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October 10, 2014  |  Falmouth Enterprise

Dr. Michael Bihari

Too Many Pills in the Wrong Hands

According to the American Academy of Pain Management (AAPM), the narcotic pain medication “hydrocodone in combination with acetaminophen (Percocet and other brands) is the most prescribed medication in the United States, the country that consumes 99% of the world’s supply. The Centers for Disease Control and Prevention (CDC) reports that enough hydrocodone is prescribed for every U.S. adult to receive 5 mg every 4 hours for a month.”

It is very important for the physical and psychological well-being of an individual to assure that all is being done to help manage moderate to severe acute or chronic pain. However, some physicians and dentists frequently prescribe large amounts of medications such as Percocet or Vicodin for acute pain related to trauma, minor surgery, and dental procedures. 

The AAPM also noted that the widespread prescribing of hydrocodone products contributes to the large quantity of these drugs available for recreational use, addiction and overdose death. Many of these drugs are prescribed for patients who are expected to have acute pain only for a day or two yet receive from a 10-to-30-day supply of hydrocodone. 

In a study about hydrocodone prescribing, 275 patients were surveyed two to four weeks after having a surgical procedure. Of these patients:

  • 63% received a hydrocodone prescription 
  • only 12% requested refills
  • 67% had leftover medication
  • 92% received no disposal instructions
  • 91% kept the extra medication at home

And, these leftover pills can find their way into the hands of teenagers and others.

The following anecdotes are examples of what happens all too often. Both of these stories were related to me by parents of a young adult.

A 19 year old boy starting his freshman year at a large university developed a toothache and went to the dental clinic at the school’s student health center. After a wisdom tooth was pulled, the dentist gave him a 5-day supply of Vicodin. He was not given any information on other things he could do to relieve any pain and no instructions on what to do with a bottle of narcotics in a dorm filled with teenagers. He called his parents who advised him not to fill the prescription and to use over-the-counter medications. He had some mild aching in his jaw for several days, which did not interfere with his college activities.

A 23 year old man went to a local emergency room after falling off his bike. Although he had no broken bones or lacerations that required stitches, he did have several bruises and a sprained ankle. The physician suggested he wear an ankle brace and to take Percocet for his pain. The young man said that he would not need the prescription and would take over-the-counter pain medications instead. The physician insisted that he would need the medication. When the young man refused again, the physician seemed annoyed and left the room. When the patient left, a prescription for Percocet was waiting for him. 

The Stigma of Addiction

According to a survey conducted by the Johns Hopkins School of Public Health,

“People with drug addiction are much more likely to face stigma than those with mental illness because they're seen as having a moral failing.” The survey of more than 700 Americans found that:

  • the public is less likely to approve of insurance, housing and employment policies meant to help people with drug addiction
  • many people consider drug addiction a personal vice rather than a treatable medical condition
  • only 22% of people would be willing to work closely on a job with someone with a drug addiction
  • 64% said employers should be able to refuse to employ people with a drug addiction
  • 43% said people with drug addiction should not be given the same health insurance benefits as the general public
  • 30 % believe that recovery from either drug addiction is impossible

In the opinion of one of the authors of the survey report, "While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition.” And, “The more shame associated with drug addiction, the less likely we as a community will be in a position to change attitudes and get people the help they need. If you can educate the public that these are treatable conditions, we will see higher levels of support for policy changes that benefit people with mental illness and drug addiction.”

The attitude of some people in this community that addiction is a life-style choice is not only an obstacle to treatment but may contribute to the lack of needed policy to assure that appropriate funding is available for management and prevention.

Sam Tarplin, the director of the film What Happened Here: The Untold Story of Addiction on Cape Cod has spoken about his own experience with the stigma of addiction. “Once I had gotten myself clean, there was yet another obstacle: the rejoining of society. Being ostracized for so long had taken its toll on me, and I once again found myself with achy hands from striking out at the concrete walls of stigma. My main goal in making this film is ending that ostracism of addicts and to lift that deadly stigma so that those who need help can seek it without shame.”

I recently had an interaction on a Facebook page with someone commenting on the announcement that all the police departments on the Cape will be carrying Narcan to use for someone who is overdosing on heroin. The following quote epitomizes the negative attitudes and lack of knowledge of some people about drug addiction: 

“Fill the narcan containers with bleach and it's a threefer, purify the blood, stops the addiction and saves on welfare. I am sick and tired of taking care of self inflected narcissistic people. They buy product from someone they don't know, melt it down and shoot it into themselves. When they OD we are supposed to send out the calvary to rescue them.”

Opiate addiction is a treatable brain disorder. It is not a character flaw or a moral problem, it is a disease that can be treated and managed over time. Addiction is NOT a sign of weakness. It is NOT TRUE that all you need to kick addiction is to “be strong.”

“It’s not like I woke up one day when I was young and told myself, ‘I wanna be a drug addict. I wanna ruin my life and ruin the lives of those around me.’ I’ve learned now that this is a disease, and when I pick up that first drug, I can’t stop.” (Dan P.)

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