The newest drug-abuse trend is a bit of a shocker.
The drug is legal, and it's found in more than half the homes in the United States. Abuse is so widespread, the U.S. Centers for Disease Control and Prevention classifies it as an epidemic.
Abusers can be rich, poor or middle class; teens, parents or grandparents. Sometimes, law-abiding people become so addicted, they become criminals in order to get a fix.
This "new" drug is not really new. It is the family of modern pain-relieving medications such as OxyContin, Percoset and Vicodin. Used as prescribed, pain medications can be effective and safe.
But not everyone follows doctors' orders. Nora Volkow, director of the National Institute on Drug Abuse, an arm of the U.S. National Institutes of Health, said 3 to 5 percent of people who take pain medication eventually become addicted.
And more people are using prescription medications just to get high. The National Survey on Drug Use and Health found that nearly one-third of people aged 12 or older who used drugs for the first time used a prescription drug for a nonmedical purpose. According to the CDC, in 2011, more people died due to overdosing on legal pain meds than on illegal drugs.
A pill that brings relief to many destroys health and happiness for others.
How bad does it hurt?
Pain is not the same for everyone. People can handle different levels of pain. Plus, sometimes the source of pain is hard to pin down.
"Pain is subjective. We cannot quantify pain," said Dr. Andrea Dumitrache, psychiatrist with Brook Lane Health Services in Frederick, Md.
When patients complain of pain, doctors might ask them to rate their pain on a scale of zero to 10, with zero representing no pain and 10 representing severe, disabling pain. There is no test to confirm what the patient said is indeed true.
As a medical specialty, pain relief is a pretty recent development. Jennifer Reinke, pharmacist with Home Care at Robinwood Medical Center, said doctors now treat pain almost as a disease state on its own.
"It used to be you go to your family doctor and say, 'I have an ache. I have a pain. I have this problem or that problem.' Now they're referring more to pain specialists or pain clinics," Reinke said. "Plus, there's back pain specialists. There's cancer pain specialists. There's spine and headache pain specialists that deal with certain subgroups of patients, so we're seeing a lot more specialized practice in pain management."
Drugs are commonly prescribed for pain. Aspirin is the most commonly available pain reliever; it was originally derived from willow tree bark. Acetaminophen, another effective pain reliever, was derived from coal tar.
But the strongest pain-relieving medications are drugs that use morphine, which is also the active ingredient in opium. These pain-relieving drugs are highly addictive, according to Dr. John Olenczak is a pain specialist with Pain and Spine Institute, a division of Mid-Atlantic Orthopaedics in Hagerstown.
"They need to be properly prescribed and followed with doctors orders," he said. He said doctors need to monitor patients closely to be sure not to overprescribe pain meds. Olenczak also recommended exploring alternatives to pain meds.
Reinke agreed that many patients benefit from other approaches to pain mitigation.
"There's acupuncture, there's herbal medications that people use. Sometimes pain can be from stress. So if you have a headache, it could be from tension," she said. "So there's relaxation techniques. Sometimes chiropractors can reset something that's out of alignment that can help with pain. And therapy — a lot of times depression can manifest as pain."
Poppin' pills
Carl Benedict is a licensed clinical professional counselor with Behavioral Health Services at Meritus medical Center. He provides therapy for families, individuals and groups.
Many of his clients are addicted to one drug or another. Some are addicted to pain medications.
"In my case load, I may see 25, 28 clients a week. You're always going to see people who have alcohol problems. But an awful lot of them are getting into pain meds," he said. "Pain meds have less of a stigma — it's a pill. But what often happens is they get hooked on the pills."
Unlike recreational drugs, legitimate pain medications are prescribed for a purpose - to relieve pain and suffering. The problem is that the strongest pain meds are highly addictive. And deaths because of drug overdoses — specifically overdoses of prescription meds — are on the rise.
"Maryland recently became one of 17 states (for which) the leading cause of death among young people is no longer car accidents but drug overdose," Benedict said. "It's a massive problem. These meds have their uses, but they're obviously being used for many other things, and people are dying. And most of it is prescription overdose."
Local cooperation
Dr. John Olenczak is a pain specialist with Pain and Spine Institute, a division of Mid-Atlantic Orthopaedics in Hagerstown.
He said he was concerned about two things. First, patients in pain don't look for alternatives to using medications.
"In England, few antidepressants are prescribed. There's more emphasis on counseling," Olenczak said. "In the U.S., there's increasing pressure to see more patients more quickly, so not as much time is spent with each one, and medications are seen as a good, efficient therapy."
Many patients who receive a prescription for pain medications fill it, use it and are done. The surgery heals. The infection reduces. The source of the pain goes away.
But some patients, Olenczak said, continue to use pain meds after the pain goes away. They become addicted to the relaxed high provided by morphine-based medications. And some people need more and more pain meds to reach that high.
That is Olenczak's second concern: People who try to scam the system to acquire pills. Sometimes these patients acquire medications by going to more than one doctor and getting simultaneous prescriptions. Sometimes, Olenczak said, these patients go to medical practices known as "pill mills," which freely prescribe pills, often on a cash-only basis to avoid insurance company detection.
Some states have a formal framework for reporting prescriptions of controlled drugs, such as opiate-based pain-relief medications. Maryland does not have such a framework yet.
To fight this trend, Olenczak said, Washington County doctors, pharmacists and other medical professionals informally communicate among themselves, trying to alert other offices when they see a patient who raises a red flag.
"Community standards in Hagerstown are pretty good," Olenczak said.
He also pointed to the lobbying efforts of the American Society of Interventional Pain Physicians in trying to limit abuse of pain meds.
Simple fact: Abuse is illegal
Special agent Edward Marcinko, public information officer with the U.S. Drug Enforcement Agency's Baltimore office, said pill mills are an ongoing problem. He said DEA shuts them down as soon as investigations turn up an illegal operation.
"We are seeing pill mills opening up a lot in Maryland," he said. "We just had a doctor here in Timonium. He operated in Florida, but he was feeling the heat, then came up here. He saw patients, charged $300 cash, saw up to 120 patients a day.
"They were seeing patients from Ohio, West Virginia, Kentucky who were having a tough time filling prescriptions (in their home states)," Marcinko said.
Abuse of prescription medications is the biggest drug problem in the United States, Marcinko said. It's a multidimensional problem. There is unintentional addiction, when a legitimate pain-medication user becomes dependent on the drug. Then there is intentional abuse, when people who actually are not in pain take opiates simply for the high. And then there are tragic situations in which children find an old bottle of pills in grandma's medicine cabinet.
"If you have a bottle of prescription meds, keep it secure. It's only prescribed to you — the dosage, everything," Marcinko said. "We hear stories of children taking a pill or two. And we hear that kids are get hooked."
Marcinko said kids being exposed to pain meds is something the DEA is trying to prevent.
"Everybody thinks prescription pills are safe," he said. "Kids think, 'My aunt or uncle are taking this, so it's not addictive.' Kids might try it because it's 'safe.'"
So DEA and local law enforcement agencies host occasional collections of out-dated or no-longer-needed medications. The next Washington County prescription drug collection will be from 6 to 8 p.m. Tuesday, Aug. 7, at Byron Park in Williamsport during National Night Out.
A hijacked brain
In addition to his day job as a therapist, Carl Benedict also hosts a support group for people whose loved ones — usually children or spouses — are addicts. One thing Benedict does is explain how addiction works.
"This is a brain illness. Drug addiction doesn't happen because this is a weak person or an immoral person, a bad person," he said. "No one thinks they're going to get addicted, but they do. Without them knowing it, their brain has been changed. It's been hijacked."
A drug changes how a brain functions, Benedict said. Brain cells have tiny receptors to which molecules of dopamine attach. Dopamine, made by the body, helps elevate mood and reduce pain. He called this the pleasure circuit.
When opiate drug molecules ripple through the brain, they attach to the dopamine receptors on brain cells, shutting out the body's natural dopamine. If this happens repeatedly, the body cuts back on dopamine production. And then the person needs the drug to experience the pleasure response.
"When you have a hijacked brain," Benedict said, "your brain is going to tell you over and over and over again that this (drug) is your best friend, that this is the answer to all your prayers, that you need this as much as you need your next breath."
But no one wants to admit they are dependent on a drug, Benedict said. Addicts have a disease, a potentially deadly disease, but they deny it.
"Other diseases have denial, too. How many people have heart disease or diabetes who are living the way they used to, even if the doctor says, 'Your disease is going to kill you if you don't change your ways'?" he said. "And the family is in denial very often. If you're a parent, for example, your mind doesn't even want to go to thinking your kid's addicted."
Generally, Benedict said, it takes severe consequences — losing a job, losing a relationship, a DUI charge — to wake up the addict and the family members.
Change your ways
Benedict said Alcoholics Anonymous calls alcoholism "a baffling, cunning disease." Drug addiction is similar, he said. Your brain has changed. You believe that, to live, you need the substance you crave. Yet you deny there is a problem.
So what do you do?
"This is way too big for you to deal with alone. You need support," Benedict said. "I recommend go to Al-Anon. There isn't Nar-Anon in this town, so go to Al-Anon. There are meeting every day. Get a therapist who's knowledgeable with addiction. Talk to your doctor, who should be able to refer you."
Addiction can be devastating to families. Addicts divert money from food or rent to buy black-market pain meds. Some addicts, Benedict said, buy heroin, which is in the opiate family. Dumitrache said addicts reorient their lives around the drug.
"I want to clarify that regular use of pain meds will lead to physical dependence ... " she said. "... Other activities — work, relationships, and leisure —are neglected in order to engage in finding, using and recovering from the drug."
Benedict said it's hard to get your house in order. On top of that, well-meaning friends and family members offer their "help."
"For you to do what's healthy and helpful in this situation, you're going to get criticized by your family, you're going to get criticized by your friends. People who know nothing about addiction are going to (give you advice)," he said.
It's vital to find a dependable, knowledgeable support network, Benedict said.
"You do not want to deal with this alone, because you end up feeling completely alone, stressed out, depressed," he said. "It's just a horrible thing."
Where to go for help
- Prescription drug collection — 6 to 8 p.m. Tuesday, Aug. 7, at Byron Park in Williamsport during National Night Out. For more information, call April Rouzer at the Washington County Health Department at 240-313-3356.
- Professionals can learn how to identify prescription drug abuse at two upcoming seminars. The session on children and adolescents is 5 to 8:30 p.m. Wednesday, Sept. 5. The session on adults is 5 to 8:30 p.m. Tuesday, Sept. 25. Both are at Robinwood Professional Center, east of Hagerstown. Each session costs $25. To register, call Deb Staley at Brook Lane Health Services at 301-733-0331, ext. 189.
- Concerned Persons support group — This group, for those who care about someone who suffers from addiction, meets Wednesday, Aug. 1, 6 p.m., Meritus Behavioral Health Services, 11116 Medical Campus Road, east of Hagerstown. Call 301-766-7600.
