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Lifting the Burden of Dependency

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Rush Limbaugh. Matthew Perry. Elizabeth Taylor. Judy Garland. Carrie Fisher. Melanie Griffith.
It’s common to hear of celebrities becoming addicted to painkillers or other prescription drugs.
But if someone close to you got hooked on them would you notice the signs?
Family and friends play a crucial role in detecting the problem because abusers are unlikely to “wake up” on their own, said Diane Hague, director of the Jefferson Alcohol and Drug Abuse Center (JDAC) in Louisville.
“The person who has (an) addiction is the last person to ever think that they have a problem with it,” said Hague, whose center is part of Seven Counties Services.
An estimated 1.5 million Americans, age 12 or older, abused or were dependent on prescription painkillers in 2002, according to a national survey.
More than 6 million people, age 12 or older, had used a prescription drug nonmedically in the past month, meaning the drug wasn’t prescribed to them by a doctor or they took the drug only for the feeling or experience, according to the U.S. Substance Abuse & Mental Health Services Administration. Painkillers were the most popular prescription drug, followed by tranquilizers, stimulants and sedatives.
Although many people associate excessive drug use with people at extreme ends of the social spectrum — street people and the rich and famous — anyone can fall prey to prescription drug abuse, experts say.
Abusers include housewives who’ve never done recreational drugs, such as marijuana, in their lives, but find themselves hooked on Vicodin, part of the opioid class of painkillers that also includes OxyContin, said Dr. Clifford A. Bernstein, medical director at the Waismann Institute, a treatment center in California.
“A typical scenario is people take the drugs for a good reason to start with, and then they have high expectations that aren’t met and they end up taking more, or they find out that, ‘Hey, not only does the drug help my pain, but I feel pretty good,'” Bernstein said.
Fearing the doctor will cut off their drug supply if they reveal their dependency, the abusers may start doctor shopping — going to other physicians to get more prescriptions — or finding suppliers on the Internet or in neighboring locales, he said.
They become preoccupied with getting the drug, even though the physical problem they initially needed it for may be resolved, said Dr. Elmer Dunbar, medical director of the Pain Control Network in Louisville. “Mentally now your mind says, ‘I need that medicine. You better get it. I have to have it, and we’re not doing anything until we get it,'” he said.
Some never had a legitimate reason to take a prescription drug.
For instance, many at-risk youths are downing soda laced with prescription cough syrup containing codeine (an opioid), promethazine (an antihistamine) and alcohol because it’s been promoted by some rappers as something cool, said Dr. Ronald Peters, assistant professor of health promotion and behavioral science at the University of Texas Health Science Center School of Public Health in Houston.
“Kids are drinking this stuff and literally going into the classrooms and falling asleep,” he said. “If they’re really to a point where they’re drinking it a lot . they can’t go to sleep without it.”
Youths also are abusing prescription painkillers, which sometimes can be easily gotten from the family medicine cabinet and may be perceived as safe because they’re professionally manufactured, according to the Partnership for a Drug-Free America.
There are “people of all ages, thinking that it’s OK to take somebody else’s prescription opioid and just take it for recreational use,” Dunbar said. “That’s accepted for some reason in our society.”
People who notice warning signs in their friends and relatives should talk to them about it, Hague said.
Typical abusers will get defensive or come up with a very convincing explanation for their habits, Hague said.
“The person, himself or herself, believes the lie,” she said. “They believe the doctor just didn’t write the prescription for enough, or ‘I need more,’ or ‘My problem isn’t that; it’s that I’m depressed,’ and they believe it so strongly . family members miss it. They start thinking, ‘Oh, I guess I misunderstood.'”
Abusers also may lash out at the loved one who suggests they need help.
“The response is usually not a very positive response,” Hague said. For instance, the person may “tell you what’s wrong with you.”
But be persistent, she said.
“The family member needs to keep saying the same thing — I call it the broken-record technique,” she said.
Don’t give lengthy lectures, she said. Be brief and direct: “I’m concerned about you. You’re taking these drugs in a way that’s not prescribed” and suggest that they get treatment.
Ultimately, the abusers are responsible for their own treatment and recovery. Loved ones must realize “they cannot control the person with the addiction,” Hague said. “They didn’t cause the addiction . and they cannot cure it and they cannot force anyone to go to treatment.”
Loved ones can inadvertently delay treatment, however, by rescuing abusers every time they get into trouble.
“If they’re going to lose their job, let them lose their job,” Hague said. “If they’re going to go to jail, let them go to jail. Otherwise, what happens is the family is absorbing all the pain.”
“If you keep stepping in the way, they might be 30 or 40 or 50 before they get treatment . that’s very sad,” she said.
Hague often recommends that families enlist the help of a doctor.
“The person who observes it (the drug abuse) has the obligation to tell the doctor who wrote the prescription because the doctor is the only one that can shut it off,” Hague said.
It’s possible that the patient will just go to another doctor. But “you can keep notifying every doctor,” Hague said.
Kentucky has a monitoring system that can help doctors spot patients who have been doctor shopping within the state for multiple prescriptions, and groups, such as the American Society of Interventional Pain Physicians, are pushing for a national system.
In the meantime, there are “drug enforcement agencies and medical licensure boards intervening with physician treatment, saying that they (doctors) were too heavy-handed, that they shouldn’t have been giving out all these narcotics, and you’re seeing physicians being sanctioned and some even sent to jail because of opioid prescribing habits that are deemed to be excessive,” Dunbar said.
Doctors have to monitor their patients closely and be on the lookout for tell-tale signs of abuse, such as outlandish excuses for running out of medication before it’s time for a new prescription and balking at the suggestion of other forms of treatment, Dunbar said.
At the Pain Control Network, “we try to educate them as quickly as possible that there are several ways to eradicate pain,” he said. “It may be a surgical intervention. It may be an injection modality. It may include a lot of different medications and none of them may be opioids.
© 2004 Courier-Journal

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