Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: oxycodone (page 2 of 2)

Time magazine piece: “Addiction by prescription”

Time drug art

Stephen Lewis for TIME

Jeffrey Kluger has a story about the boom in prescription drug addiction in the Sept. 13 issue of Time magazine. Full story not on the website, but here are some tidbits from the issue that came in the mail:

  • In 15 states and the District of Columbia, unintended drug overdose is now the leading cause of accidental death, having surpassed car wrecks—and in three more states, it’s almost a tie. … No telling which drugs are doing it, he writes, but most experts agree that the “exploding availability of opioids could be behind the exploding rate of death.”

Written in true Time alarmist style, but consider the statistics Kluger lines up:

  • In 2007 (the most recent year for which data are available!! for godsake) 3.7 million people filled 21 million legal prescriptions for opioid painkillers
  • 5.2 million people 13 and older said they used these drugs “nonmedically” in the previous month.

Which is probably an underreport. Just taking my own case as an example: if you’d asked me back in 2000 whether I was using my Lorcet “nonmedically”? I’d have said, “No indeed,” despite the fact that I was chewing the pill that I took every day, which is a “nonmedical” way of using an opioid painkiller. I had pain, and I was taking one pill a day—one pill a day! how could that do anyone any harm—was my thinking. I had been to meetings where drug addicts had talked about selling the entire contents of their houses, selling their bodies, risking their lives for drugs… I couldn’t relate. I thought, Surely I can’t be an addict… I take one pill.

Here’s what I wish had happened: I wish a physician had asked me point-blank, “Do you chew your medication?” (I wish I could tell you how many people get here by Googling “chew Vicodin” or “chew Lorcet.” It’s a lot. I’m sure Analytics could give me the exact number… it’s hundreds.) Not the nurse, not the fellow-in-training—the physician. The prescriber. … I might have blinked too many times, or stuttered, or sweated, or given some clue. (I’m a terrible liar. Both my blood pressure and heart rate were sky-high at my doctor visits toward the end of my active addiction.)

And then I wish the doctor would have said, “You know, G, chewing pills is a way of taking medication ‘not as prescribed,’ and it’s a sign that your behaviors have changed from appropriate use into inappropriate, dangerous use. I’m concerned that you could be addicted. Addiction is a fatal illness. I’d like you to see an addictions specialist for an evaluation, and I have the names of some here that I trust. But don’t worry about being kicked out, because we’re going to make sure that you’re taken care of throughout this process so that you can keep doing your life to the best of your ability. It might be difficult for a while but we’ll help you.”

This is my dream for pain patients who cross the line into addiction. I would have gone along with the above scenario and saved myself a lot of pain. I’m not naive enough to believe that everyone would… But I think there are a lot of people suffering actual pain and actual addiction, who simply don’t know how to get out of the bind.

Anyhow, I saw my own story in the history Kluger outlines. He talks about how the “epidemic” had its roots in the campaign to make pain the “fifth vital sign.” In the late 1990s the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the body that accredits hospitals, nursing homes and other facilities, wanted to get staff to treat pain more assertively, so they developed methods to evaluate pain along with the other vital signs—temperature, blood pressure, heart rate, and respiratory rate. As a result, these days, during assessment, nurses will quite often ask you to rate your pain on a scale of zero to ten (sometimes, I notice, nurses get it wrong and say “one to ten”), with zero being no pain and ten being the worst pain you can imagine.

So, over time, more attention was brought to the phenomenon of pain. And to the treatment of pain. The sensibility that developed was that pain was an illness in and of itself, and as such it should be treated aggressively with medications tailored specifically for that purpose.

During this time I was in the position of talking with people who had participated in the writing of JCAHO’s fifth-vital-sign policies—as well as prominent physicians and policy analysts who were trying to bring attention to pain treatment. During my reporting, I happened to mention to a few of them that I was having intractable migraines and other pain. And they encouraged me to get myself to a pain clinic. And I did. And I was given daily opioids in great quantity: hydrocodone to morphine to OxyContin to fentanyl.

At that first appointment, as I recall, the physician and her fellows asked me if I’d ever used street drugs, and I hadn’t, so I said no. Good girl that I was, I’d never even smoked pot. They asked if I drank and I said no, because I didn’t—not then. This apparently proved to everyone’s satisfaction, even mine, that I had no problem with addiction. Meanwhile, if you’d turned over the rock of my life, you’d have found crawling under there the facts that my mother had died of lung cancer having failed ever to quit nicotine, and my father was well on his way to a nasty end via cirrhosis and GI cancer due to alcoholism. And I myself was chewing Lorcet—which I thought (insisted to myself during lengthy subconscious arguments even then) was no problem, because it was Just One Pill Per Day.

I was a white professional middle-class mom with two neurological disorders. Hell, I remember being down with a migraine during my first appointment at the clinic. I was practically prostrate with pain—truly. But it was all good because, says one source in Kluger’s piece:

When you’re well dressed and you have insurance, they don’t think of you as an addict.

More importantly, I didn’t think of myself as an addict.

So I saw myself in Kluger’s story. It had unrolled just as he said, and I could hear the voices of the players.

Do I blame them? Hell no. As they say, nobody shoved anything down my throat. I did it my own self.

Even so, I can hear the voices of the blowback, the chronic pain patients and those in the same bind as I was in, as well as the drug companies…  wanting to protect patients’ sources of medication (and profits) by vilifying and calling to lock up the “junkies” who “just can’t control themselves.” When in fact we should all be able to work together.

A final point: Kluger did get the drugs wrong. OxyContin/OxyIR and Vicodin/Lorcet were much more widely prescribed than any fentanyl preparation during the 1990s. And he misses methadone altogether. Some pain clinics were using methadone exclusively: they believed it to be “unabusable” because they thought its long half-life would prevent people from using it to chase a high. But people with addiction will always use ANY opioid (yes: even Suboxone) to chase some kind of feeling. And the data show that many overdoses (perhaps not always fatal, but nevertheless) are due to methadone.

CDC: Oxycodone ER visits up 152 percent in five years

The Centers for Disease Control and Prevention (CDC) director is calling for “urgent action” due to a sharp increase in emergency-room visits—in other words, overdoses—for illicit prescription opiate use.

Oxycodone (the active ingredient in OxyContin) is the most-abused pain drug—visits for nonmedical use have jumped 152 percent from 2004 to 2008 to 105,214 visits.

Hydrocodone (the active ingredient in Vicodin, the most commonly prescribed drug in the U.S. by about twentyfold) is second on the list—ER visits rose 123 percent to about 89,000.

Methadone came third, with a 73 percent increase to 63,629 overdoses.

Reuters reported this story a few days back. Statistics from the Drug Abuse Warning Network (DAWN); in all the reporting I did about end-of-life care, I never understood why DAWN’s stats couldn’t be more recent, I mean here we are halfway through 2010 and we can only get ER data from 2008?—but hey. … What’s provocative are the comments: As in the story about the Kansas doctor on trial for causing 68 fatal opiate ODs, the remarks are divided largely into two camps: those advocating for pain patients’ rights to opiate treatment, and those advocating for/against “enforcement.”

One or two stray comments call for allowing as many “junkies” as possible to OD fatally (!!), as the “natural consequence” of their poor choices. For fook’s sake, as they say here in Yorkshire.

What we need is more compassion for both pain patients and addicts.

Just today I was responding online to the partner of an addict who wanted to know whether addiction could really be considered a disease. “A ‘disease’ implies that people have no control over the substance abuse,” this person said, “when, in fact, substance abuse is a choice.”

Do people who get diabetes by eating too many boxes of Krispy Kremes despite a family history of diabetes not have a disease?

Do people who get cancer by smoking too many cartons despite the surgeon general’s warning not have a disease?

Do people who get heart disease by eating too many burgers and steaks on top of a genetic predisposition toward heart disease not have a “real” disease?

Do people who get high blood pressure by indulging in too many pizzas and bags of junk food on top of a family history of hypertension not have a disease?

Do people who get addicted by eating too many drugs or drinking too many beers/scotches/vodkas on top of “bad genes” not have a disease?

These are not rhetorical questions. I really wanna know what you think.

More Americans over 50 seeking drug-treatment

On the Today Show this morning: The rate of baby-boomers checking themselves into detox units has doubled.

More stats:

• admissions for heroin addiction: doubled from 1992 to 2008

• admissions for cocaine: quadrupled

• admissions for prescription drug abuse: quintupled

From the Today Show’s resident physician, Nancy Snyderman: “Patients want to go to their doctors and say, ‘Give me something, I can’t sleep. Give me something, I’m anxious.’ Doctors don’t want the pressure and say, ‘Sure, here’s your prescription, but I’m only giving it to you for two times.’ Then patients go doctor-shopping. And we are all complicit.”

Then she brings up Heath Ledger. Which is interesting, because so did the Time article we talked about yesterday. Heath Ledger died in 2008 aged 28 from an overdose of oxycodone, hydrocodone, Valium, Xanax, and a couple other drugs, according to the New York City medical examiner’s office. Said Snyderman:

Everyone should think about Heath Ledger. That was an accidental overdose that a lot of people who have affluence and means and a couple extra dollars can be a pill combination away from. If women think, “Oh, this can’t happen to me”—remember the last time you blew $60 on some fancy face lotion? If you’ll do that, you’ll spend $60 on a prescription medication. So we can’t all say it’s people we don’t know—it’s your next-door neighbor.

Kansas doctor accused of causing 68 fatal opiate ODs

A two-month trial of a Kansas doctor accused of contributing to the deaths of 68 patients who overdosed on opiates he prescribed them has gone to a jury today in Wichita.

According to Time magazine, prosecutors allege Dr. Stephen Schneider and his wife, Linda, prescribed large amounts of all manner of opiates—Schneider prescribed hydrocodone, oxycodone, fentanyl, you name it—to patients without enough oversight, and with profit as their primary motive.

The defense, the story says, argues that the Schneiders provided proper and compassionate care for pain patients who couldn’t get it elsewhere, and also:

that the deaths were due to underlying conditions or dangerous choices by addicted patients.

The Time article, and also an Associated Press story, quote a lot of people, including:

pain-patient advocacy organizations who say that “This is really a civil rights issue” because pain patients can’t get their meds and are treated like hell when they go to the drug store or the doctor

bioethics people who say that “most government prosecutions appear to be well-founded” but that if everybody keeps talking about arresting docs for “overprescribing,” it’s gonna have a “chilling effect” on taking care of pain patients

DEA dudes and prosecutors, who say, bottom line, SOMEBODY IS GONNA HAVE TO BE ARRESTED HERE, OK?—so let’s get on with it. Who can we lock up?

Does anybody talk to an addict? No.

Addiction is squarely at the center of this story, it is the elephant in the room, and nobody is quoting an addict.

I find this absolutely fascinating.

Quote me:

Guinevere Matheson, a recovering addict and writer experienced in health-policy issues, told the press as the jury went to trial, “What this case highlights is the fact that physicians do not know how to recognize addiction in the doctor’s office. When we hear the term ‘addict,’ we think of a homeless person living under a bridge, jamming a dirty needle into his arm. This is not an enforcement issue, it’s a public-health issue. Physicians are treating more pain, so it’s logical that some chronic pain patients are going to become addicted. Addiction is a disease, just like diabetes, AIDS or cancer—we need to understand how to recognize it and treat it.”

Update: After deliberating seven days, the U.S. District Court jury convicted the Schneiders of 19 criminal counts, including illegally prescribing opioids, laundering money, and defrauding the health-care system. More about the convictions here. The source says the Schneiders prescribed Actiq lollipops to a migraineur who subsequently overdosed… This practice isn’t as rare as the story makes out. Many of us were prescribed Actiq for migraine. What saved those of us who lived remains a mystery.

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