Prescription drug abuse is not a phenomenon that targets just the rich and famous. Nor is it something that we normally think of when we hear the word “junkie”. However, prescription drug addiction is just as common (probably more so) and just as dangerous as being addicted to crack or meth. And unlike with street drugs, where you need to have access to a drug dealer to get your fix, anyone with access to a doctor and a pharmacy can be a potential prescription drug addict.

Prescription Drug Addiction fueled by Doctor Shopping

It was recently revealed that Corey Haim was able to obtain over 500 doses of addictive prescription drugs over the past year. Upon his death, California officials began a probe of how Haim had been able to get his hands on such a vast quantity of medication. They determined that Haim had become a pro at “doctor shopping”.

Doctor shopping is a term used to describe two different phenomenon. First, it describes a situation where a patient continues to try out new doctors until she finds one that is willing to write regular prescriptions to satisfy her dependence on a particular drug or drugs. These doctors either are negligent in ensuring that patients really need the drugs, know that they have become a twenty-first century version of the back-alley drug dealer but don’t care, or simply have very liberal approaches to pain management or treatment of mental issues. Patients are able to rationalize this type of prescription drug addiction with the knowledge that their regular doctor has prescribed the drug and, thus, they are not abusing anything. The prescription drug addict’s insurance company will often pay for the pills, further legitimizing the abuse.

A different form of doctor shopping occurs when a patient goes to a variety of doctors and health care facilities, either once or repeatedly, in order to stockpile medication. This addict knows what he is doing, cares little about rationalizing the behavior and will take measures to avoid detection such as using different pharmacies and paying in cash. He will go to places where the staff does not know him, or claim that his current supply of medication was destroyed or lost. In this situation, the doctor bears less responsibility for enabling the addiction, as ER and urgent care doctors must make quick decisions about a patient’s condition with very background information. Corey Haim engaged in this form of doctor shopping.

Haim was able to get prescriptions for the painkillers Vicodin and OxyContin, anti-anxiety drugs Valium and Xanax, and muscle relaxant Soma from seven different doctors; he filled the prescriptions at seven different pharmacies. Haim had also gone to several emergency rooms and urgent care clinics in order to get drugs.

I believe that we will start hearing more about doctor shopping and prescription drug addiction as a result of these infamous demises. While armed robbery of pharmacies connected to OxyContin addiction has been the focus of the media in recent years, attention has now shifted to the more deadly side of prescription drug abuse among Hollywood celebrities. A crackdown on an addict’s ability to exploit doctors, pharmacies and insurance companies has already begun in California. Let’s see how far officials are willing to go in order to combat this latest form of drug addiction.

http://edition.cnn.com/2010/HEALTH/04/07/doctor.shopping.haim/
 

Alison Stateman of TIME writes that according to a Los Angeles County Coroner’s report, Jackson died of "acute propofol intoxication." It said the standard of care for administering the drug, which typically includes equipment for patient monitoring, precision dosing and resuscitation, was "not present."

Murray allegedly gave Jackson Propofol, an anesthetic normally used in hospital settings for surgical procedures, to treat insomnia in the hours leading up to his death on June 25, 2009. If convicted, the Houston-based cardiologist may face up to four years in state prison. Murray pleaded not guilty and was released on $75,000 bail. He is due back in court on April 5. Murray was also ordered to quit prescribing heavy sedatives, including propofol, to his patients.

Stateman poses the question of whether the homicide charge facing Murray will do anything to discourage celebrity clients with substance-abuse problems finding doctors to give them the medication they crave, even if it goes against proper medical practice.

"The whole thing is going to send a chill," says Dr. Drew Pinsky, a substance-abuse expert and television personality who treats many addicted celebrities, "but it’s a highly complicated and nuanced problem that many people just don’t understand. You know, there’s a young celebrity dying of addiction every day now. And they’re all dying from pharmaceutical death. So where are they getting them? They’re getting them from my peers."

Dr. David Sack, CEO of Promises Treatment Centers, an alcohol-abuse rehabilitation program in Malibu and West Los Angeles, says that at the very least the case will serve as a cautionary tale.

"In many instances where there’s been a fatality and there has been an investigation, the doctors have been reprimanded by the board, licenses have been suspended or revoked, but every one of these instances reminds the public and physicians of the risks," says Dr. Sack. "Will that be enough? For some it will, and for some it won’t."

Dr. Sack points out an often fatal misconception. "What I would hope, first of all," he says, "is that people would realize that just because a drug is prescribed doesn’t mean it’s safe. It’s only safe in a context, and once you change that context and you start to mix it with other pills and alcohol, it’s not going to be safe. The public needs education, and I think physicians, when they realize the risks, are much less likely to be pressured into prescribing them when they’re inappropriate or, more importantly, prescribing things without adequate supervision."
Part of the problem is that many times, when a doctor is treating a famous individual, the traditional relationship is reversed and boundaries are blurred, with the celebrity dictating what drugs or care they want and using their allure, threat of banishment and lucrative pay as means to get their way.

"I found it was very easy to get sucked into that population," says Dr. Victoria McEvoy, medical director and chief of pediatrics at Mass General West Medical Group, who has written about the pitfalls of taking on high-profile clients.

"One, because they’re interesting people. But they’re also very narcissistic in general, and needy, and as a result, if you want to be part of their care, often you can find yourself going beyond normal boundaries and going above and beyond what you would do for other patients." She adds, "It’s very easy to slip over the line of giving good, objective care and maybe over-treating at times. You may feel pressure, like this physician apparently felt pressure by Michael Jackson to give him propofol and all these other things. It’s very hard to say no to these people unless you keep a very strict sense of boundaries in their head."

Dr. Sack says the charge against Murray should give physicians pause before over-treating patients or administering to problems outside their areas of expertise. "It’s going to make it much more likely that if I’m a cardiologist or general practitioner and I have an affluent or celebrity client who has a problem with drugs or alcohol, or it has turned into a drug or alcohol problem, then I’d be much more likely to refer them than to manage them in my office. It’s going to make people much more cautious about the potential risks, and that’s a good thing. People shouldn’t get worse care just because they’re famous. That’s clearly the concern here. By virtue of his incredible wealth and celebrity, [Jackson] actually got worse treatment."

Dr. Pinsky says that most doctors who get into trouble with celebrity clients mean well but are in over their heads. "It’s not as simple as it seems, and it needs to change. If you want to distill it down to one thing, it’s doctors really don’t understand addiction, and that’s how they get themselves into trouble. And then they also don’t understand their relationship with celebrity and their own personality figuring into that relationship."

Even if Murray is acquitted, the trial’s impact on other doctors won’t be diminished, Dr. Pinsky says. "Doctors are very sensitive to their professional status being questioned. They would rather go to prison than to be publicly humiliated like this, with their ability as a doctor being questioned."

However, Arthur Caplan, Ph.D., director of the Center for Bioethics at the University of Pennsylvania, doesn’t think the trial will have much consequence for the questionable doctors who are enlisted by celebrities when they can’t get aboveboard practitioners to pander to their needs. "Even with those tough charges, the combination of extraordinary wealth, lavish lifestyle and doctors who operate on the fringes of their profession almost guarantees a replay at some point down the road," he says. "Medicine hasn’t figured out how to weed out the fringe operators, and celebrities haven’t figured out that it isn’t good for their health to have a doctor who simply caters to their whims."

"I love Aerosmith; I love performing as the lead singer in Aerosmith. I am grateful for all of the support and love I am receiving and am committed to getting things taken care of," the 61-year-old performer said in a statement released Tuesday.

The Associated Press reports that the band canceled a summer tour in August after Tyler fell off the stage during a performance in South Dakota and broke his left shoulder.

Dr. Brian McKeon, who is treating Tyler, said in a statement that orthopedic injuries over the past decade have left the singer with severe chronic pain that will require surgeries on his knees and feet.

Tyler checked into rehab last year to recover from several foot surgeries and physical therapy. He said the procedures were to correct longtime foot injuries resulting from his physical performances.

The singer was known for heavy drug and alcohol abuse in the 1970s and early 1980s, but completed rehabilitation in 1986.

"At that point, he was, uh, he [Tiger Woods] was snoring," Adams told the police. "He was snoring?" asked the investigator. "He was actually snoring," Adams confirmed.

Gerald Posner writes for the Daily Beast that he learned from trauma doctors that Woods should have been hyper-alert because of the adrenaline rush naturally associated with an accident such as his.

One law enforcement officer familiar with the investigation told the Daily Beast that police on the scene suspected that Woods was disoriented and loopy because he had taken Ambien, a prescription sleeping pill. A person familiar with Woods’ medical treatment two years ago told Posner that Woods has used prescription sedatives, when injured, to help him sleep.

Despite this, the Florida Highway Patrol did not administer any drug or alcohol tests to Woods, telling the Orlando Sentinel that it did not have the “probable cause” for such tests.

But the incident raises questions about Woods and his pill habits. The suggestion of an Ambien link to the early-morning crash comes on the heels of reports that one of Woods’ alleged mistresses told friends that she and Woods liked to have “crazy” sex in an “Ambien haze.”

Meanwhile, a source familiar with Tiger’s medical treatment in the latter half of 2007 told Posner that Woods’ regular dosing of painkillers was “potentially a problem” during those six months because of the addictive nature of his medications. That coincides with Woods tearing his left knee ACL, a common athletic injury, in July 2007. Woods and his advisers decided against surgery then and instead he continued playing and winning on the PGA Tour.

Posner asked Woods’ agent, Mark Steinberg, about the golf star’s prescription drug history. His response came by email on Friday: “As any doctor would attest, patients are universally prescribed medication for bone fractures and following major orthopedic surgery. Tiger’s care has been managed with especially attentive observation by leading medical professionals, and others simply aren’t in a responsible position to make any assessments. Most importantly, the specifics of his medical care ought to be private, which is why unending Internet innuendo about his condition is so irresponsible and offensive. For amateurs to make speculative judgments about the quantity, propriety, or duration of a patient’s care is reprehensible.”

Posner notes that in some ways this answer sounded similar to part of the statement that was first issued under Woods’ name after the car accident: "This is a private matter, and I want to keep it that way. Although I understand there is curiosity, the many false, unfounded, and malicious rumors that are currently circulating about my family and me are irresponsible.”

DJ AM, also known as Adam Goldstein, was a recovering addict who died of a drug overdose in August during production of "Gone Too Far," in which he sought to help fellow sufferers.

"After careful consideration we have decided to air the show," Goldstein’s family said in a statement released by MTV.

"Adam felt strongly that by doing this series he could help other addicts who were at a crisis point to get sober. Adam was fully aware that if it were not for his own sobriety he never would have achieved the level of success and happiness he had found. Helping people in their recovery was a huge part of Adam’s life. It is our hope through airing this show that people will get to see the side of Adam that we knew and loved, not just the celebrity DJ, but the honest and caring person who gave so much of himself to help others. The decision to air the show has been difficult, but we do this with the profound belief that it will inspire others to seek help."

The 73-year-old actor was admitted to the Hanley Center in Florida last month after a nasty fall at his waterfront mansion in Hobe Sound led him to realize he’d become "a prisoner of prescription pain pills".

The Smokey and the Bandit star agreed to undergo detox and a 30-day rehab program after doctors raised fears for his mental health in the aftermath of the accident.

The actor has previously confessed to being dependent on the sleeping aid Halcion after turning to the drug to ease the pain he felt from temporomandibular joint disorder (TMJ) in the 1980s.

Reynolds’ manager, Erik Kritzer, confirmed the rehab stint, explaining that the star relapsed after undergoing painful surgery on his back and "checked himself into rehab in order to regain control of his life."

Kritzer also revealed that Reynolds has now left the facility, but no further details were given

Griffith struggled with alcohol and drugs in the 1970s and 1980s, and spent time in rehab in 1998 and again in 2000 in an effort to stop abusing prescription painkillers. Griffith’s representatives had previously refused to disclose the reason for her stay in rehab, but Banderas has said she turned to professionals in order to prevent a relapse.

Banderas also told talk show host Ellen Degeneres that his marriage is not in danger. "Let me explain to you,” he said. “It was actually in some magazine that I said that I gave an ultimatum to my wife. That I present the matter of divorce because she has been involved in addictions and blah, blah, blah…”

"Melanie has been addicted for many years and we always came out. We said it out loud. It was OK, we were never embarrassed of the situation but…she was clean and sober for six years."

However, Griffith felt her resolve weaken after three operations on her knee following a skiing accident at the start of 2008. She feared taking the medication she was prescribed to numb the pain would tempt her back onto harder drugs.

Banderas said, "In March, she came to me and said, ‘I’m feeling a little bit weak in my determination for this (to stay sober)…so I just thought to go to rehabilitation by myself.’"

Griffith’s entire family is behind her, and her relatives even attend group therapy sessions with her.

Banderas said, "We have been following some type of therapy with other families. There are a number of invisible heroes working in AA (Alcoholics Anonymous) all around the world. I just say to families, ‘Don’t get embarrassed, just confront this problem head-on. And don’t hide from that because there is a beautiful gift at the end of this tunnel, and it is the person that you love back, and that is what I am searching for.”

"So the whole entire family is supporting her, and I am supporting her, and at this particular time more than ever. I’m very proud of her."