A Beginner’s Guide to the Rx Drug Abuse Epidemic in America
Part 1: A Snapshot of America’s Pill Problem
They’re in every home. Stacked in the bathroom cabinet or above the junk drawer in the kitchen—those brown and white bottles of pills. They’ve been prescribed by a doctor and are intended to ease pain and assist in restoring health. But it’s no secret that prescription drugs have now become so vulnerable to exploitation that they are viewed by many as a quick and easy high. Due to their powerful effects, prescription drug misuse and abuse has become a dangerous game of roulette inside the homes of millions of Americans nationwide.
Prescription drug abuse has become increasingly widespread in the past decade. According to the Centers for Disease Control and Prevention,1 sales of prescription painkillers have quadrupled since 1999. Along with them, the number of prescription painkiller poisonings2 has risen at the same rate.
These prescription drug-related deaths2 have outnumbered heroin and cocaine-related deaths combined, resulting in their rank as the second highest cause3 of accidental death in America. The fact that deaths due to prescription drug abuse have surged past those due to illegal drugs has warranted great concern and investigation.
So how has prescription drug abuse and addiction become so rampant? And why is it so easy for people to get their hands on prescription drugs?
A pill mill5 is “the term used by local and state investigators to describe doctors, clinics or pharmacies that prescribe narcotics inappropriately or for non-medical reasons.” Those who run the pill mills are often fully licensed physicians with Drug Enforcement Administration numbers who are writing prescriptions illegally. In fact, if caught, the physicians and pharmacists involved can face felony charges with the possibility of up to life in prison. But with the demand for prescription drugs remaining high, the pill mills persist.
Though pill mills are a nationwide problem, the highest concentration of these clinics has historically been found in Florida. Nicknamed the “Oxy Express,” Florida had lax state regulations and an absence of prescription drug monitoring programs up until the last couple of years. These monitoring systems6 help pharmacies keep a record of the sale of controlled substances in a database that, in theory, should help prevent pharmacy-hopping.
Major chain pharmacies like CVS are also coming up with their own systems to help prevent pharmacy-hoppers. They have created a program of analysis3 and action that identifies physicians and prescribers with extreme patterns of being associated with high-risk drugs.
But even with these programs in place, tracking down patients and prescribers attached to pill mills is a difficult task. When the facilities do not require X-rays or the medical records needed to get prescriptions and operate on a cash-only basis, paper trails are limited, making it nearly impossible to identify the doctors involved.
“Controlled prescription drugs like OxyContin, Xanax and Ritalin are easily purchased over the Internet without a prescription,” states Anupam B. Jena, MD, PhD, in a 2011 article from PsychCentral.7
In the article, writer Rick Nauert, PhD, reports that people buying prescriptions off these sites aren’t required to have a legal prescription or medical information on hand. All of this—on top of the fact that these individuals don’t even need to be seen by a doctor to get these prescriptions—makes online pharmacies a major problem in the fight against prescription drug abuse.
A study7 published in 2011 showed that states with the greatest expansion in high-speed Internet access from 2000 to 2007 also had the largest increase in admissions for treatment of prescription drug abuse.
“The Internet serves as an open channel for distribution of controlled prescription drugs with no mechanism to even block sales to children,” says Susan Foster, MSW, of the National Center on Addiction and Substance Abuse at Columbia University, in the same 2011 PsychCentral article.7 With this open access to a world of drugs, there are many organizations and regulations popping up to build roadblocks.
One such roadblock came in 2008 with the Ryan Haight Online Pharmacy Act.8 This legislation prohibited the delivery of controlled substances prescribed by a physician who had never examined the patient.
The Food and Drug Administration (FDA) is also playing a major role in the crackdown9 on online pharmacies. In June of 2013, the organization took action against more than 9,600 websites and seized more than $41 million worth of illegal medications.
In a 2013 article from CBS News,9 John Roth, director of the FDA’s Office of Criminal Investigation, states, “Illegal online pharmacies put American consumers’ health at risk by selling potentially dangerous products. This is an ongoing battle in the United States and abroad, and the FDA will continue its criminal law enforcement and regulatory efforts.”
Rules and regulations help when it comes to shutting down law-skirting online pharmacies, but simple education about the dangers of shopping for medications online can also be an important deterrent.
“Physicians need to educate patients about the risks of purchasing any medications over the Internet and should consider brief but routine questioning about Internet-based medication use,” says Dr. Anupam B. Jena in the 2011 article from PsychCentral.7 “Given the ability of illegal online pharmacies to evade law enforcement efforts, physical awareness and involvement will be crucial to reducing this problem.”
The Real Dangers of Prescription Drug Addiction
But for people who disregard these dangers or have become consumed by their addictions, the reality of life is one of fear and loss. The stories of death and broken homes caused by prescription drug abuse are overwhelming, especially in West Virginia,2 where the overdose death rate is the highest in the country at 28.9 deaths per every 100,000 persons.
In an area where abuse is common, almost every home is affected, leaving a generation of parentless children to take the hardest hit.
“Growing up without parents, without a normal mom and dad, you feel different,” says Sean Watkins, a junior at Rockcastle County High, in a 2013 article from CNN.10 Reporters Stephanie Smith and Nadia Kounang write that Watkins lost his mother when he was 10 years old to an overdose of OxyContin. After her death, he moved in with his grandmother until she became addicted to prescription drugs and vanished.
“You’re always worried,” says 16-year-old Avery Bradshaw in the same 2013 CNN article.10 “If your parents are even going to be there, you know what’s going on in your house. A lot of kids have to go through that every day and it definitely wears them down.” The article mentions that Bradshaw also lost his father to an OxyContin overdose when he was seven years old.
For some, prescription drug abuse leads to the abuse of illegal drugs. A 2011 article from Washington and Lee’s Preliminary Hearing11 tells the story of Jason Wheeler, an individual who was prescribed Xanax after being diagnosed with bipolar disorder. But when he developed a tolerance to his dosage, his doctor upped the prescription.
“It hurt me more than anything because I took them religiously,” said Wheeler in the Preliminary Hearing article.11 “If I didn’t have one… I felt fidgety, and I thought, ‘I’m not helping myself.'”
To combat the sedating effects of the Xanax, Wheeler began to take uppers like cocaine and methamphetamines. He eventually landed in jail for distributing methamphetamines and driving under the influence of drugs.
Watch Video: Prescription Drug Abuse: Where Are We Now?
The prevalence of prescription drug abuse has taken many by surprise. But while this issue has become an epidemic across the country, many organizations are putting strategies in place to curb prescription drug misuse. A number of states are creating prescription drug monitoring programs2 to help identify doctor-shopping, and they are enacting other laws to require education by providers of prescriptions and immunity from criminal charges for people trying to help themselves or others from overdosing.
According to the National Survey on Drug Use and Health,2 prescription drug abuse decreased from seven million in 2010 to 6.1 million in 2011. While this is a tremendous drop, we still have a long way to go.
 “Prescription Painkiller Overdoses in the US.” Posted November 2011. Accessed November/December 2013. Centers for Disease Control and Prevention. http://www.cdc.gov/vitalsigns/PainkillerOverdoses/
 “Prescription Drug Abuse: Strategies to Stop the Epidemic.” Posted October 2013. Accessed November/December 2013. Trust for America’s Health.
 “Abusive Prescribing of Controlled Substances—A Pharmacy View.”
Mitch Betses, R.Ph., and Troyen Brennan, M.D., M.P.H.
N Engl J Med 2013; 369:989-991. Posted September 12, 2013. Accessed November/December 2013. DOI: 10.1056/NEJMp1308222.
 “Special Report: Prescription Drug Abuse Part 1.” WLOS News 13, Asheville, NC. Posted November 2013. Accessed November/December 2013.
 “What’s a Pill Mill?” Pia Malbran. CBS News. Posted May 2007. Accessed November/December 2013.
 “Florida Shutting ‘Pill Mill’ Clinics.” Lizette Alvarez. The New York Times. Posted August 2011. Accessed November/December 2013.
 “Prescription Drug Abuse Aided by Internet Pharmacies, MD Ignorance.” Rick Nauert, PhD. Reviewed by John M. Grohol, PsyD, on December 20, 2011. Accessed November/December 2013.
 Ryan Haight Online Pharmacy Act. GovTrack.Us. Accessed November/December 2013.
 “FDA shuts down over 1,600 online pharmacies.” Ryan Jaslow. CBS News. Posted June 27, 2013. Accessed November/December 2013.
 “Prescription drugs ‘orphan’ children in eastern Kentucky.” Stephanie Smith and Nadia Kounang. CNN. Posted December 2013. Accessed December 2013.
 “Prescription Drugs Easy to Access, Easy to Abuse.” Eleanor Kennedy. Additional contributors: Melissa Powell, Caitlin Doermer and Robert Grattan. The Preliminary Hearing. Washington and Lee. Accessed November/December 2013.