A young man approaches the pharmacy counter with two prescriptions. One is for a painkiller. One is to treat a medical condition. Shaky and anxious, he asks the technician what the total is. Unable to afford both, he opts for the painkiller.
“You can tell when they are addicted, but you can’t do anything but give it to them because they have a prescription,” said one local pharmacy technician who asked to remain unnamed.
“You’ll see them come in several times a week with prescriptions from different doctors,” said another.
Pharmacists in the area have lots of stories like these, so it’s no surprise to some that a recent report—“Substrate Estimates from the 2006-2008 National Surveys on Drug Use and Health,” based on a nationwide survey commissioned by the Substance Abuse and Mental Health Services Administration—showed Santa Barbara County can boast the highest percentage use of non-medical prescription pain relievers in the state. The report was based on the survey of 200,000 people across the country who were asked questions about their health, habits, and hobbies. The results showed that region 10, which includes Santa Barbara and Ventura counties, had a 7.05 percent abuse rate compared to an overall state average of 5.27 percent.
In some ways, the authors of the report have an advantage over local organizations in assessing the situation. Rehabilitation centers only see people who’ve come to a point where they need help. Hospitals only see those whose painkiller addictions have caused serious illness. The sheriff’s department and the local police see only people who have been arrested for a crime under the influence of the prescription drugs.
Apart from their presence in such after-the-fact situations, people who abuse prescription painkillers are essentially invisible. They are seniors who already need several medications from different doctors, none of whom communication with each other. They are teens who find handy access to a relative’s medicine cabinet. They are people who have been sick or injured and find it hard to return to a normal life after their painkiller regimen officially ends.
What’ll it be?
John Doyel, interim program manager for Santa Barbara County Alcohol and Drug Programs, said there’s definitely a nationwide increase in prescription drug abuse. Think Vicodin and Oxycontin, or tranquilizers like Valium and Xanax. He also said he’s seen nothing to suggest Santa Barbara County has a higher rate of abuse than does the rest of the country.
Doyel said there’s no real reason for the national increase other than that drugs trend in cycles, just like cocaine was popular in the ’70s and alcohol dependency was high in the ’90s. To his office, however, the latest trend doesn’t matter; they just try to treat it, whatever it is.
“Our point of view is that even though treatment models differ a bit, a drug is a drug is a drug,” Doyel said. “It doesn’t matter what it is.”
Doyel said there are always certain areas of the country that will be predisposed to harboring higher rates of certain types of drugs, simply because of the ports of entry. But other factors come into play as well, especially internally in the county.
He finds a higher incidence of alcohol, heroin, and prescription painkiller abuse in the city of Santa Barbara, while northern Santa Barbara County counts a higher incidence of methamphetamine use. The reason, according to Doyel? “Money. Prescription medications take money.”
While financial considerations do come into play, a prescription painkiller abuser’s demographics don’t stick with any one type.
“It’s across the board,” Doyel said. “It might be a little more adolescents, going through their parents’ cabinets, just like with alcohol. That’s usually how they get a hold of it.”
There is one possible explanation behind the rise of prescription painkiller abuse, Doyel said: They’re seen as safe because they’re FDA-approved. Medications like Vicodin and Xanax are readily prescribed and relatively easy to obtain. He said there’s even a party drink now that consists of codeine mixed with alcohol.
“Now pharmaceuticals are advertised on TV, they’re just seen as being safe,” Doyel said, “and no, they’re really not. In some cases, they are more pure.”
For the most part, prescription painkiller abuse carries no telltale signs, so when it comes to the question of how Santa Barbara County surveyed its way into the highest percentage of painkiller abuse in the state, the answer may be that Santa Barbara County actually has that distinction, or it may simply be that the more people in this region admitted to it.
Ed Guerena is pharmacy director for Marian Medical Center in Santa Maria. He said many people who abuse prescription painkillers show little or no symptoms unless they’re going through withdrawal. That’s because the abuser builds up a tolerance.
“It could be your coworker and you wouldn’t know it unless they started having angry outbursts or mood swings,” he said. “A lot of times someone will be arrested for doing something, and it comes out they were under the influence, and people around them will say they didn’t even know or realize.”
Most painkillers are in the opiate family. This is how they work—and create problems: First, they flood the brain with endorphins, which create positive feelings. The brain in turn stops making those endorphins because it’s been tricked into thinking they’ve already been produced. That creates a need for more opiates in order for the user to feel normal. Eventually, the body needs more and more opiates to produce the needed amount.
This chemical imbalance doesn’t stop once an abuser stops; it can take weeks or months for brain chemistry to return to normal and for a user to stop needing the drug.
Clare Kavin, a pain addiction specialist with the Waismann Method in Los Angeles, said she doesn’t have any statistics or graphs to indicate why there’s a rise in painkiller abuse in Santa Barbara County, California, or the United States—but she has an opinion on what may be the underlying cause.
“In my personal opinion, in this country, we want instant rewards,” she said. “We want it now. If we have pain, whether it’s physical or mental pain, we want it to go away now. If we have a headache, we don’t take a Tylenol, we take a Vicodin.”
Marian Medical Center’s Guerena agreed that we live in a pill-popping society.
“We are so busy. It’s not like ‘I have a headache, I’m going to rest for a few hours and take a nap,’” he said. “Instead, it’s ‘I’ll just down this and keep going.’ That’s what we’re wound up to do.”
Guerena said he couldn’t speculate on the abuse rates in Santa Barbara County specifically, but he said that generally there are many factors at play in society. Increasingly potent drugs that can be prescribed by any doctor, not just specialists, are more readily available every day. For instance, he said strong drugs meant for cancer patients can be prescribed by any doctor, not just oncologists.
Busy doctors also contribute to the problem. Guerena said family practice physicians have to see a lot of patients in order to pay the bills. Devoting only 10 minutes to each patient means doctors often aren’t fully aware of other medications the patient may be taking or whether a patient really needs the medication prescribed.
Direct-to-consumer advertising is also at play. While pharmaceutical companies say they’re educating patients, they may also be creating bias.
“You see beautiful people in beautiful surroundings, and everyone is happy because they’re taking these medications,” Guerena said. “So patients go to the doctor and say, ‘I want this,’ and depending on the physician and how busy they are, patients get what they want. I’m not saying all physicians are doing this, but it happens.”
The increase in painkiller abuse rates indicates such scenarios happen fairly often. With patients becoming more educated about available prescription medications, society seems to be growing more accepting as well.
“It’s not like these days you meet someone and say, ‘Hi, how are you?’” Guerena said. “It’s, ‘Hi, what are you on?’ Everybody wants to be the happy beautiful people.”
Guerena said pharmacists have an obligation to report suspected painkiller abuse under a mandate called CUREs, which requires pharmacists to report all controlled substance prescriptions to a coalition that aggregates the information by physician.
“If we see a patient that is obviously getting a lot of drugs, first thing we do is call the physician. But sometimes the physician says, ‘Yeah the patient needs it,’” Guerena said. “It’s not uncommon for a pharmacist to refuse to fill it, but there’s not a lot we can do about it. The patient will just go to the next pharmacy.”
How safe is safe?
Guerena said painkillers are dangerous simply because of their potency. While many people view them as safe because they’re prescribed, that sense of security is misleading. The medications alter brain chemicals, creating a need to continue using them in increasing amounts. Guerena said they make people groggy, cloudy, and oftentimes forgetful—as in forgetting they took a dose of the medication already.
That’s an important factor to remember when asking why it’s so hard for people to stop using painkillers in the first place. Many abusers get used to the feeling of not feeling. Painkillers, antidepressants, and anti-anxiety medications, with their endorphin-inducing properties, cause a numbing sensation, in essence a wall between what users feel and what’s going on around them. Or, as Kavin from the Waismann Method put it: “It causes them to live with their emotions in a straight line without experiencing any ups or downs.”
It’s when patients stop using the medications and their brain chemistry starts to return to normal that they start experiencing ups and downs.
The dangers of opiate abuse go beyond user addiction, too; others can get hooked. Guerena said when patients save medications in case they need them later, they inadvertently add to the chance of someone else acquiring them. Children or grandchildren, for instance, may find them and use them, leading to addiction.
For this reason, Guerena said it’s best to get rid of those medications. He said they shouldn’t be stored in the medicine cabinet in the first place, because heat and moisture degrade potency, but keeping them elsewhere gives others easier access.
All of these scenarios could be—and likely are—contributing to the rising numbers of painkiller abuse. But again, Doyel said it ultimatel