This wasn’t supposed to
happen.
Justin (not his real name)
needed open-heart surgery
in early 2009, and was prescribed
narcotics to relieve
the pain. After the pain had
passed, however, he kept
taking them, and soon, he
was hooked.
According to a 2009
National Survey on Drug
Use and Health, 6 million
Americans age 12 and older
admitted to taking a prescription
pain reliever, tranquilizer,
stimulant, or sedative
for non-medical purposes
at least once during
the past year.
The National Institute on
Drug Abuse funded a study
in 2010 that found that 8
percent of high school seniors
had abused Vicodin
and 5.1 percent had abused
OxyContin, an opiate like
Percocet, in the year prior to
the survey.
Dr. Mark Liebriech, a
Yardley family physician,
has seen the prevalence of
prescription pill abuse skyrocket
in his 20 years of
practice.
Young adults mostly
abuse narcotics, painkillers
such as Percocet and
Vicodin, chemically similar
to heroin. Less often, they’ll
use stimulants: Ritalin, a
treatment for Attention
Deficit Disorder, is commonly
sought.
Patients go “doctor shopping,”
maybe seeing six
physicians in a month.
“They play their role very
well and they know how to
use the system,” says Dr.
Liebreich.
But as abusers get savvier,
physicians get smarter.
One clue that patients are
after pills is that they will
claim they have unusual
medical allergies, that they
can’t take anything other
than a narcotic. “They’ll
say, ‘I’m allergic to Aspirin
and Tylenol and Motrin,
and the only thing that
works for me, Doc, is
Percocets.”
In some states, a physician
can look up a patient on
computer databases by his
demographics and see the
medicines he’s been prescribed
by any other physician.
This system is not yet
approved in Pennsylvania,
however.
The Drug Enforcement
Administration is currently
proposing random drug
screening for patients with
prescriptions for chronic
narcotics. If the patients
come clean, it means that
they are not taking the
drugs to treat a medical
condition. Most likely, they
are out in the streets selling
them, or giving them to
family members.
Of course, most of Dr.
Liebreich’ss patients see
him for legitimate medical
reasons. For discretion, he
depends on how well he
knows the patient.
However, he must always
keep in mind that some
patients are those who
“start with legitimate pain
syndromes, who just start
using more and more and
more.”
Dr. Liebreich does not
need to state a reason for
refusing to give a patient a
prescription. “You can ‘just
say no,’ like Nancy Reagan
used to say.”
Drug-abusing patients fall
under two categories: Those
who obtain pills to use
themselves, and those who
seek to sell them for a profit.
Dr. Liebreich says, “I’d
say the larger majority are
people who are looking to
get medicine to turn around
and sell it, because the cost
of the medicines on the
street is unbelievable. One
pill of Percocet may be just a
couple pennies at the pharmacy,
and can be sold for
up to $10 or $12 a pill,
maybe more.”
Though Dr. Liebreich can
rely on clues in the office to
catch a potential swindler in
the act, much more power
rests with the pharmacies.
At his practice, patients “are
just getting a piece of paper
that gives them the right to
get pills. The point of access
is the drugstore.”
He continues, “The pharmacy
will call me: ‘We’re
really suspicious about
Patient X, he’s here with a
prescription for either a
large number of narcotics or
a narcotic that you usually
don’t write, Dr. Liebreich.’
I’ll check my computer;
‘No, I didn’t write that. Call
the police and have them
meet him when he comes to
pick up the prescription.”
If the need arises, Dr.
Liebreich does have the
power to go to the police.
“It doesn’t happen very
often that someone becomes
belligerent in the office
when they don’t get their
prescription,” he said, but,
“we’ve had to have police
come once or twice for
that.”
Catching prescription pill
abuse does not start with
the physicians like Dr.
Liebreich. Drug developers
have put into place measures
to deter abusers.
“One of the stimulant
medicines, they make it in
small little micro-pellets, so
you can’t crush them up and
snort them or put them
under your tongue for a
quick rush.” says Dr.
Liebreich. “A narcotic pill,
actually in the middle of it,
has small chemicals that…
reverse the narcotic effect of
the medicine, so if they try
and crush it up, it neutralizes
it.”
“The pill manufacturers
are trying to help, the pharmacists
are trying to help,
the computer database
[compilers] are trying to
help…”
Dr. Liebreich says that,
from what he’s read, prescription
pill abuse is much
more prevalent in the inner
city than it is in Bucks
County. But it’s more
prevalent here than you
would think, and abuse is
primarily among the young.
“There are some cases
where an older patient who
is on hospice getting pain
medicine for their terminal
cancer – the younger members
of the family will take
those pills and will turn
around and sell them. They
may be bringing this person
into the doctor’s office to
refill their pain medicines,
so it’s under the older person’s
name, but still being
abused by the younger population.”
They’ll even rummage
through their relatives’ cabinets
while they’re over for
dinner.
Some clues include “overly
frequent trips and taking
a long time during bathroom
visits…listen for the
sound of water running for
an extended time to disguise
the noise of cabinets
and drawers opening and
closing,” writes Melanie
Haiken in an online article,
“20 Secret Signs of
Addiction.”
“When visiting a home
with more than one bathroom,
a drug user will find
excuses to use a different
bathroom each time.”
Says Dr. Liebreich,
“Teenagers, for a party, will
just grab whatever pills they
find in their parents’ house;
everybody dumps them in a
bowl, stirs them up, and
takes a couple pills. It could
be blood pressure medicine,
it could be a Vicodin, it
could be a vitamin, who
knows?”
Is all the fun worth the
consequences?
“For the younger generation,
it’s usually jail. For the
older generation… they are
affected financially, they
may ruin their relationship
with their spouse or significant
other, even their family…
and end up out on the
streets.” The trick is breaking
the fall before it’s too
late.
Drug rehabilitation, not
quite a cure-all, has mixed
rates of success.
“It depends why the person
is going into rehab. If
they’re going in because
they want to get better, the
success rate is high. But a
lot of people go in there
either because their spouse
or legal issues forces them…
they’ll go through the
motions, but the odds of
them staying clean and
sober are very low.”
Justin, who swiftly moved
from prescription drugs to
hard narcotics, spent over a
month in rehab to wrench
himself away from heroin,
then went back to pills.
Dr. Liebreich adds, “Some
people just need to get out
of the environment that has
got them addicted in the
first place, so if they go to a
rehab around the corner, it’s
not the same. Their friends
can come and visit them,
and say, ‘Hey, man, what
are you doing in here?'”
Complete removal from
their typical environment,
Dr. Liebreich believes, is
beneficial for the patient.
Justin is now in recovery –
or at least, he says he is. He
now says his open-heart
surgery was the start of the
narcotic addiction that
sucked up two years of his
life. He’s not searching for
an excuse anymore – he’s
trying to move on.