Sunday, July 18, 2010

Pill Head: Book Review

Desperately seeking Vicodin.

Recently, the Office of National Drug Control Policy, home of the nation’s “drug czar,” released a survey of the nation’s drug use, demonstrating that prescription drugs used non-medically have become the nation second most “abused” drug, after marijuana. In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA) chipped in with a cheery report that painkiller drug abuse had increase by a staggering 400% from 1998 to 2008.

 Radio entertainer Rush Limbaugh’s 2006 bust put prescription drug abuse on the public radar. Limbaugh surrendered to authorities on a charge of prescription fraud involving pain pills, the result of a three-year investigation into Limbaugh’s addiction to oxycontin—an addiction that may have cost him his hearing.  (Earlier, in 2001, Winona Ryder was arrested for shoplifting and found to have collected 37 prescriptions for painkillers from a total of 20 different doctors.)

Joshua Lyon, the young author of Pill Head: The Secret Life of a Painkiller Addict, can tell you exactly how people have pulled that off: Steal a prescription pad. “Doctor shop” with a list of hard-to-disprove physical ailments. (Migraine is a favorite.) Impersonate a physician and call a pharmacy if you have his or her Drug Enforcement Agency (DEA) number. Perhaps connect with a corrupt pharmacy employee, or with an organized ring of truck thieves. Another favorite is stealing pills from old people. Or you can suck it up and try buying them in bars or on the street. For a while, Joshua Lyon found a workable shortcut: “I just posted a bulletin on my MySpace page, asking if anyone had any Vicodin they wanted to sell. By the next day I had three different offers.” Users have learned to easily circumvent the time-release formulations by crushing the pills and snorting the powder, like Edie Falco’s Nurse Jackie. Corrupt doctors don’t appear to play a major role in much of this, even though they are a favorite DEA whipping boy.

Lyon’s pain pill odyssey began in 2003 when, as a 27-year-old reporter for Jane magazine, he was assigned a story about the “no prescription needed” Internet pill farms that were stuffing everyone’s email inbox with spam about cheap drugs. The author placed his orders, and in a few days, received Fed Ex boxes containing Xanax, Valium, and Vicodin. In only one case was he required to talk to a prescribing doctor over the phone. The "doctor" briefly asked him why he wanted painkillers, and then simply asked him how many pills he wanted.

No stranger to drug use, and a frequent habituĂ© of the gay club scene in New York City, Lyon quickly discovered that prescription opioids were his drugs of choice. “The media,” he writes, “hadn’t dubbed us ‘Generation Rx’ for nothing.” A DEA official told Lyon: People taking Vicodin or hydrocodone, which is probably the most popular pharmaceutical drug in the United States, get the same rush as they would taking heroin, but you’re taking something that people perceive to be safe.”

There is at least a partial answer to prescription drug abuse: digital prescription databases. Unlike other addictive drugs, opioid medications begin life as legal compounds, licensed and produced under specific federal guidelines. The implementation of an electronic prescription drug reporting system, something several states have already undertaken, is a first step, but is obviously limited by the lack of a federal clearinghouse. And privacy concerns have hampered attempts to systemize the collection of prescription records from different doctors.

A health worker in a Lower East Side naloxone program told Lyon that if he called the ambulance about an OD, “don’t tell them that it’s an overdose. Tell them your friend has stopped breathing. They’ll come faster that way.”

All of this makes the ready availability of naloxone, the anti-overdose drug, an ethical imperative. See my posts on overdose kits for opioid addicts HERE and HERE.

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1 comment:

Bobby said...

Thank you so much for braining this issue to our attention. Addiction to painkillers is out of control. Especially with the younger generation, the use of painkillers is becoming all to common and even acceptable. This is so dangerous because painkiller addiction is really difficult to break. It is a painful detox process and because they are so easily available, relapse is hard to avoid. Thanks again.

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