Community and Health Implications of PrescriptionDrug Abuse in KentuckyBy: Holly E. Hopper, MRC

Health Associate, HEEL Program

How common is prescription drug abuse?

Nationally, 2% of the population age 12 and older have misused prescription drugs.

Most misused were: Pain relievers (2.6 million) Sedatives (1.3 million) Stimulants (.9 million)

These trends most seen in older adults, women, and teens.

How big is the problem?

In 1999, approximately 9 million Americans used prescription drugs for non-medical reasons.

These drugs are often taken in large doses or are altered before they are taken.

Since January 2003, 345 Kentuckians have died from methadone-related overdoses alone.

On average, Kentucky has 400 overdose deaths per year. (Associated Press, May 10, 2004)

Prescription Drug Abuse in Kentucky

Prescription-related Deaths in Kentucky Oxycodone-related deaths have increased since

1998. From January 2000-May 2001, the presence of

oxycodone was identified in 69 deaths (Kentucky State Medical Examiner’s Office).

During 2000, there were 19 OxyContin-related deaths in Pike County (Pike County Coroner).

7 OxyContin-related deaths occurred in southeastern Kentucky during December 2000 alone (Area Law Enforcement).

Terms: Diverted substance - a legally

prescribed substance that is illegally sold or misused.

Opiates - naturally occurring substance, from the opium poppy that has pain relieving properties

Opiods - synthetic drugs that act like morphine and are very effective pain relievers

Methadone Abuse: Diverted substance Methadone, common treatment for narcotic

addiction, is often abused or diverted. Clinics in Bowling Green, Lexington, and Louisville

are known for diverted methadone transactions. Pills not taken in compliance are often crushed,

filtered, and injected intravenously. In the Fall of 2000, 6 individuals died from

methadone overdoses in Breathitt County alone. Since January 2003, 40 people have died from a

combination of methadone and alcohol or another pain killer. (County Coroner, Bobby Thorpe, Associated Press, May 10, 2004)

General Implications of Prescription Drug Abuse

Community crime rates have increased. Families experience the stress of drug-

seeking family members. Drug-related health conditions emerge, often

resulting in disabling or life-threatening results or death.

Employability declines resulting in damage to the local economy.

Effects of Drug Abuse on Community and Health Increased crime rates Increased risk of harm Loss of medical professionals Chronic disease Over-utilization of emergency care Occupational stress/loss Family distress Child abuse/neglect Death

Methods used by Abusers ofPrescription Pain Medications Abusers do not take prescription medications

as directed. Abusers may be dishonest to healthcare

providers to get prescription medications. Abusers may crush pills in order to snort, eat,

or inject the powder. Abusers often take medications in high doses

or when pain symptoms are not present.

Types of Commonly Abused Prescription Drugs

Stimulants (“Uppers”) Prescribed to treat narcolepsy and

attention deficit/hyperactivity disorder CNS Depressants (“Downers”)

Used to treat anxiety and sleep disorders Opiates/Opiods (“All-Arounders”)

Often prescribed to treat pain

Natural “Feel Good” Chemicals Endorphins-the body’s natural

pain killer Dopamine-the brain’s “pleasure”

chemical Serotonin-the body’s “mood

control” hormone

Natural High vs. Chemical High: Surprising Similarities Endorphins

a naturally occurring chemical, is released in times of stress, to decrease pain, or to produce pleasure.

3 times more potent than morphine. Individuals with chronic pain have high levels of

naturally occurring endorphins. Endorphins release during food consumption

and pleasurable physical activity. Exercise-increased production releases

endorphins, resulting in a sense of euphoria that has been popularly labeled “runner’s high.”

How Do Pain Killers Work?

Many painkilling drugs, such as morphine and codeine, act like endorphins by activating the same receptor sites in the brain.

Euphoria is only experienced with the use of prescription pain medication when there is no physiological pain present or when taken in larger doses.

Health Risks Associated with Prescription Drug Abuse Addiction

Severe respiratory depression Organ damage Heart damage Seizure Death

Most commonly abused prescription drugs in Kentucky

Alprazolam, Diazepam (Xanax) Oxycodone (OxyContin, Percocet,

Percodan, Tylox) Diazepam (Valium) Hydromorphone hydrochloride (Dilaudid) Methadone hydrochloride (Methadone) Codeine phosphate/sulfate (Codeine) Amphetamine sulfate (Amphetamine)

Source: Kentucky Drug Threat Assessment, KSP, 2002

What are Opiates and Their Uses? Opiates have been used for thousands of years

for both recreational and medicinal purposes. Morphine, derived from the opium poppy, is a very

powerful painkiller and the most active by-product, but it is also very addictive.

Morphine was named after “Morpheus”, the Greek god of dreams.

Codeine, a less powerful drug, is also found in opium.

Opiates relieve pain, relax muscles, and cause drowsiness.

Pain-relievers: Opiates and Opiods of Abuse

Morphine was discovered to be addictive after the American Civil War.

Heroin was created as a less-addictive substitute.

Most morphine and heroin use outside of the military was in cough “mixtures”.

Camp physicians gave miners painkillers to help them work longer in the mines without feeling fatigue.

Use of Sedatives or CNS Depressants In 1975, Valium© was the world's bestselling

drug - 15% of Americans were taking it. Most doctors have now stopped prescribing

benzodiazepines for long-term use because of worries that they might cause addiction.

Used to treat anxiety attacks. Used to help sleeping difficulty. Used to calm people before dental treatment

or surgery.

Treatment Uses of Commonly Abused Prescription Drugs Anxiety

Tension Sleep disorders Panic attacks Chronic pain Post surgery pain Pre-anesthetic preparation Severe diarrhea Cough

Stimulants of Abuse: AmphetamineAmphetamines were used to help soldiers stay alert for

many hours; to be better soldiers.

Medical warnings now read:

METHAMPHETAMINE HAS A HIGH POTENTIAL FOR ABUSE. IT SHOULD THUS BE TRIED ONLY IN WEIGHT REDUCTION PROGRAMS FOR PATIENTS IN WHOM ALTERNATIVE THERAPY HAS BEEN INEFFECTIVE. ADMINISTRATION OF METHAMPHETAMINE FOR PROLONGED PERIODS OF TIME IN OBESITY MAY LEAD TO DRUG DEPENDENCE AND MUST BE AVOIDED. PARTICULAR ATTENTION SHOULD BE PAID TO THE POSSIBILITY OF SUBJECTS OBTAINING METHAMPHETAMINE FOR NON-THERAPEUTIC USE OR DISTRIBUTION TO OTHERS, AND THE DRUG SHOULD BE PRESCRIBED OR DISPENSED SPARINGLY.

What are Amphetamines? All amphetamines are based on the naturally occurring

chemical, ephedrine, found in the herb Ephreda vulgaris.

Chinese people have used this plant for over 5000 years to treat asthma.

In 1887, chemists made amphetamine, a synthetic substitute for ephedrine.

Amphetamine affects the brain, increasing alertness and decreasing appetite. It increases the levels of dopamine, the “excitable, movement control, emotional response, pleasure, and pain” chemical.

The natural form, ephedrine, causes heart damage and risk of stroke or death.

Marketing Lies for Amphetamine-containing products DIRECTIONS FOR MEN & WOMEN: As a dietary supplement,

take 3 capsules with a 12-ounce glass of water 3 times daily, approximately 30 to 60 minutes before meals (preferably before breakfast, lunch, and dinner). Do not exceed 3 capsules in a 4-hour period and/or 9 capsules in a day. Do not take within 5 hours of sleep. To assess individual tolerance, follow the dosing chart below.

Week 1 1 capsule, 3x dailyWeek 2 2 capsules, 3x dailyWeek 3 & beyond 3 capsules, 3x daily

For best results, combine (product) with a low-fat, calorie-reduced diet and an exercise program. Do not snack after dinner. Consume ten 12-ounce glasses of water per day. Read the entire label before use and follow directions.

Why Do Drugs Feel Good?

Scientists believe addictive drugs activate the brain's 'reward system‘ by increasing the release of dopamine in the brain.

Dopamine release occurs naturally after food or sex, but can also be induced by some drugs.

Drugs that artificially increase dopamine-release in this way may cause craving for more.

Some people may have a genetic tendency to quickly develop drug addictions.

What is Addiction? Unpleasant withdrawal symptoms that occur

unless users regularly take the drug.

Drug cravings that interrupt thought until drug is taken or person becomes distracted.

An overwhelming urge to continue taking the drug, even after withdrawal symptoms have disappeared or negative consequences are experienced.

Signs of Prescription Drug Addiction Excessive tiredness

Physical complaints with no identifiable cause Lying Lack of control or impulsive behavior Doctor shopping Difficulty discussing prescription use without getting

upset Arguing about or justifying personal use Late to work Inability to stay awake Erratic behavior Seeming to be in a “deep hole”

Signs and Symptoms of Medication Misuse Changes in sleeping and eating patterns

Confusion or disorientation Malnutrition Poor hygiene Neglecting one’s appearance Slurred speech Incontinence or difficulty urinating Constipation Complaints of blurred vision or dry mouth Tremors Shakiness Frequent falls and bruising

Depression and the Prescription Drug Abuser Persons addicted to drugs become desperate

to just feel normal. Substance abuse has so altered brain

chemistry that this process takes time. Depression, physical pain, and anxiety are a

part of the withdrawal process. Medical supervision is necessary as stopping

use of prescription drugs without medical supervision can sometimes be fatal.

                                                                                                                            

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Prescription Substance Use Among Older Adults

Older adults are prescribed medications 3 times more than the general population.

This group has poorer compliance with directions than any other group.

Addiction rarely occurs among people who use the drug as prescribed.

Inappropriate use increases the risk of addiction.

Tolerance and dependence to medications are normal results of the treatment process.

Refusal to discuss these symptoms can lead to addiction.

What Can Extension Do? Educate the public about proper medication use. Target senior’s groups and those with chronic illnesses that

may be treated with prescription pain killers. Inform others of the importance of proper medication storage.

Family members should monitor quantities of medication accessible to in-home caregivers and guests.

Inform individuals of what to do if they feel they are dependent on medications. Symptoms can be eased and doses tapered to decrease the discomfort of withdrawal and craving.

Provide assurance to those older adults who suffer conditions that require such treatment. Appropriate use under medical supervision is not addiction.

Stress that prescription abuse is not about bad drugs or bad people but rather lack of education and a fear of communicating.

Resources: www.whitehousedrugpolicy.com www.nida.nih.gov/Infofax/PainMed.html www.health.org www.kentuckyconnect.com www.samsha.com www.sciencemuseum.com www.usdoj.gov/dea/pubs/states/kentuckyp.html “OxyContin replaced as drug of choice: Methadone

abused more in E. Kentucky”, The Lexington Herald Leader online, May 10, 2004. Associated Press article.

For more information:

Contact your local County Extension Office or visit the HEEL website at:

www.ca.uky.edu/HEELEducational programs of Kentucky Cooperative Extension serve all people

regardless of race, color, age, sex, religion, disability, or national origin.

This information is provided by the H.E.E.L. Program. Health Education through Extension Leadership (H.E.E.L.) is a partnership among the University of Kentucky College of Agriculture Cooperative Extension Service, Kentucky State University Cooperative Extension Program, the University of Kentucky College of Medicine, and the Kentucky School of Public Health.

The development of the HEEL program was made possible by Senator Mitch McConnell with funds earmarked for the University of Kentucky, College of Agriculture, Lexington, KY and budgeted through the CSREES/USDA Federal Administration.