Scientists from the Geisinger Health System in Pennsylvania found that there are four main risk factors for becoming addicted to prescription painkillers: being younger than 65, having a history of depression, abusing other drugs in the past, and using psychotropic medications.

The researchers gathered DNA information from 705 patients who were being prescribed opioid painkillers such as morphine and codeine for back pain for more than 90 days. They also examined a gene located on chromosome 15, which has been linked with alcoholism, cocaine addiction, and nicotine addiction, and found that gene mutations on this chromosome may be linked to opioid addiction.

Joseph Boscarino, an epidemiologist and senior investigator at Geisinger’s Center for Health Research, said that their study suggests that people with these risk factors are 26 percent more likely to become addicted to painkillers, and that screening patients for the risk factors prior to prescribing narcotic painkillers could help prevent addiction. He added that the same risk factors could increase the risk of addiction in patients without chronic pain.

Source: HealthDay News, Robert Preidt, Study Identifies Risks for Painkiller Addiction, September 2, 2010

The study, published in the Journal of Addiction Medicine, will be used to train medical students and residents at the University at Buffalo School of Medicine and Biomedical Sciences, as well as physicians who are already treating patients. The researchers hope the study will help doctors screen for addiction among patients so that at-risk patients can be referred to treatment or given an intervention. 

Richard Blondell, MD, professor of family medicine and senior author of the study, said that researchers and doctors are seeing more and more patients who are addicted to prescription medication, and wanted to better understand how they first started using the drugs.

He said their study suggests that prescription opioids can lead to illicit drug addiction, and that people who abuse prescription medication may be at a greater risk for later heroin use.

The participants in the study were patients who were addicted to opioids, such as methadone, OxyContin, and fentanyl. The researchers gathered information from the participants, including the drugs they used, the age when they started using, the ways in which they took the drugs, how they started using, and how their drug use progressed.

The average age of drug users was 32. 65 percent were male, 77 percent defined themselves as white, and 74 percent graduated from high school but had no college education. Fifty-one percent said they started using the drugs after surgery or an injury or for consistent pain, and 49 percent said they were curious or a friend or family member had the drugs.

People who became addicted after being legally prescribed the medication were more likely to be female, older, have a college degree, and take drugs orally instead of snorting or injecting. Most people said they continued taking the drugs to help alleviate emotional pain and stress and to help them feel "normal." 

An interesting point was that out of the 53 patients who answered the question, 74 percent said that their doctors didn’t ask whether they had a substance abuse problem before handing over the prescription. 

Blondell said that the physician prescribing the medication has the best chance to prevent addiction or help patients get treatment, and that all physicians should tell their patients that addiction can be a result of using certain medications. He added that doctors need to monitor their patients’ use of the medication closely, and to properly dispose of leftover medication.

Source: Science Daily, Drug Addicts Get Hooked Via Prescriptions, Keep Using ‘to Feel Like a Better Person,’ Research Shows, August 21, 2010

Recently, Massachusetts passed legislation that requires all pharmacies within the state to provide prescription drug lock boxes for sale to the public at their locations. On August 9, Massachusetts State Senate and House of Representatives passed Chapter 283 to the Acts of 2010: An Act Adding Safeguards to the Prescription Monitoring Program and Furthering Substance Abuse Education and Prevention. The legislation is the first of its kind not just for the state of Massachusetts, but the entire U.S. The bill was sponsored by Governor Deval Patrick, Senator Steven Tolman, and the Massachusetts Pharmacists Association. Section 11(b) of the legislation states that all pharmacies that dispense Schedule II, III, IV, or V prescription drugs are required to make purchasable prescription drug lock boxes readily available to consumers in order to encourage the public’s safety efforts when handling over-the-counter and prescription medications.

Prescription drug lock boxes are safe and secure locking mechanisms that cannot be tampered with without extreme force and can only be opened through its combination lock. A combination lock ensures that only the prescribed patient will have access to their prescription medications as intended, and keeps these prescription drugs from falling into the wrong hands, particularly children. Most retailed prescription lock boxes are designed to hold up to four prescription bottles and can fit within the average medicine cabinet.

Prescription drug abuse has become a national epidemic in recent years, with an alarming rate of abuse among adolescents and older adults alike. On June 3, the Center for Disease Control and Prevention (CDC) reported that 20.2% of American teenagers (1 in 5) admit to having illicitly taken a prescription medication one or more times in their lifetime. Furthermore, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 55.9% of prescription drug treatment admissions had illicitly obtained prescription medications from a friend or family member. Pain relievers, tranquilizers, stimulants, and sedatives are all highly potent drugs that can be just as toxic as street drugs when misused.

Teenagers who abuse pharmaceuticals most often obtain the drugs from their own parents’ medicine cabinets. Some teenagers may bring collections of prescription drugs to parties known as ‘pharm parties’ where multiple prescription drugs are shared among peers and often mixed with other substances such as alcohol, marijuana, or even cocaine. SAMHSA reports that the number of emergency room visits related to prescription pain relievers rose from an estimated 144,644 in 2004 to 305,885 in 2008—an increase of 111%. The abuse of opioid pain reliever medications has caused more overdose deaths in the U.S. than heroin and cocaine combined.

Even though pharmaceuticals are intended to help treat illness or alleviate pain, they are often misused for recreational purposes. Many Americans are unaware of pharmaceutical drugs’ potential for abuse, dependency, addiction, and overdose. The prevalence of prescription drug abuse has now become parallel with illicit substance abuse across the nation, affecting Americans of all regions and demographics. Prescription drug lock boxes are an effective tool for combating prescription drug abuse, and puts control right in the hands of parents to help keep their households safe. By mandating the sale of lock boxes, Massachusetts pharmacies are helping residents understand the dangers involved in handling controlled substances.

Source: PR Newswire, New Law Requires Pharmacies in Massachusetts to Carry Rx Lock Boxes, August 18, 2010

Although the database will cost about $1 million to set up and $400,000 per year to maintain, it will save more than that in health costs by keeping abusers from feeding their addiction. It will also help doctors better understand which patients are truly in need of the medication and which are abusing powerful painkillers such as Valim and OxyContin.

An estimated 9,000 Massachusetts residents engage in doctor shopping every year, according to Alice Bonner, director of the state Bureau of Health Care Safety and Quality.

More than 600 deaths per year in Massachusetts are due to substance abuse. It isn’t known how many of those involve prescription medication, but studies have suggested that prescription medications make up more than half of deadly overdoses.

Massachusetts already has a prescription monitoring program, but it only covers opiates such as OxyContin, Percocet, and morphine, and doctors don’t have direct access to the data. With the new system, pharmacists will be required to report to the Department of Public Health when they fill prescriptions from many other categories of drugs, such as Vicodin, Darvon, and steroids. The database will also now be updated weekly instead of monthly. Patients or family members will also have to show a form of identification the first time a prescription is filled.

Sources: Associated Press, State plans crackdown on prescription drug abuse, August 12, 2010

Boston.com, Stephen Smith, State OK’s tool to detect prescription drug abuse, August 12, 2010

Established in 2007 in part by a $150,000 grant from the U.S. Environmental Protection Agency’s Aging Initiative, Maine’s Center on Aging has run a successful state drug mail-back pilot program. Maine’s mail-back program involves prepaid mailing envelopes for consumers in which they can return their unused medications to a central collection location that is owned by the state’s Drug Enforcement Agency. The prepaid envelopes are made available through physicians’ offices, pharmacies, or post offices. The mail-back program ensures the safe disposal of unused medications to authorities who then sort and incinerate the waste. Since the program’s inception, approximately 3,926 envelopes have been returned that contained a total of 2,300 pounds of drugs. Individuals who have participated in the simplistic mail-back program have utilized 42% of the available envelopes distributed throughout public resources.

Prescription drugs—like painkillers (opioids), benzodiazepines, antidepressants, and antipsychotics—are causing more overdoses and more emergency department visits than any other drug of abuse across several states due to recent surges in prescription drug diversion. Unlike illicit substances that are being sold on the street, Americans of all ages are mostly obtaining prescription drugs from friends or family members, either for free or at a price, for their intentional misuse. Pill mills are churning out pain relieving medications daily, and addicts and drug dealers alike are willing to cross state lines to get their hands on the drugs. Other addicts partake in ‘doctor shopping’ by visiting several doctors and pharmacies to gain multiple prescriptions for drugs like OxyContin, Vicodin, or Percocet—or even resort to identity theft or robbery to continue feeding their habit.

Since 2007, several states including Maine began initiating state legislation to manage the return of unused prescription drugs by implementing drug mail-back programs. Not only does the proper disposal of unused medications help the environment by avoiding drug waste from entering water treatment facilities or landfills, but it helps to prevent drugs from falling into the wrong hands. Too often, teenagers are confiscating prescription pain medications right from their parents’ medicine cabinets for recreational use, which can lead to severe consequences. These legal drugs can be stolen from patients and resold on the streets; in the case of prescription drug overdose death, the source of the prescription drugs is held accountable for the drug-induced fatality. The problem of prescription drug abuse is far-reaching, but can also be prevented with community involvement and intervention support.

After the Maine’s legislature acknowledged the success of its pilot drug mail-back program in early July 2010, the state has approved extended funding of the program to continue it for another two years. Besides Maine, states like Iowa, Oregon, Wisconsin, Pennsylvania, Virginia, California, Arkansas, Colorado, Hawaii, New York, and Tennessee have all adopted a form of consumer drug take-back programs or drug return programs with nursing homes and mental health clinics. The new model drug mail-back program is one method of alleviating prescription drug abuse that has exploded into a national health problem within the past decade. Now, advocates from Maine’s health community are urging Congress to adopt Maine’s pilot drug mail-back program for a national platform. Health professionals are citing the success of the Maine program as an effective method of preventing drug diversion and related health consequences, costs, and economic hazards.

Sources: The Portland Press Herald, David Hench, State gets a partner in fighting pill abuse, July 24, 2010

Enviro.BLR.com, Drug Mailback Program Effective, July 1, 2010

In 1998, prescription drug abuse among Americans ages 12 and older was at 2.2% of admissions nationwide. By 2008, the percentage quadrupled to 9.8% of admissions. This dramatic rise in the abuse of prescription pain relievers swept across all genders, ages, ethnicities, education and employment levels, and regional areas.

In 1998, 1.8% of male admissions had reported abuse of prescription pain relievers. By 2008, this percentage increased to 8.1% of male admissions. In 1998, 3.5% of female admissions reported abuse of prescription pain medications, but by 2008, this percentage rose to 13.3%.

Admissions for all races and ethnic groups showed steep rises for reported prescription drug abuse. Caucasian admissions for prescription drug abuse rose from 3.2% in 1998 to 14.4% in 2008; African American admissions rose from 0.8% to 2.0%; Hispanic admissions rose from 0.8% to 3.1%; and Asian American admissions rose from 3.6% to 5.2%. Most dramatically, however, was a six-fold increase in admissions for prescription drug abuse among American Indians–from 1.3% in 1998 to 8.0% by 2008.

Although all age groups demonstrated an incline in admissions for prescription drug abuse, those between the ages of 18 to 34 had the highest rates over the ten-year period. Those between 18–24 years of age rose from 1.5% of admissions in 1998 to 13.7% in 2008. Admissions aged 25–34 years reported prescription drug abuse in 2.1% of admissions in 1998, and 13.5% of admissions in 2008.

Admissions of adults ages 18 and older in 2008 grew three to four times the amount of admissions from 1998, regardless of their educational level and employment status. Statistics from other age groups showed alarming increases as well, such as 0.6% of admissions ages 12–17 in 1998 rose to 5.2% in 2008, admissions ages 35 to 44 years rose from 2.9% to 7.6%, and admissions ages 55–64 years rose from 1.9% to 6.1%.

The rate of admissions for individuals who were either employed or unemployed at the time they entered treatment (regardless of whether they were full time, part time, unemployed, or not in the labor force) displayed almost identical statistics, as all categories of employment increased more than fourfold. Similarly, admissions for prescription drug abuse from all educational levels increased by 350–500% within the ten-year period.

Adults with an education beyond high school represented the highest amount of admissions (3.8% of admissions in 1998, and 12.1% in 2008), but adults who had never received an education beyond middle school saw the largest percentage increase, from 1.9% in 1998 to 9.7% in 2008–a five-fold increase. Furthermore, admissions for prescription drug abuse quadrupled in nearly all regions of the U.S., including the Northeast (from 2.2% to 11.2%), Midwest (2.1% to 8.2%), South (3.0% to 13.9%), but tripled in the West (1.9% to 6.1%).

Nonmedical use of prescription pain medications is more than a public safety hazard, it has become an epidemic. While all these medications have the potential to assist healing and alleviate pain, many Americans have made prescription drug abuse a recreational endeavor, and the illegal drug market is making its biggest market on prescription drugs than ever before.

According to SAMHSA, however, 55.9% of those admitted to substance abuse treatment for prescription drug abuse report that they obtained the medications from a family member or friend for free. Another 8.9% admit that they purchased the drugs from a friend or family member. Many drug addicts and dealers perform ‘doctor shopping’ to score multiple prescriptions for pain relieving medications and obtain their prescriptions from various pharmacies throughout their home state or beyond.

Prescription drug monitoring programs have proven to be a valuable resource for law enforcement and medical professionals alike in their efforts to reduce prescription drug diversion, but many of these state programs lack enough funds to run their programs efficiently. The abuse of prescription drugs has clogged the nation’s health care system, from insurance, emergency care, to medical resources, and also depletes the nation’s economy due to loss of productivity, increased law enforcement, rising criminal justice, and soaring rates of overdose deaths.

SAMHSA’s study is based on the Treatment Episode Data Set (TEDS), a national database that collects information on the primary, secondary, and tertiary substances of abuse among addiction treatment facilities’ admissions ages 12 and older. The study was sponsored by the Office of National Drug Control Policy and the Drug Enforcement Administration.

Joyce Garbaciak of WISN 12 News writes that Maddie Kiefer, Luke Murphy, and Kati Hammen are among the local people who’ve fatally overdosed with prescription drugs in their systems.

"We’re definitely seeing an increase in the problem in southeastern Wisconsin," said Jim Bohn, the assistant special agent in charge of the Milwaukee office of the Drug Enforcement Administration.

"There’s a perception out there that pharmaceutical drugs are safer because you might’ve gotten them legally and they’re manufactured legally," said Bohn. "So if they feel like they’re safe, they’re safe; they’re not addictive, which is certainly not true."

Bohn says people fall into the trap of abusing pharmaceutical drugs because they can be easy to get initially, by filling a prescription, ordering medication online or stealing from a medicine cabinet.

"Many of these drugs are very powerful," said Bohn. "And in some cases more addictive than some of the illegal narcotics out there."

As the problem grows, one local county is taking a novel approach by creating the job of pharmaceutical investigator.

"We felt the position was important because the abuse of prescription drugs and the consequences we’re seeing from that abuse is getting pretty serious in Washington County," said Washington County Sheriff Dale Schmidt.

Schmidt gave that job to former Deputy Keith Uhan.

"I’ve tried to make contact with every pharmacy in the county," Uhan said. "I want to let them know who I am so they can call me with questions or if they feel anything is not legally done they can call me."

In Milwaukee, John Lemberger knows all about working with law enforcement. In his 33 years as a pharmacist, he knows what raises a red flag, including an altered prescription or someone asking which brands of medication he carries.

"Some tablets are easier to crush up and inhale," Lemberger explained. He also says someone stopping in minutes before closing can be suspect.
"We’ll be in a rush, we want to go home," Lemberger said. "We might not pay as much attention to the prescription if it was altered or even counterfeit."

Certain medications demand more attention including morphine, methadone, hydrocodone, and especially oxycodone, which the DEA’s Jim Bohn says is the most abused pharmaceutical drug in the state.

"The users crush the pill and snort it, which gives them a heroin-like high," Bohn said.
Officers say the going rate for an 80-milligram tablet is $80 and once that gets too expensive Bohn says users look elsewhere for that high.

"You’ll see a lot of users turn from abusing prescription drugs to other drugs like heroin," said Bohn, "because heroin is cheaper and it is somewhat more easily available than a prescription drug might be."

But by then, the hold of addiction may be too powerful to break.

Law enforcement says what would help is if Wisconsin joined 41 states in establishing a prescription monitoring program. Such a program would create a statewide database to track which patients are filling prescriptions for drugs that have a high-abuse potential. That would give officers a better handle of who may be trying to doctor-shop.

A bill to create this kind of monitoring program overwhelmingly passed the state legislature and is currently before Gov. Jim Doyle.

The NIH’s Office of Research on Women’s Health podcast, "Pinn Point on Women’s Health," provides updates on women’s health research, and is hosted by Vivian W. Pinn, M.D., director of NIH’s Office of Research on Women’s Health. This month, Dr. Pinn interviewed Nora Volkow, M.D., director of the National Institute on Drug Abuse (NIDA).

Dr. Volkow stated that it is important to understand the sex and gender-based differences regarding drug abuse in order to better target prevention and treatment approaches.

"In general, males tend to take more drugs than females. The exception is the period of time between 12 and 17 years of age. There, we see a higher rate of abuse of most drugs, including psychotherapeutics, among girls than among boys," Dr. Volkow said.

Drugs of abuse also include pain medications that contain opiates, such as Vicodin or OxyContin, as well as stimulant medications, which are used to treat attention deficit hyperactivity disorder. Dr. Volkow noted that adolescent girls have almost 60 to 70 percent higher rates of abuse of these substances than adolescent boys.

"Adolescents and young adults take stimulant medications to improve cognitive performance, to study for an exam, or to prepare for something that requires a deadline involving intense work," Dr. Volkow said. In addition, girls take stimulants in order to lose weight. Stimulant medications are anorexigenic; meaning, they reduce feelings of hunger.

Not surprisingly, prescription drug abuse can result in addiction. Dr. Volkow has conducted imaging studies that show how repeated drug use affects the brain.

"Not only are there disruptions in the circuits involved in reward (the ability to feel pleasure), and learning; but also in frontal areas of the brain that are involved with executive control and that enable you to make decisions, to judge, to control your desires and your emotions," Dr. Volkow said.

There exists a misguided belief that abuse of prescription drugs is less dangerous than that of illicit substances because they are prescribed by physicians. "When you take psychotherapeutics outside the surveillance of a physician, these medications can be as dangerous as illicit substances," Dr. Volkow said. She noted the importance of educating both the public as well as the health care system about how these drugs work, under what conditions their use is beneficial and under what conditions their use can lead to adverse medical consequences.

Treatment for addiction will depend on the type of psychotherapeutic used. "For opiate analgesics, we have medications that look quite promising. We’re currently conducting a trial to investigate the use of buprenorphine in the treatment of addiction to opiate analgesics, and the results appear to be quite promising," Dr. Volkow said.

There are also several evidence-based behavioral interventions that include motivation intervention strategies, incentive intervention strategies, and group therapy intervention strategies that have been shown to be effective. For information on treatment options in your area, go to http://www.samhsa.gov/ or call 1-800-662-HELP (1-800-662-4357).

On his night shift in a busy emergency room, Dr. Jacob Khushigian inevitably finds a few patients more likely to be hunting for drugs than medical attention.

The guy who claims he has severe abdominal pain doesn’t grimace when sitting up. A woman who recently moved to the area fails to disclose she sees a doctor elsewhere. An ambulance patient complaining of a sore leg and back doesn’t reveal she was turned away by another hospital.

There was a time Khushigian’s hunches took weeks to confirm and required phoning or faxing the attorney general’s office to obtain a patient’s prescription drug information. Nowadays, a computer helps him catch cheaters. But it can only reach so far.

While a state online drug database went into effect last year to thwart addicts who bounce from doctor to doctor to feed a habit or make a small fortune peddling meds, there’s now a push to extend it beyond state lines to snare so-called doctor shoppers and curb drug abuse.

"The whole purpose of this is to have states communicating with one another," said Dr. Laxmaiah Manchikanti, chief
Doctors can be hamstrung in making critical decisions about prescribing painkillers if they aren’t able to find out if patients filled prescriptions elsewhere.

A nationwide network might have helped Michael Jackson’s doctor better monitor the medication he was receiving from multiple doctors.

Dr. Conrad Murray, who was recently charged with involuntary manslaughter in the singer’s death, told police Jackson gave few details when Murray repeatedly asked about Jackson’s medications, according to an affidavit. The Los Angeles County coroner said Jackson was killed by a mix of a powerful anesthetic and a sedative.

Police have searched for information in three states to see if Jackson’s medical history played a role in his June death.

Jackson’s death and those of other celebrities such as former Playboy Playmate Anna Nicole Smith and actor Corey Haim highlight the dangers of prescription drug abuse. More U.S. teens used prescription drugs over any other illicit drug except marijuana, the Office of National Drug Control Policy reported.

Forty states have passed legislation to allow prescription drug monitoring programs, but only 34 are operating.

Under the National All Schedules Prescription Electronic Reporting Act signed by President Bush in 2005, more than $50 million has been appropriated to states for programs where doctors and other authorized users, such as police in some cases, can access patient records.

The law aims to have a coordinated national system, but there are no estimates what that would cost and a majority of the federal money hasn’t been allocated.

Joanee Quirk, who runs Nevada’s prescription monitoring program, said having access to other state databases would help stop those from Southern California or Hawaii who come to Las Vegas or Reno to score Vicodin or OxyContin.

Nevada’s four-year-old program has grown to more than 225,000 patient requests in 2009 from about 155,000 in 2008.

Most prescription monitoring programs are voluntary, but Nevada requires doctors to check a patient’s drug history during a first visit.

"If we took it away the practitioners would have a revolution," Quirk said. "It’s almost like getting a lab test, where the doctors are trying to figure out what is wrong with this person and whether they are trying to get drugs legally."

Some privacy groups are concerned databases could invade patients’ privacy. Virginia’s database was hacked into in April 2009 and millions of electronic records were stolen by a thief still at large.

"There is a significant intrusion into the lives of individuals who are taking these medications legitimately," said Pam Dixon of World Privacy Forum, a nonprofit public interest research group. "There needs to be more restrictions about who can access this information."

The response to having secure, online access to patient records has been overwhelming so far in California. More than 2,300 doctors, pharmacists, physician assistants and registered nurses have used the Web site since September to access more than 134,000 patient reports. The state had averaged about 60,000 requests annually when they received requests by phone or fax.
Katherine Ellis, who runs the database of about 100 million prescriptions, said emergency room doctors would benefit most from a multistate system.

"If there was a way for ER doctors to sign on as they are triaging that patient and see if that person has been doctor shopping, then they may not elect to give them the controlled substances," she said.

Khushigian, 52, who works at Kaweah Delta District Hospital in Visalia in the Central Valley, is glad he no longer has to rely solely on his gut every night. He uses the database two or three times a night to shut down potential abusers.

"When they get caught, there isn’t much they can say," he said.

Many abusers get the drugs from the medicine cabinets of family and friends. ABC4 News talked to two men who are recovering from prescription drug abuse at the Journey Healing Centers.

For one man, nearly two decades of painful addiction started when his father gave him a prescription pain killer for his headache at age 12. "I liked the way it made me feel,” the man, who asked not to be identified, told ABC4 News.

This eventually led to stealing from his parents’ medicine cabinet and later from extended family. "We’d go to grandparents or aunts and uncles and I would start looking in medicine cabinets and finding most people left a lot of their painkillers in the bathrooms," he continued.

Another man said his near-fatal addition started in college after an accident left him with an injured wrist and back. Six months later he was hooked on the prescription painkillers the doctors gave him. "I’d wake up in the morning and feel that I’d have to take two painkillers just to get out of bed," he said.

When ABC4’s Noah Bond asked if anyone noticed that the pills were missing from their medicine cabinets, one man said he would replace whatever he took with a similar-looking pill.

Both men agreed to share their stories in the hopes of educating people to lock up or properly dispose of their prescription medications. "I’d strongly advise to throw them away. There are centers where you can actually take your medications to dispose of it properly," said one man.

The Midvale Police Department is hosting a prescription disposal day at Hillcrest High School April 24, and everyone is welcome to drop off expired or unused medication.

Go to www.medicationdisposal.utah.gov for information about other disposal places. For more information on Journey Healing Centers, call 1-866-535-8958.