The Hidden Dangers of Prescription Drug Misuse
Rachel: Welcome to today’s webinar entitled ‘The Hidden Danger of Prescription Drug Misuse’. We are very fortunate to have Dr. Phil Quinn as our presenter.
Dr. Quinn has facilitated hundreds of trainings and webinars for Beacon Health Options over the years and we are thrilled to have him with us today.
Dr. Quinn is the chief psychologist at South Shore Mental Health Center, a psychiatric consultant at the University of Massachusetts Medical School and is a Corporate Consultant and Trainer. So without further delay, Dr. Quinn, I will turn things over to you.
Dr. Phil Quinn: Well, thank you Rachel! Today, we’re going to be talking about the hidden dangers of prescription drug use and misuse. As all newspapers slightly it’s a significant problem or it has been for quite a long time in our culture, but how to recognize some of the dangers, we are going to look at ways of dealing with this effectively.
So we are going to look at sort of explain that prescription drug misuse, how does happen and identify some of the drugs that are misused. We are going to look at some risk factors and what are some of the effects and we will recognize some of the signs and symptoms. So if you have a colleague or a friend or a loved one who is having some difficulties, who know what to look for and we will explain some treatment for prescription drug use and also we will talk a little bit about the Employee Assistance Program, which can be a great aid in helping you deal with this problem and many other difficulties.
But what is prescription drug use? It’s basically, and this is simply put, if you take a medicine that is prescribed by your physician or a nurse practitioner in a way that’s different as prescribed, and that’s really important, is to take the medication as prescribed by the person giving it to you because all sorts of dangers can happen if taken incorrectly.
So certainly if you have any questions, talk to your doctor before you get meds. I know often we don’t see like we have the time, we feel rushed to go to a doctor’s appointment, but this is really a very, very important issue. So it’s very important that you deal with this at a timely manner when you are dealing with your doc.
But let’s look some of the examples, taking medicines that were prescribed for someone else, it’s not unusual, people take meds and they seem to work but they may not work in the way they are supposed to. Taking a larger dose than you are prescribed, we will talk about the dangers of that. Take medicine in a different way than you are supposed to. Most medicines we will talk are prescribed to be taken orally but many people crush the tablets and some medications are designed so you can no longer do that, some people, may crush them, take them nasally or inject them.
And finally using medicines for other purposes, such as getting euphoric feeling and getting high, and some meds even though they are intent may be to reduce pain, intent maybe to help us relax, the end result is they can make us high or euphoric.
The prescription drug problem is complicated. Let’s take a look for a moment, there really are four main reasons that we often take prescription drugs that can lead to abuse and that’s an important distinction, some of the drugs that we are given for a variety of medical problems still lead to abuse. But in four areas, pain, where often someone maybe prescribed an OxyContin, sleep where people have trouble falling asleep or staying asleep, maybe prescribed a medication such as Ambien. People -- children and adults with attention and concentration problems who are diagnosed with ADHD maybe prescribed a stimulant med such as Adderall. And the fourth area is anxiety, it’s not unusual where people are anxious or fearful have anxiety are prescribed an anti-anxiety or benzodiazepine to help them relax. Medications like Xanax and Klonopin fall into that category.
There are numerous reasons that people go from using medications in a proper way to abusing them. Sometimes we don’t have the knowledge of the medication, so we may take more than prescribed or take a medication more often than prescribed. This may happen for example in a pain medication, where all of a sudden you have a spiking pain.
So you need to take a little bit more of the medication, even though the doctor has not suggested you do that, or, if you are feeling anxious and you are having an anxiety attack or a panic attack, you may want to take a little bit more of the medication, but that creates some difficulties.
Many of the medications that are used to help us reduce pain, to help us sleep, help us concentrate and reduce anxiety result in tolerance. Essentially our body starts to get used to the medication, and if we use them too often that we may ultimately have a high tolerance rate, and if we discontinue the medication, we go to withdrawal. Our body reacts to the medication or drug leaving the body. So let’s take a little closer look at tolerance.
Tolerance results, when we need more-and-more of the prescription medication of the same therapeutic effect. We need to take more-and-more medication to be pain-free, to sleep through the night, to pay attention or relax. Our bodies get used to this medication, and kind of adjusts slowly to this new medication that we have introduced, and if we try to stop, we go into withdrawal.
A withdrawal can be very difficult and many people prescribe medications after they are no longer needed to avoid withdrawal. Some of the withdrawal symptoms are pain and aches. So, you can appreciate the difficulty if you are taking a medication for pain, and you discontinue the medication, you may have a spike in the pain. We may feel anxious, we will have trouble going to sleep, we will have trouble staying asleep, we would have a panic attack as our heart races, so we have tachycardia. And often what happens is, to avoid these symptoms people use more of the drug.
If we continue taking the medication beyond what is prescribed, we also run into the level of lethality of the drug. These prescription medications may be lethal because of tolerance. As we use larger-and-larger doses of the medication to maintain the desired therapeutic effect, such as reducing pain, the effective dose of the medication and the lethal dose of the medication become closer and closer. So if people use an OxyContin, for example, and they keep upping the dose, they don’t realize they’re getting closer and closer to the lethal dose.
Also, one of the things that we have to consider is the delivery system, how we take the drugs. Most prescribed medications are usually prescribed and taken orally. Individuals who abuse prescription medications however, often change the delivery system to get faster results. They may take the drugs nasally or intravenously, because this gets the medication, the prescribed medication to the brain faster, and what that does is increase the chances of addiction, dependency on the drug, and also death. If syringes are used, it can often have an increased chance of disease processes like HIV and hepatitis.
Because people who have been prescribed medication by their physicians often become addicted to these medications, when the doctor no longer prescribes medication, they often transition to street drugs, such as substituting heroin for OxyContin. So it is important to recognize that while these medications can be very helpful in helping us deal with the day-to-day problems such as pain, they have to be treated with a great deal of respect, because they can be very lethal.
Let’s take a couple of moments to look at some of the medications that can be overused and result in difficulties, and let’s look at these categories. The first is opioids or the class of drugs that we get to relieve pain. So, if a person has had surgery, chronic back ache, all those situations, it's not unusual that they would be prescribed an opiate-based medication, such as -- such as Vicodin. These medications or analgesics help us deal more effectively with pain, so they can be exceedingly helpful. For all the people listening today who had an operation, come out after the operation in significant pain, these medications can be very helpful and really life-savers in many ways, and that's what makes this difficult. It’s not that these medications are bad, these medications can be very helpful, it’s just how their use can cause difficulties.
Secondary is tranquilizers and sedatives. If we look at this list, one as we will see barbiturates, which are exceedingly rare to be used or often used in other settings such as migraine, sometimes people with epilepsy, but we really don't see barbiturates used very often. One of the reasons being is they could be very lethal if taken inappropriately, so that drug we don’t see very often.
Benzodiazepines, such as Xanax and Klonopin are often used for people with panic attacks or anxiety, and people tend to use those more frequently than prescribed, and the reason for that is we may run into situations that cause us to feel anxiety, and these drugs work effectively to reduce the anxiety, but at the same time we are reducing the anxiety, we may be increasing our dependency on these medications.
And also under tranquilizers and sedatives is the sleep medications. Sleep is a significant problem in our culture today and often people rely on sleep medications to help them get to sleep or fall asleep. These can be very addictive, often they should only be used for short period of time, because it’s a very complicated process. These medications help us get to sleep, but we don't want to be in a position where we can't wake up the next morning.
Next are stimulants. We certainly see that with children and adults diagnosed with ADHD. If taken appropriately, these medications can help kids, especially kids who are in school where they have to go to class after class, and sometimes the teachers are the most stimulating in the world, and it’s hard to -- the material may not be that interesting to the child. So, ADHD medications that are prescribed appropriately to the child or adult can be very helpful. But on the other hand, as we all know, these medications can be abused, especially in the hands of children, because children may -- especially older kids and teens may give them to other kids as well. So certainly, parents with children using an ADHD medicine should certain monitor those very, very closely.
There are a lot of risk factors in terms of dealing with drugs, and one of the interesting things I have seen clinically is these medications are prescribed, any medication that’s prescribed, we think that they are inherently safe. I mean we were dealing with a young gentleman a few years ago who was abusing OxyContin, and I explained to him the dangers of it. He looked at me and sort of chuckled a little bit and said, how dangerous they may be, they prescribe them to old ladies with cancer? And he looked at it as it was, this is prescribed medication, it’s quality control, it’s got a manufacturer’s name on it, how dangerous can it be? So, I thought that emblematic of how people think these drugs may be more safe than they really are. I don’t think people understand the possibility of dependence and addiction. Most people live their lives who are becoming addicted to a substance, and as a result of that they don't realize that these drugs can cause addiction.
We also want to look at past and present additions to substances, even alcohol, and especially alcohol and benzodiazepines, because it’s a cross-tolerance. If a person is using more and more alcohol, if they do need a benzodiazepine such as Xanax, they actually need a little bit more of that medication to get the desired effect.
We want to take a look at our family history, our parents, our grandparents, did they have a problem with substances. Certain preexisting mental health conditions, a person is anxious or depressed, they can control their mood states and control their anxiety with medication, and that puts a person at more risk to abusing them.
Peer pressure, there is a lot of peer pressure. All of us who are in high school, we know the peer pressure to use alcohol. For today’s young people, it’s a peer pressure to use drugs and alcohol. So, it really does create a significant problem for your people. It’s their easier access to prescription drugs today. And finally, lack of knowledge about prescription drugs and their harmful effects. Most people don't do much reading about it, and really we don't have a lot of information about them. As a result, people are confident in taking medications. They don't completely understand the risk.
We look at some of the signs or potential signs and symptoms of addiction. Often what we are seeing here is change. What was the person like or what were we like prior to starting a medication, and what are we like? Have our moods changed? We have more mood swings. Are we more depressed, more irritable, more difficult to get along with? Do we feel depressed? Have some more suspicious it’s the paranoia, do we feel suicidal at times, and that’s one of the things we have to remember is that we may take a med to help us with depression and deal with problems but they can increase our suicidal feelings.
It also really changes in behavior such as deteriorating job performance, school performance, not going to school, not going to job. Poor hygiene as we don’t take care of ourselves as well as we had previously. The bottom few are really well-connected with intoxication, pupils change, slurred speech, and seeking prescriptions, really more for one doctor, it’s a little harder today than was in the past but often trying to get a prescription or showing up at various emergency rooms to get a medication.
Person may feel drowsing; it’s very easy to overdose on these medications without understanding -- acknowledging it. Separation from friends and family, since we are hiding a drug use we often avoid our friends who may notice it. With a lot of these medications, we see a decrease or increase in appetite and really a change in our behavior. And overall that’s what we are really looking for, a change in behavior.
They are dangerous all of these drugs may have a sedation or slowly or grieving effect. Many of the drugs are central nervous system depressants, they slow things down.
And finally, we do run the risk of overdosing, the longer we use a drug, the more likely that we are going to take it inappropriately and overdose. Also, the whole issue of legal issues, often people run into difficulties and what happens is they have to either buy them, sell them illegally and it often runs the risk of getting caught, prosecuted, which results in a myriad of legal problems.
There is however treatment for people and that’s important to recognize is that treatment for people who have been stared by prescription drug abuse or addiction, there is treatment for these people, the treatment can be effective. Well, look, we can look at behavioral treatment such as individual counseling, psychotherapy, group and family psychotherapy because often this is a family problem, especially if young people are involved, it impacts the sibs, it impacts the parents, it impacts everybody. Usually, the form of psychotherapy or the form of treatment most commonly used would be what’s called Cognitive Behavioral Therapy.
We also have pharmacological treatments, now this sounds a little bit strange that we are trying to help a person deal with substance abuse and we are giving them another medication but it can be very effective. And pharmacological treatment is many ways treating this as a medical moment. Now there is sort of two basic forms that we see, we often see a person prescribed methadone, which is really a longer acting synthetic opiate that is less likely to be abused. When it is used appropriately, it does not cause intoxication or sedation so a person can go to work, drive a car and do all of the things they need to do.
Well, often you will see methadone use in two different ways, one is long-term methadone maintenance where a person maybe on a certain level of methadone for long, long periods of time, it can be effective. Some people use it to help with withdrawal and the early stages of sobriety, they slowly titrate the methadone now.
A second area that’s commonly used is Suboxone; Suboxone is different than methadone. There are really two components to Suboxone, one is it helps to deal with withdrawal and cravings, and two, the naloxone aspect that we probably all read about in the newspaper or Narcan, it really reverses or prevents the effects of opiate. So when somebody overdoses, it’s not unusual that policemen, firemen will use Narcan to help them delay and save the person’s life.
Finally, the self-help options such as narcotics -- alcoholic anonymous, smart recovery which is self-management for addiction and recovery. The advantage of these is they are free and available all the time; most cities have a variety of meetings throughout the day, throughout the week that have no cost to the person, can give a person support going through withdrawal. Also, for the family we have Al-Anon/Alateen that can be very helpful. But in addition to treatment one of the things we want to think about is try its prevention. So if you are having surgery, if you feel that you are going to have some difficulty, especially in pain, sleep, tension or anxiety, discuss with your physicians of alternative treatments. Times we may be able to eliminate use or we may be able to reduce the amount and time of medication use.
For example, a gentleman named Chris Mather, a PhD. writing in the JAMA Internal Medicine notice that aerobic exercise and a variety of exercise can reduce pain by 45%, so it may be a better way to treat pain than with analgesics. People with ADHD, behavioral intervention such as cognitive behavioral therapy have been shown to be very effective with ADHD. So we may be able to use the behavioral approach along with the medication as well.
Sleep, many people have difficulty with sleep because of poor hygiene. Sometimes it’s as simple as avoiding naps, avoiding caffeine several hours before bed-time. Avoid eating too close to bed; aerobic exercise early in the day and a regular routine of sleeping; and finally, with anxiety. Relaxation training, cognitive behavioral therapy can be very effective in helping people deal with anxiety without putting them at risk for getting scared with benzodiazepines or the very least may reduce the amount of benzodiazepines that are needed.
So quickly let’s take a look at this. I know that we provide a lot of information in relatively a short period of time, but drug misuse is the use of drugs for purposes which they were not intended and that doesn’t mean the person wanted to do it, it means that this was resolved.
The signs and symptoms of prescription drug misuse vary depending on the type of medication, who is using them. So one person may look one way, another person may look differently.
They can mimic mental health problems in terms of the person looking depressed, looking anxious. Remember that while a person is using the drug essentially have a brain disease. Their brain – their neurochemical activity et cetera within the brain is different than it normally is. As a result of that their behavior may be different and also their mood may be different. So a person who is depressed may want to moderate this mood state with medication. A person who is feeling anxious on withdrawal, they want to moderate this with a medication. And that’s where the person is really significantly at risk.
Most treatments can be successful and that some combine a behavioral intervention such as psychotherapy along with some pharmacological treatment and self-help groups such as AA, some use one or more of the other, but what it is important is to talk to your treating physician really about the best way to deal with your particular problem which is really important.