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 habitué 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.

Graphics Credit: http://blog.makezine.com/

Cindy McCain’s Drug Addiction

She’s no Betty Ford.

In 1989, Cindy McCain had back surgery for ruptured disks. By her own admission, she became addicted to powerful painkillers—Vicodin and Percocet. Mrs. McCain spoke openly on television about her addiction, which had culminated in 1992 with an intervention staged by her parents. She told Jay Leno on the “Tonight Show” that she wanted to talk about the experience as often as possible, “because I don’t want anyone to wind up in the shoes that I did at the time.” She also penned a column about her addiction for Newsweek in 2001, and did an interview for Harper’s Bazaar.

As it turns out, however, Mrs. McCain’s openness about her addiction may have been the involuntary result of a yearlong DEA investigation into her drug use. Moreover, it is far from clear that addiction awareness and treatment are high on her list of First Lady priorities, should John McCain win in November.

Writing in the September 15 New Yorker, Ariel Levy says that the McCain campaign “has attempted to portray McCain’s past addiction to prescription painkillers and her public statements about it as a Betty Ford-style story of altruism and accountability.” However, in an investigation by the Washington Post into the circumstances surrounding Mrs. McCain’s 4-year bout with painkillers, reporter Kimberly Kindy writes: “Her misuse of painkillers prompted an investigation by the Drug Enforcement Administration and local prosecutors that put her in legal jeopardy. A doctor with McCain’s medical charity who supplied her with prescriptions for the drugs lost his license and never practiced again. The charity, the American Voluntary Medical Team, eventually had to be closed in the wake of the controversy.”

The Washington Post probe, based in part on official county records in Phoenix, documented that Mrs. McCain obtained her drugs from her medical charity non-profit organization through the group’s medical director, who wrote prescriptions for her in the names of unsuspecting employees. The Phoenix New Times obtained excerpts from a journal kept by an employee of the American Voluntary Medical team. One such excerpt begins: “I do not know what Cindy is up to but it appears as though she is trying to use several doctors’ DEA #s so that she can acquire drugs for personal use....”

In 1993, the DEA began to take an interesting in Cindy McCain’s case. The DEA pursued the investigation for almost a year, during which Mrs. McCain hired John Down, the attorney who had defending her husband in the Keating 5 scandal. She faced several federal charges, including fraud and forgery, which could have resulted in a jail sentence of up to 20 years. According to the Post, “Down negotiated a deal with the U.S attorney’s office allowing McCain, as a first-time offender, to avoid charges and enter a diversion program that required community service, drug treatment, and reimbursement to the DEA for investigative costs.”

Mrs. McCain has not publically discussed the nature of the treatment she received as a result of the deal. The Washington Post article said that “the only public reference to treatment is her mention in the county investigator’s report of a one-week stay at the Meadows,” a treatment facility in Arizona.

First Lady Betty Ford went through a similar addictive ordeal with painkillers. From her biography at the National First Ladies’ Library:

“Her family became alarmed with Betty’s drinking and apparent addiction to pain pills. In 1978, just before her 60th birthday, they had an intervention. Thereafter, Betty Ford checked into the Long Beach Naval Hospital for treatment. The treatment was tough, but she later acknowledged that it probably saved her life.

“Betty’s experiences led her to create the Betty Ford Treatment Center in Rancho Mirage, California. From the start, Mrs. Ford was open with what she had gone through. The Center has become her greatest accomplishment. As the head of the Board, she continues to be actively involved in the Center.”