A menudo la Adicción empieza en un hospital
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Some doctors aggravate prescription drug abuse
By Chris Zdeb, Edmonton Journal
Prescription drugs are suspected in the death of singer Michael Jackson. If the toxicology report from the autopsy confirms this, he joins a growing number of people falling victim to prescription-drug abuse.
Public perception is that illegal street drugs are a bigger problem than prescription-drug misuse, but that’s not the reality, says Calgary psychiatrist Dr. Ronald Lim. So many people abuse and are addicted to the drugs found in their medicine cabinets, that he calls it “an epidemic.”
Whenever someone high-profile like actress Anna Nicole Smith, and possibly Jackson, dies because of their prescription-drug abuse, Lim says, it shines a light on the problem, and that’s a good thing.
The most commonly abused prescription drugs are opioids (pain-relievers) and benzodiazepines, used to treat such things as anxiety, panic attacks, depression, insomnia and stress, because they affect the mind, behaviour or mood.
In 2002, the Canadian Centre on Substance Abuse found Canadians were among the heaviest consumers of such medications — the fourth highest per-capita use — in the world.
“Part of the problem is that North Americans expect that there’s a magic pill for everything, and they put pressure on physicians to give it to them,” says Lim, medical consultant for Alberta Health Services’ opiate-dependency program.
In the short term, these drugs are highly effective, but very addictive, and it’s a known fact that 10 to 15 per cent of the population is at risk for developing substance dependency, he explains.
Since 2005, the rate of new prescription-drug addicts has outpaced the number of people getting hooked on marijuana, the most commonly used illegal drug in North America, Lim says.
“People don’t think of (prescription drugs) as an addiction because they’re prescribed to them initially, because they’re made by a drug company, and sanctioned by medical professionals,” Lim says. “But that doesn’t mean their properties are any different from those of illicit drugs to the brain.”
Prescription drug problems often start in hospitals. Auto mechanic Patrick Lance, 39, developed his addiction in one, 11 years ago, after falling off a hoist at work and breaking his back. It took several surgeries to remove three squished discs and fuse his spine. Lance, who was living in Calgary then, spent eight months in hospital, where he became dependent on the morphine he was getting for pain.
“I had a concern when they started giving me morphine, but the doctor said, ‘Don’t worry, it won’t make an addict out of you,’ ” Lance recalls.
When he was discharged, the doctor said, “Don’t worry, you’ll be up and jogging in no time.”
In hospital, Lance had received 300-400 mg of morphine a day, but his family doctor, who didn’t believe in prescribing high doses, cut that back to 90 mg.
“He said, ‘You’re going to have to make do with the dose I give you and you’re going to have to take some of the pain,’ ” Lance says.
“But I just couldn’t handle it, the pain was that bad. I was going through morphine like candy and it wasn’t doing anything because I had built up a tolerance.”
He thinks he took about 40 ambulance trips to emergency the first few months seeking help, but after checking with the doctor who had treated him in hospital, the emergency physician would come back and tell Lance they couldn’t help him.
“Hospitals addict you and then they show you the door and the most they give you is Tylenol 3s.Come on! From morphine to Tylenol 3s, that’s a big drop.”
While waiting one day to see his surgeon, Lance met a man who told him about a guy on the street, a former paramedic, could sell him morphine. The paramedic had lost his job because of his own addiction to morphine. (Medical professionals have a 15-20-per-cent risk of becoming addicted because of their easy access to prescription drugs.)
Lance says the street dealer injected him with morphine which, he says, worked better than pills.
“He injected me and wow! the pain was gone and I was feeling just great,” Lance says. He then taught Lance how to inject himself.
Within two years, he went from an employed and married father of two young kids, to an addict panhandling on the street after his wife found needles in his jacket pocket and threw him out of the house.
“She said, ‘I don’t want a druggie living here,’ instead of helping me.”
Turned to AADAC
Lance lived in motels until his savings ran out, then he sold his car. When he couldn’t reach a satisfactory settlement with the Workers’ Compensation Board, the morphine addict, who was shooting up four or five times a day, turned to the Alberta Alcohol and Drug Abuse Commission (AADAC) for help.
He was added to the list of 180 people waiting for treatment and told he would probably get help faster in Edmonton. The list in Edmonton turned out to be just as long, but Lance heard about a Dr. Mat Rose working with addicts at the inner-city Boyle McCauley Health Centre.
The problem with prescription drug use starts with the physician who doesn’t do a thorough substance use and abuse assessment with a patient prior to prescribing opiads, mostly, because the system isn’t set up for that, says Rose.
Yet, a predisposition to addiction or substance abuse because of other problems in a person’s past, problems with alcohol, or because of genetics, is one of the strongest predictors of people developing addictions to prescription drugs.
Melinda Hollis with the Loussa Counselling Centre, thinks many people are unnecessarily medicated.
“I honestly think drugs are given out too easily when it comes to dealing with anxiety and depression. We’re told that feeling bad is not acceptable, so we’re the society that’s into feeling good and instant gratification, but feeling bad is a natural part of who we are, as natural as feeling good, and we need to learn to embrace that,” Hollis says.
She blames pharmaceutical companies, which do a$330-billion business in the United States annually.
“Drug companies are very big business and doctors are trained to deal with people with pharmaceuticals, that’s what they know,” Hollis says.
Physicians like to blame the pharmaceutical industry too, Rose says, but that’s like running over a bunch of people with a fast car and then blaming the car manufacturer.
“Physicians are both, and often within the same person, too paranoid and too open-handed with how they prescribe,” Rose says. They won’t prescribe morphine because it’s morphine, but will prescribe Percocet, a painkiller stronger than morphine. Or they’ll prescribe morphine and give the patient a three-month supply, because it’s easier than having to see them every week or two, he explains.
People with conditions requiring painkillers who are carefully screened and monitored, basically never develop an addiction, even those who are at higher risk, Rose says.
‘Lucky to be alive’
“One of the things I drive home to medical students is you’re probably doing the best job for your patient when they leave without a prescription or when their prescription hasn’t been increased, because it means you spent time telling them that the benefits of a prescribed medication are outweighed by the risks at this point in time, and you’ve probably given them some advice about lifestyle changes to improve their health,” Rose says.
Opiate dependency expert Dr. Ronald Lim says both patients and doctors have to move away from thinking that every pain needs a painkiller. “They should think of other ways of managing the symptoms first,” he says. It’s one part of a multi-pronged war on prescription drug abuse.
The first time he saw Rose, Lance told him the truth about things such as double-doctoring (visiting multiple doctors to get prescriptions) to feed his addiction, and was immediately put on methadone, a synthetic narcotic drug similar to morphine, but less habit-forming, used in narcotic detoxification.
Seven years later, Lance is a recovering addict, living on disability assistance, in an inner-city group home. He’s estranged from his kids, but hopes that changes once they’re 18, if he can get an opportunity to explain what happened to him.
For now, “I’m trying hard to keep my head above water. I’m lucky to be alive.”
REDUCING YOUR RISK FOR PRESCRIPTION ADDICTION
– Be a proactive patient
– Ask if there is an alternative to drug therapy for your medical problem
– Tell the doctor about your use of alcohol or illicit drugs and any family history of substance abuse or addiction
– Ask the doctor for a rundown of the pros and cons of a drug being prescribed and how addictive it is
– Tell the doctor about other medications or natural therapies you’re taking that could negatively interact with a new prescription
– Strictly follow the doctor and pharmacist’s instructions for taking the drug
– Educate yourself about the drugs you’re prescribed. Ten to 15 per cent of the population is at risk of developing an addiction, but 100 per cent of people who take a painkiller like morphine, for at least four months, will develop a physical dependency and will go through withdrawal if they suddenly stop the medication.
Sources: Dr. Mat Rose, Boyle McCauley Health Centre and Dr. Ronald Lim, Alberta Health Services