Since 2008, this social worker has seen a huge increase in court ordered treatment for pill addiction or pill related arrests. With the advent of Oxycontin and the increased education about the dangers of methamphetamine, users are turning to prescription medications These offenders use or abuse only prescription drugs prescribed to them by their physicians. They feel that they are totally validated in their ability to use whatever prescription drugs their doctor(or doctors) have ordered, in any combination necessary. They are rigid in their beliefs that they are not responsible for their DUI/Drug arrests. “They are only following doctor’s orders!”, sort of. And their pain is REAL! Pill addiction is sweeping through our community and our nation in alarming numbers. There have always been pill addicts. Remember the distant aunt you had on your mother’s side who always had Valium for her “spells”? Well, multiply that by 10,000.
The two most abused classifications of drugs in this county are narcotics and benzodiazepines. In laymen’s terms: pain pills and Xanax. These two classifications are fast acting mood changing drugs. For the purpose of this post, I will focus on narcotics. Oxycontin is a relatively new drug on the market used for severe pain management. It has a time release coating which delivers 12 hours of pain medicine to the body over a period of time. This social worker has seen Oxycontin make the difference in someone writhing(yes writhing) in the floor in terrible pain and being functional. So, there is a need for this drug. But, if the coating from the pill is destroyed in some way… like crunching it off, or sucking it off or even cutting it in half… the dose is 12 hours of medication in one blast. There is a high…an incredible high. But there are drawbacks!
Drawback number one: If one is using pain pills to get high instead of to manage pain, the tolerance builds very quickly. I have known addicts who become physically addicted in a three month period of daily use. It is not un-heard of for a pill junkie, as I refer to them, to start getting high by eating 15 milligrams of a 30 milligram Roxycontin. In a three month period, the user can progress to needing 90-100 milligrams of the same medication to get them high.
Drawback number two: There is a physical addiction and withdrawal with pills. The withdrawal includes but is not limited to shakes, sweats, muscle cramps, lower back pain, diarrhea, feeling like you have the flu. The intense withdrawal (depending of course on the dose and longevity of the addiction), is four days. They feel like they are about to die, but they are not. Less intense withdrawal symptoms include sleep disorder and shaking for a period of 30 days. Often, the detoxification regimen is “cold turkey” while serving a sentence in the county jail! Again, narcotic withdrawal is not usually life threatening, however benzodiazepine withdrawal can be life threatening.
Drawback number three: The cost. Roughly speaking, the cost of Oxycontin addiction is $1 per milligram. And 100 milligrams use per day is blasé. An average addict can easily consume 240 to 320 milligrams per day. Oxycontin is dosed in 80 milligram pills. One can use Hydrocodone, Lorcet, Darvocet or other lower dosed drugs, but the popular narcotics on the street are the Roxycontin (30 milligrams) and Oxycontins (20, 40, 80, milligrams, etc). Can you see how quickly a person could get into financial trouble with a narcotic addiction? They end up doing one of three things: They deal, they steal or they substitute heroin because it is actually cheaper. But there are a few well documented drawbacks to heroin.
Drawback number four: Any crumble of a pain pill that the user does not have a prescription for or a crumble of a pain pill that is not in a proper container is a felony drug arrest. Uh oh.
Drawback number five: One can very easily be charged with a DUI for using just the prescribed amount of pain pills, alone (note the label on all of this stuff that says “Do not drive or operate heavy equipment”), mixed with a cold beer, taken on an empty stomach or taken without much sleep. It is easy to become involved in a DUI accident or an accident with injuries, or worse, on medications.
Drawback number six: Overdose potential. While it is difficult to overdose on medications that your doctor and your pharmacist know that you are taking, it is easy to overdose when you take an extra pill because you are hurting, you are in withdrawal or just for fun, with a cold beer. I am always amazed at the number of meth addicts who survive catastrophic medical problems, but when pain pills and Xanax tell your heart to stop beating, it will follow orders… period. And we have had multiple accidental pill overdoses in this community in the last 10 years…unnecessary deaths.
Drawback number seven: Pill addicts tend to practice medicine without a license or training. They double up on one pill. They cut back on another. They feel like they have a medical degree from the “I Got This University”. They are sure that since they have handled this particular dose of a drug before, they can handle it again. They are sure that mixing this with that is ok. They are practicing medicine on themselves and behind the wheel of a 4000 pound vehicle.
So, what is the problem with these addicts in a treatment program? Well, they may actually have pain. They may actually need some of the medications that are prohibited in treatment. They may not be able to be clean. In which case, the coordinator cannot accept them into the program. Sometimes the drug test needed for their particular drug of choice may not be included in the routine drug tests that the program offers. Some medications, such as Ambien or Soma, are particularly difficult to test for. Hair tests, if you use them, may not pick up the drugs you need to test for. ! Coordinating treatment with a doctor for a pill addict can be difficult especially since they usually have multiple doctors prescribing them drugs. 99 percent of the time, these doctors are completely unaware that their patient is getting medications elsewhere. These people use the emergency room like we use the grocery store. They pop in and out two or three times a week, for cramps, for a headache, vomiting….anything they can think of to get medications prescribed by a physician that THEY NEED! Physicians are often difficult to contact. They also can become irate and defensive because they feel like you, the lowly counselor, are trying to tell them how to practice medicine.
So how do we address the impact of pill addiction in treatment? You have to educate yourselves and your staff about medication addiction. Go to all of the training and read all the research that you can on prescription medication addiction. You must be open to making changes and adjustments to your program as new treatment information becomes available. You must be prepared to spend more resources on these particular addicts. Pill addicts can(and do) cause DUI fatality accidents, drug arrests, child endangerment, etc. But a pill addict is a bit of a different animal than a street drug addict or an alcoholic.