills to solve an array of complex medical problems. “There’s little education for physicians on how to respond to patient discomfort other than by writing a prescription,” he says. “Patients, inundated with ads of “miracle” drugs on TV, are increasingly demanding pills too. Why se a psychologist or physical therapist for months or years when you can pop a pill and feel fine? “We’re in a society that expects a quick fix to everything,” says Gitlow. “Doctors are undoubtedly feeling this pressure. When they see a patient suffering, their first reaction is often to make them comfortable as quickly as possible.”
But why aren’t doctors sufficiently addressing the potential for addiction by screening, educating, and checking up on patients? Largely because the majority of doctors have little or no training in diagnosing or treating addiction. According to a survey conducted by the Journal of Addictive Diseases, 56 percent of doctors have only a small amount of training in addiction; 20 percent reported having none at all. Combine this with physicians’ increasingly tight schedules, and you’ve got an accident waiting to happen. “Many doctors lack the time or training to make sure patients don’t get addicted to prescription drugs,” says Jamie Court, executive director of the nonprofit Foundation for Taxpayer and Consumer Rights in Santa Monica, California, and an author of Making a Killing: HMOs and the Threat to Your Health.
In an ideal world, says Cynthia Romero, a family physician in Virginia beach, Virginia, “I’d like to see 15 patients a day. But since reimbursements from health insurance companies haven’t risen to meet the costs of running my business,” she continues,” I have to see 20 to 30 patients a day to make my overhead.” And in the 15 minutes she has per patient, there often isn’t time to educate patients about all the dangers of addictive drugs or to fully assess their backgrounds. “I do what I can, but it’s impossible to do everything,” she says. “Sometimes I’m forced to cut visits short.”
Plus, Romero adds, patients often don’t appreciate when she does take the time to discuss a medication’s potential for addiction. “When I start to explain how a drug works, they roll their eyes and say, ‘Come on, doc, I’ve been on this medication for years; no one else has ever asked me these questions,'” she says. She fears that these time-pressed patients won’t return and will choose instead to go to doctors who offer faster service without thoroughly reviewing their symptoms and the potential side effects of medications they prescribe. “It’s a tough situation,” she says.
But busy doctors are only part of the problem; Colvin emphasizes that pharmacies could also do more to stop prescription drug abuse. “Most pharmacies have now way of knowing if a patient is doctor-shopping in order to fill numerous prescriptions for the same drug,” says Colvin. Some states are making progress on this front, however: Currently 17 states have centralized electronic monitoring systems that can track whether someone’s filling excessive prescriptions in various pharmacies; names of people who do so can be turned over to law enforcement. “But until these monitoring programs are in place nationwide, many people will continue to get away with fooling pharmacies – and stay addicted,” says Colvin.
How To Get Healthy – Not Hooked
“While we’ll probably never stop all prescription drug addiction, we can do something about the ‘unwitting’ addicts – people who innocently end up hooked,” says Colvin. To avoid this fate, patients must take a more active role in their health care, and broach subjects their doctors may be too busy to bring up themselves:
- When prescribed any drug, ask your doctor if it’s addictive. ‘Many people get hooked on prescription drugs merely because the don’t realize the drug they’re on is habit-forming,” explains Colvin. “By knowing this from the outset, patients can avoid becoming addicts through sheer ignorance.”
- If your family has a history of drug addiction or alcoholism, tell your doctor; it may mean that you’re not a good candidate for the more addictive drugs or that you should be monitored more closely.
- If ay any point you feel your doctor is not taking the time to fully understand your problems or explain your treatment and its side effects, insist on seeing a physician who will – if possible, someone who specializes in pain management, anxiety disorders, or addiction.
- If the drug you’re being prescribed is habit forming, ask your doctor, “How quickly could I develop a dependence?” With opioids and sedatives, dependence can occur in two to four weeks; with stimulants, in one to three weeks, says Fleming. If you’re on these drugs for this amount of time or longer, discuss with your doctor how you should taper off the drug to prevent withdrawal symptoms.
- While you’re taking these drugs, monitor yourself for signs of addiction. Colvin suggests keeping these questions in mind: Have you ever felt that the amount of the drug you’re prescribed isn’t working as well as it used to? Do you experience more than just symptom relief on the drug, such as a feeling of excitement, or a “high”? Do you feel that you can perform certain tasks or activities (like driving in traffic or socializing at parties ) only with the medication? If you answer yes to any of these questions, this may be a sign that you should broach the subject of addiction with your doctor.
- While on these drugs, ask three friends or family members to keep an eye on you as well. Say to them, “I’m on a medication that’s potentially addictive. Can you tell me if you notice my personality changing over time – say, if I’m acting too happy, or more remote or irritable than usual?” The less secrecy and shame you have about using these drugs, the more likely you are to get help if you need it, says Colvin. “Most people understand alcoholism,” he says. “But when an addict’s drug of choice comes from a doctor, there’s a lot more confusion. People think, Maybe she’s supposed to be taking these. The more people who know that prescription drugs can be a problem, the faster we can stop this epidemic of addiction.