Painkiller abuse worsens over decade

By Caitlin Yilek, Opinions Editor -- yilek12@up.edu

Editor's note: The Beacon has a policy to generally avoid the use of anonymous sources because we believe our readers are entitled to know the identities of sources so they can evaluate their credibility for themselves.

We may make exceptions when we believe the public benefit of publishing a story could be told best only when an anonymous source outweighs the value of the policy.

In this case, because the story of the use of painkillers by students illuminates a public health issue, we granted anonymity and the pseudonyms "David" and "Jane" to the students who spoke to us. We do not make this exception lightly but with the hope it will spark awareness and constructive discussion about the use of painkillers.

 

David, a University of Portland senior, used to start his mornings by snorting Vicodin, a narcotic used to relieve moderate to severe pain.

David did not have moderate or severe pain. Nor did he have a prescription.

"A lot of people used them at my (high) school and coming from a family of alcoholics, it makes sense," David said about his addiction.

David estimates he spent more than $1,000 in a year on painkillers such as OxyContin, Codeine and Vicodin, which he bought from friends.

During one of David's highs he mixed painkillers with alcohol.

"I hallucinated for a day and hooked up with my friend's girlfriend," David said.

In late February, a random sample of 1,600 University of Portland students received the Core Alcohol and Drug Survey. According to Kristina Houck, a counselor at the University Health Center, the Health Center administers the national survey every other year and the results from the survey affect prevention education on campus.

For the first time, the survey covers prescription drugs.

"We have no doubt there are likely students at UP who are either abusing or becoming dependent upon painkillers," Paul Myers, director of the Health Center, said.

The National Survey on Drug Use and Health, sponsored by the U.S. Public Health Service, reports that 25 percent of people ages 18 to 20 have used prescription drugs for a non-medical reason at least once in their lives. And by students' sophomore year in college, about half have been offered the opportunity to abuse a prescription drug.

"Prescription drug abuse is using a medicine in a way that it was not intended when the prescription was written by a health care provider," Tim Crump, a family nurse practitioner at the Health Center, said. "On college campuses, you have a large student body congregating together and sharing ideas or daring each other to do risky things and in certain cases that can be a dangerous situation."

Painkillers, which are prescribed for moderate to severe pain and block pain messages from reaching the brain, are the prescription drugs most frequently abused.

"One reason (people) choose to abuse prescription drugs is due to the misperception that abusing prescription drugs is safer than using illegal drugs," Houck said.

However, it isn't.

Abusing painkillers can lead to an increase in blood pressure and heart rate, organ damage, addiction, seizure, heart attack, stroke and death.

David started abusing painkillers out of curiosity and says the dangers did not deter him from taking them.

Jane, also a senior at the University, began experimenting with drugs in high school because her brother was addicted to painkillers.

"Looking back I can't ever remember any physical problems (with my body) while on Vicodin," Jane said. "It was mostly just fun."

For a while.

"On Vicodin everything is sort of hazy and nothing really matters," Jane said. "It's really hard to be stressed or upset when you are on painkillers. All of your problems don't matter, but once you come down (from the high) you have to face your problems and want to do more (drugs)."

Although Jane was able to escape reality through painkillers, the escape was only temporary.

"(Painkiller) abuse inhibits the dopamine reuptake process in the brain, resulting in an increased volume of dopamine - the brain's pleasure chemical - in the brain, resulting in a high," Houck said.

Abusing painkillers has negative health effects, and it is also illegal.

Jane says she hung out with people who had access to a lot of different drugs, until she was arrested her freshman year at UP. She spent four days in jail and had $15,000 in fines, not including lawyer fees.

Accidents related to painkiller abuse

After abusing painkillers for a year, David stopped after he almost died while driving high.

"I wasn't paying attention at all and almost got hit by another car, and another time by a train," David said.

Others have not been fortunate enough to stop abusing painkillers before an overdose.

Last November, the Centers for Disease Control and Prevention (CDC) reported the number of deaths from overdose of painkillers more than tripled over the past decade. Prescription painkillers led to the deaths of almost 15,000 in 2008, up from 4,000 in 1999.

By 2008, the epidemic of prescription drug overdoses (which includes painkillers among other prescription drugs) approached the number of deaths from motor vehicle crashes, the leading cause of injury in the United States, according to the CDC.

Though the drugs never affected his grades and his family never knew about his addiction, David's actions while on painkillers led him to make the decision to quit.

Overdose

Painkillers, which include Oxycodone, Methadone and Hydrocodone, now account for more overdose deaths than heroin and cocaine combined in the U.S., the CDC reported.

David has dealt with his friends overdosing.

"One friend went into severe overdose," David said. "He fell asleep for a day and a half and was happy to wake up."

His friend continued to use painkillers, despite his near-death experience.

"The big danger with (painkiller) overdose is respiratory depression," Crump said. "An overdose can last from four to eight hours, and if your breathing slows for long enough, it can be lethal."

According to Crump, patients who overdose need to seek immediate medical attention to get medication that will block opiate receptors and reverse the respiratory depression.

The CDC believes the number of painkiller-related deaths is underestimated because the type of drug is not specified on many death certificates.

Health care providers can prevent prescription painkiller overdoses while ensuring safe, effective pain treatment through responsible prescribing, according to CDC Director Thomas Frieden.

The painkiller abuse has worsened due to the wide variations of prescribing them, the CDC said in its Morbidity and Mortality Weekly Report released Nov. 11, 2011.

Last fall, the Oregon Prescription Drug Monitoring Program was established to help healthcare providers and pharmacists manage patients' prescriptions. The program is an online database with the intention of tracking patients' prescriptions and putting an end to "doctor shopping."

"It helps catch those people who go to multiple providers who are looking for multiple prescriptions for narcotics," Crump said. "It's easier for patients to 'doc shop' if you don't know their history."

Crump says he has used the program a few times while at UP, but was not able to discuss why due to patient confidentialit y.

The Health Center does not have a stand-alone database counting the number of painkiller prescriptions, nor does it stock painkillers.

"Our prescribers follow practice standards and are careful to not over-prescribe pain medications," Myers said.

Myers says the Health Center is aware of the abuse of painkillers nationally.

"If we believe any of our patients fit the categories (of abusing painkillers), we would address those concerns directly with the patients, and if it would ever be necessary, we would facilitate treatment referrals for addressing those behaviors," Myers said.

Monitoring number of prescriptions

Crump, along with Nurse Practitioner Sue Oshiro-Zeier and a mental health nurse practitioner are the only staff at the Health Center licensed to prescribe medications.

According to Crump, it can be difficult for doctors to accurately measure the amount of pain a patient is in.

"Patients can complain of conditions that are very hard to verify," Crump said. "There are certain things like lower back pain and headaches that you cannot see with tests."

Doctors often take a patient's word for it and treat the symptoms with pain medication.

According to Myers, the prescribers at the Heath Center often consult with one another in responding to pain management situations that take longer to treat.

"The goal is to guard against contributing to abuse or dependency on painkillers," Myers said.

The Health Center does not keep statistics on prescription drug abuse at the University.

Health Center protocol

The Health Center is extremely careful when prescribing painkillers, according to Crump.

Crump estimates the Health Center writes one prescription a month for painkillers, compared to 60 to 80 prescriptions for antibiotics and 10 to 20 antidepressant prescriptions per month.

The most commonly prescribed painkiller at the Health Center is Vicodin. The drug is short-acting and mixed with Tylenol.

"We also prescribe it in a very low dosage because we do not have students with chronic pain," Crump said.

Crump said a typical dosage of Vicodin is 5 milligrams of Hydrocodone and 500 milligrams of Tylenol, which is a low dose of painkillers.

David and Jane kick the habit

Jane was supposed to study abroad her sophomore year but had trouble getting her visa due to her arrest.

"I told the school about it, and they ended up booting me out of the study abroad program," Jane said. "Other than that, there were no repercussions from the University."

Jane has had several friends who have been in rehab for addictions to drugs, including painkillers.

"I know multiple people who have addictions to various substances, and it is really awful to watch," she said. "I stopped doing drugs because I can't stand looking at what my friends have become."

 She is currently paying, with her parents' help, $100 a month toward her $15,000 fine and lawyer fees.

David stopped abusing painkillers cold turkey but has used them occasionally over the past few years.

"The withdrawals were the worst part of quitting," David said. "I experienced headaches, nausea, aches and insomnia. It wasn't very fun."