Term Paper: Addiction to Prescription Drugs

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Prescription Drug Addiction

When people think of drug addiction, they usually picture the use of illegal drugs such as heroin or crack cocaine, but people who use prescriptions drugs for non-medical purposes -- and become dependant and preoccupied with a compulsive need for them -- have become a serious problem in the United States (Meadows, 2001).

Ukens (2005) reports that controlled prescription drug abuse nearly doubled between 1992 and 2003 -- from 7.8 million to 15.1 million. Prescription drug abuse among teenagers has risen by 212%. There has been an 81% increase in prescription drug abuse in adults over 18. The U.S. Drug Enforcement Administration reported 146 deaths attributable to OxyContin abuse in 2000 and 2001. Former U.S. Secretary of Health, Education, and Welfare, Joseph Califano, Jr. states, "Our nation is in the throes of an epidemic of controlled prescription drug abuse and addiction" (cited in Ukens, 2005, p. 8).

According to Lisa Kiebzak, the director of a substance abuse program in Florida, many people use opioids (such as Vicodin and OxyContin) "to heal psychological wounds" (cited in Sverdlik, 2005). Moreover, the Substance Abuse and Mental Health Services Administration states nearly one-quarter of Americans between the ages of 18 and 25 take painkillers recreationally. The abuse of OxyContin, for example, has jumped 40%. Among adults who are 26 and older, the jump was 60% (Sverdlik, 2005). Painkillers, obtained legally by prescription only, have great potential for abuse and addiction, but their users often think taking them is safer than abusing heroin or a "street drug." They think it's okay because it is prescription "medicine" -- so what could be the harm?

Three categories of prescription drug abuse have been identified: (1) Patients who come to the doctor with an already established dependence on a prescription drug; (2) patients who develop drug dependence during the course of taking drugs that were prescribed by a physician; and (3) patients who come to the doctor seeking drugs in order to divert them -- that is, to get drugs they intend to sell (Gerada & Ashworth, 1997). Additionally, heroin users often turn to prescription drugs when they cannot obtain heroin (Bailes, 1998).

The problem is not that potentially addictive drugs should never be prescribed or used. They have an important place, particularly in the control of severe or chronic pain. People suffering from cancer, for example, have terrible pain, and need medicine to control it. Even a history of substance abuse doesn't completely rule out using potentially addictive drugs. Some doctors are so concerned and worried about penalties for over-prescribing these substances that they fail to treat patients in pain appropriately (Meadows, 2001). According to Longo et al. (2000), "Physicians' concerns about possible legal, regulatory, licensing or other third-party sanctions related to the prescription of controlled substances may contribute significantly to the under-treatment of pain syndromes and anxiety disorders" (p. 2401). Obviously, patients who have legitimate medical problems may truly need them.

Furthermore, when drugs are taken exactly as prescribed, addiction is actually uncommon. Problems arise when patients increase the dose in hopes of gaining more relief or begin to take more sooner than prescribed instead of waiting for the first dose to work. This can lead to addiction and to addiction-related behaviors such as doctor-shopping, fraudulent prescriptions, pharmacy thefts, and various techniques addicts use, such as the use of scams to obtain drug supplies (Byrd, 2001; and Longo et all, 2000). The problem of prescription drug addiction is not simple at all. The ineffectiveness of many drug treatment programs along with social and cultural factors that complicate the issue of drug abuse make it a complex social issue.

Drug abuse can affect people from infancy to old age. The children of addicts often suffer neglect or maltreatment, and as they grow up may develop malnutrition, poor self-esteem, depression or attention deficit disorder. Conditions like these often lead to adolescent drug use, early pregnancy, and dropping out of school. If drug abuse is not identified and help forthcoming, the next generation may fall victim as well.

Doctors get investigated by State Licensing Boards more frequently for over-prescribing controlled substances than for any other allegation. Not only that, the street value of prescription drugs is more than for heroin, and second only to cocaine. Longo et al. (2000) points out, "This sets up an unfortunate paradox for physicians: the desire to relieve pain, anxiety and other discomfort must be weighed against the fear of creating addiction, of being investigated by law enforcement or licensing authorities, and of being 'scammed' by the occasional patient who abuses opioid analgesics, sedative-hypnotics or psychostimulants" (p. 2402).

Brief History of Substance Abuse

During the 19th century patented (over-the-counter) medicines often contained morphine and opium, which were used for relief of coughing, diarrhea, dysentery, and "women's pains." These drugs were the only effective remedies available to doctors for pain. They were readily available to patients from pharmacists and physicians. There were no laws to control their sale or use, and pharmaceutical companies advertised them heavily. Coca Cola, originally developed as a "health drink" and sold in drug stores, contained cocaine, but most doctors considered it a "harmless stimulant." Parke-Davis produced cocaine in forms that could be sniffed, injected, and smoked. In the U.S. The use of cocaine spread quickly and stories began to appear in newspapers about overdoses, addictions, reactions, and antisocial behavior. About the same time, morphine became a prescription drug, and its use declined as people became more aware of the possibility of addiction (Byrd, 2001).

Early in the 20th century Federal laws were enacted to control drug abuse. Specifically, the Harrison Narcotic Act of 1914 made it illegal to buy more than a small quantity of opium, morphine, heroin or cocaine unless prescribed by a doctor. Opiate abuse declined after that except among middle and upper class people, who presumably could afford to buy "under the counter." Cocaine's popularity declined except with Hollywood celebrities and underworld criminals. Marijuana came to the United States with Mexican workers during the 1920s and '30s and became popular with jazz musicians. Concern about drug abuse was at low ebb at that time, at least, comparatively (Byrd, 2001).

Concerns changed, however, after World War II when pharmaceutical companies began to design tranquilizers, sleep inducing remedies, and mind-altering drugs to treat anxiety, depression, and to help people lose weight. By the 1960s and '70s most people viewed drug addiction as a symptom of psychological problems that required hospitalization. At that time the use of psychedelic drugs became widespread among young people and "barbiturates, amphetamines, and cocaine became readily available to athletes and the wealthy" (Byrd, 2001).

The 1980s and '90s brought crack cocaine and "designer drugs." A designer drug is a synthetic derivative of a prescription drug and produced in a laboratory. But any drug that has been redesigned for easier use or greater appeal may be called a designer drug -- crack cocaine, for instance (Byrd, 2001). By 2000 prescription drug addiction had increased alarmingly.

What is Addiction?

The Merck Manual of Diagnosis and Therapy (2006) suggests there is no universally accepted definition of drug abuse, and that the term expresses society's disapproval more than the behavior associated with it. Merck goes on then to state, "It may involve experimental and recreational use of drugs, which is usually illegal; unsanctioned or illegal use of psychoactive drugs to relieve problems or symptoms; or use of drugs first for the previous two reasons but later because of dependence and the need to continue at least partially to prevent withdrawal" (p. 1683). The term drug abuse, according to Longo et al. (2000) refers to using a prescription drug in a manner that is inconsistent with the doctor's intention. Addiction "is a further evolution of this preoccupation, with loss of control and acquisition of an obsessive-compulsive pattern that takes on a life of its own as a primary illness" (p. 2409). The Merck Manual (2006) describes addiction as, "compulsive use and overwhelming involvement with a drug, including spending an increasing amount of time obtaining the drug, using the drug, or recovering from its effects..." (p. 1683).

When an individual takes a drug for a long period of time and in high enough doses, the body adapts to it and develops a tolerance to it. Bigger doses are needed to produce the same effect (Carlson, Eisenstat, & Ziporyn, 2004). According to Alice Young, Ph. D. At Wayne State University in Detroit, "If the patient stops taking the drug, then withdrawal will occur" (cited in Meadows, 2001, p. 19). To avoid withdrawal symptoms, the patient has to taper down the doses gradually, taking progressively smaller and smaller amounts. Physical dependence does not necessarily lead to addiction, however, and naturally, that raises the question why some people become addicted but others do not. Byrd (2001) states, "Dopamine, a neurotransmitter in the brain, appears to be the major determinant in whether or not a person progresses from casual substance use to substance abuse" (p. 65).

Addiction is a brain disease and… [END OF PREVIEW]

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