A Beginner’s Guide to the Rx Drug Abuse Epidemic in America: Part 2

The beginner's guide to prescription drug abuse epidemic in America

A Beginner’s Guide to the Rx Drug Abuse Epidemic in America

Part 2: How Did We Get Here?

Part 1 | Part 2 | Part 3 | Part 4 | Part 5

The medical benefits1 of opiates have been recognized for thousands of years, but it wasn’t until the 16th century that opiates were used as a painkiller. Prepared in an alcohol solution, opiates were used in a medicinal form called laudanum.

In the 1800s, laudanum was a widely used cure-all2 that was cheaper than alcohol. Used as a sedative and painkiller, it was popular for headaches, muscle cramps, coughing and various other ailments. Famous figures like Samuel Taylor Coleridge, John Keats, Elizabeth Barrett Browning, Charles Dickens and Lord Byron were noted as frequent users of laudanum, and many Victorian women fell under its abuses in order to manage pain after childbirth, mood swings and anxiety.2 But it was not until the discovery of morphine, a pure derivative of opium, that medicinal drugs became a widespread addictive problem.

Morphine was introduced in Europe in the mid-1800s as a perceived cure for opium addiction.3 It quickly traveled to the United States and became the painkiller of choice for the Civil War, leaving many soldiers addicted.4 Over the next few years, the recreational use of opium grew. In 1905, the United States Congress banned opium and the following year enacted the Pure Food and Drug Act,1 requiring labels to be placed on all medicines.

During the following years of the early 1900s, a war began between the government and these drugs.

Major events and laws for drug control: 1914 (Harrison Narcotic Act), 1930 (Federal Bureau of Narcotics), 1933 (Amphetamines introduced WWII), 1951 (Humphrey Bill), 1960s (Manufacturing Act), 1970 (Comprehensive Drug Abuse Prevention & Control Act), and 1988 (Anti-Drug Abuse Act)

Harrison Narcotic Act5, The Federal Bureau of Narcotics6, Amphetamines6, Durham Humphrey Bill6,
The Manufacturing Act6, Comprehensive Drug Abuse Prevention and Control Act6, Anti-Drug Abuse Act6
With the rise of online pharmacies, an abundance of accessibility and a lack of education about drug dangers, prescription drug abuse has far surpassed the abuse of illegal drugs like cocaine and heroin.

Safety in a Prescription

One of the main reasons prescription drug abuse has risen is because of the false perception that these drugs are safe. Because they’re prescribed by a doctor, it’s assumed by many that they’re safe to take7 under any circumstance. But this couldn’t be further from the truth.

Watch Video: Are Prescription Drugs Safer than Street Drugs?

For example, hydrocodone8 is basically a synthetic heroin, and painkillers like fentanyl are 100 times more potent than natural opioids like morphine. These drugs are prescribed based on body chemistry, illness symptoms and many other factors. Abusing them for nonmedical purposes can lead to serious health problems or even death.

But because of a lack of education, this misperception continues. When surveyed, 86 percent8 of teens said their parents never talked to them about the dangers of prescription drugs. Without this information, prescription drugs abuse starts for many in their teen years. According to a survey8 from The Partnership at Drugfree.org and the Metlife Foundation, one in four teens has misused a prescription drug at least once in his or her lifetime.

One in four teens has misused a prescription drug at least once in his or her lifetime

And with the availability of prescription drugs greater than ever before, all someone has to do is look into the medicine cabinet. Prescriptions for opioid analgesics7 alone increased from about 75.5 million to 209.5 million between 1991 and 2010. It’s imperative to increase education about prescription drugs as access spreads across the country.

Prescriptions for opioid analgesics alone increased from 75.5 million in 1991 to 209.5 million in 2010

A Pill for Your Pain

But all the blame cannot be laid on the person receiving the prescription. We must also look at our medical system, which continues to dispense these drugs too liberally.

In a 2012 New York Times article,9 Dr. C. Richard Chapman, director of Pain Research Center at the University of Utah, states, “Doctors are prescribing like crazy.” But taking into consideration the actual pain that some face in comparison to those trying to scam the system, these doctors must be very cautious.

Doctor prescribing medicine This is what physicians are calling the “perfect storm”10: pain control versus the abuse of prescription drugs. In order to properly prescribe a medication, prescribers need to evaluate that patient’s history and addiction risk factors while still managing his or her pain.

This can be a complicated procedure. These doctors need to recognize all the signs of addiction and abuse, but less than 40 percent10 receive this kind of training in medical school and more than 90 percent fail to recognize the symptoms at all. This failure at the top of our medical system is a major cause of our prescription drug epidemic.

There is also concern about the mere amount of these drugs being prescribed. Some experts report that doctors keep patients on prescription drugs for years, slowly upping their dosage as their bodies adapt.9 This overprescribing leads to severe physical and psychological dependence.

Still, under-prescribing can also cause issues. In some cases, not allowing patients the proper prescription drugs can lead to a situation that resembles addiction. Patients may constantly seek higher doses11 to relieve their very real pain.

“We started on this whole thing because we were on a mission to help people in pain,” states Dr. Jane C. Ballantyne, a Seattle pain expert, in the same 2012 New York Times article.9 “But the long-term outcomes for many of these patients are appalling, and it is ending up destroying lives.”

Many states are trying to combat these failures in our system by creating processes that will lessen the likelihood of over- or under-treating patients. For example, in Washington,9 doctors are referring patients with high dosages of opioids to pain specialists if their conditions don’t improve. Primary care providers10 are also being urged to review their patient’s pattern of use and go over prescription drug use education material often with each patient.

Hopefully, with these systems coming into place, we will begin to see a decrease in the misuse of prescription drugs. But as prescription drug abuse continues to affect our culture, it also begins to affect the perception of addiction in our communities.

This is part 2 of 5. Click here to read Part 3: The Changing Face of Addiction

Part 1 | Part 2 | Part 3 | Part 4 | Part 5

References

[1] “Painkillers: A Short History.” The Foundation for a Drug-Free World. Accessed November/December 2013. http://www.drugfreeworld.org/drugfacts/painkillers/a-short-history.html

[2] “History of Opium, Morphine, and Heroin.” InTheKnowZone.com. 2011. Education Specialty Publishing. Accessed April 2014.
http://www.intheknowzone.com/substance-abuse-topics/heroin/history.html

[3] “Morphine History.” News-Medical.Net. Dr. Ananya Mandal, MD. Reviewed by Sally Robertson, BSc. Accessed April 2014.
http://www.news-medical.net/health/Morphine-History.aspx.

[4] “Morphine.” InfoPlease.com. The Columbia Electronic Encyclopedia, 6th ed. 2012, Columbia University Press. Accessed April 2014.
http://www.infoplease.com/encyclopedia/science/morphine-history.html

[5] Chapter 8. The Harrison Narcotic Act (1914). The Consumers Union Report on Licit and Illicit Drugs. Edward M. Brecher and the Editors of Consumer Reports Magazine, 1972. Schaffer Library of Drug Policy.
http://www.druglibrary.org/schaffer/library/studies/cu/cu8.html

[6] “The History of Prescription Drugs.” DEA Museum, online exhibit: “Good Medicine, Bad Behavior: Drug Diversion in America.”
http://www.goodmedicinebadbehavior.org/explore/history_of_prescription_drugs.html

[7] “Topics in Brief: Prescription Drug Abuse.” National Institute on Drug Abuse. Revised December 2011. DrugAbuse.gov.
http://www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse

[8] “Survey Finds Teen Misuse And Abuse Of Prescription Drugs Up 33 Percent Since 2008.” Dr. Mercola. Posted May 8, 2013. Mercola.com.
http://articles.mercola.com/sites/articles/archive/2013/05/08/prescription-drug-abuse.aspx

[9] “Tightening the Lid on Pain Prescriptions.” Barry Meier. Posted April 8, 2012. The New York Times. Accessed November/December 2013.
http://www.nytimes.com/2012/04/09/health/opioid-painkiller-prescriptions-pose-danger-without-oversight.html?pagewanted=all&_r=0

[10] “Use, Abuse, Misuse & Disposal of Prescription Pain Medication Clinical Reference.” A Resource from the American College of Preventative Medicine. 2011. Accessed November/December 2013.
https://www.acpm.org/page/UseAbuseRx_PatGuide?&hhsearchterms=%22use%2c+and+abuse%2c+and+misuse+and+disposal+and+prescription+and+pain%22

[11] “Are Doctors Too Reluctant to Prescribe Opioids?” Maia Szalavitz. Posted February 24, 2010. Time Magazine. Accessed November/December 2013.
http://content.time.com/time/health/article/0,8599,1964782,00.html