If you haven’t had a cup of coffee yet today, here is an eye-popping curve that will wake you up. The national Centers for Disease Control and Prevention discovered that over the last forty years the death rate from prescribed drugs rose over 400%. The curve below tells the story. It shows the death rate from accidental drug overdoses per 100,000 people. In math class this curve would be called exponential. Of prescription drug deaths, about ¾ are from pain relievers. In 2008, for example, these drugs- opioids- killed 14,800 people. The total drug death rate now is roughly the same as the death rate from car crashes. This figure means that the abuse of prescription drugs is the fastest growing drug problem in America.
A big problem with legal drugs is that they can move from the people who need them to those who don’t. The DEA calls this diversion. Take, for example, the recent story of methadone. This drug has a proven benefit for treating addiction and patients with terminal illness. In recent years doctors began to use it for patients with chronic pain. Although it is prescribed only 2% of the time for this indication, it’s responsible for more than 30 percent of prescription painkiller deaths. Most likely this is in part because of drug diversion.
Kids are world champs when it comes to drug diversion. They find drugs at home, and pass them like candy from friend to friend. Surveys find that they fool with prescription drugs more than they do heroin, cocaine, and methamphetamine combined. Among 12 and 13 year olds, prescription drugs are the drugs of choice. In 2011 8% of high school seniors had tried them. The most common ones are pain medicines (e.g., Vicodin, oxycodone, OxyContin), stimulants (e.g., Ritalin and Adderall), and less often, tranquillizers (e.g., Xanax, Ativan).
Why do they do such stuff? Most of all, because the drugs are available. Open your medicine cabinet and see if you have any mind altering left-overs there. You don’t? Good! Some folks do. Kids can purloin them from purses, or from the medicine cabinets of their grandparents. 54% of high school seniors say that pain drugs like Vicodin are easy to get. Boys tend to abuse stimulants to get high. Girls take them to stay alert.
Kids also mess with them because they think they’re safer than street drugs. Nothing could be less true, which is why you need to go to medical school to learn how to prescribe them safely. They can also get them at the local pharmacy in the form of over-the-counter drugs (e.g., DXM, or dextromethorphan, a component of cough syrup). Finally, doctors and dentists have made them more available in past years, nearly always for the compassionate relief of pain.
Since this report, the response from government has been both admirable and scary. States have targeted doctors in pain clinics and patients who divert drugs illegally. Computerized patient drug data now flow across state lines to catch those who shop for sympathetic or unethical doctors. The right of privacy is rarely defended against the trampling of regulatory feet. But some ideas are enlightened. One bill in Massachusetts sponsored by Steven Tolman and others would increase the availability of the drug naloxone, which is life-saving in any narcotic overdose.
This mix of bad policy and good in the last few years appears to have helped more than it’s hurt. For example, the number of people who abused prescription drugs fell from 7 million people to 6.1 million in 2011. In 2009, 2.1% of the population abused pain pills. Two years later it was 1.7%. This is the lowest rate since 2002. The drop was particularly encouraging among 18 to 25 year olds. The numbers may seem small, but from a public health perspective these gains are great, especially when you consider the rising tsunami of prescription drug deaths over the last decade.
But the game of preventing prescription abuse starts at home, and parents hold the best cards. You play them by educating your kids about drugs, keeping the meds secure, and getting rid of them once they’ve done their job. Stockpiling drugs is always a no-no. There are those situations when, despite your best efforts, you make no progress in keeping a kid safe from drugs. That’s a time for professional help.
Remember, though, that the drugs in the medicine cabinet were put there for good reason. For the right person and the right dose they reduce suffering and save lives. When they are in the wrong hands and used for the wrong reasons, drugs are trouble. This is especially so when kids free to help themselves to some of the most powerful chemicals in history. This is not new knowledge. In 1960 the Massachusetts physician Oliver Wendell Holmes said “if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be better for mankind- and all the worse for the fishes.” Certainly this should apply to your medicine cabinet, when its contents are no longer needed.