Not your typical drug dealer
When legal drugs used to relieve chronic pain become a chronic problem
Photos by Wesley Bauman, Brooks Institute 2009
By Butch Warner 03/26/2009
It starts when a kid is maybe 12 years old, when Little Miss Sunshine or Junior realizes there is gold in Mummy’s medicine cabinet or nightstand. A bottle of Xanax bars for Mummy’s stressful days. A vial of Vicodin or Soma for Daddy’s bad back. Ambien or Lunesta for sleepless nights.
By the time some kids are ready to graduate from high school, they have learned how to “work,” or manipulate, family practitioners and psychiatrists. Some are lucky or clever enough to actually have or acquire a diagnosis. ADHD (attention deficit/hyperactive disorder) is good, because that means you can get Adderall or another amphetamine. Generalized anxiety disorder (GAD) is a bell-ringer, because then some unsuspecting shrink might prescribe you “benzos.” Or you can try to sell that old muscle pull as chronic pain and score some painkillers that will kill the pain and make you forget your problems — until the problem is getting the 50 or 60 pills a day you need just to maintain.
OxyContin is the new heroin. Adderall is the new meth. Xanax is more popular than heroin or cocaine.
According to the Drug Abuse Warning Network (DAWN), prescription drugs are the most abused substances in the United States. Benzodiazepines and painkillers rank highest on the list.
The National Institute on Drug Abuse (NIDA) reports that the number of people who abuse prescription drugs far surpasses the millions of people who use heroin or cocaine. Prescription drugs rank third (behind tobacco and alcohol) of the top 10 misused drugs in the world today. In fact, 14 of the top 20 abused drugs of all types are prescription drugs. It’s estimated that 20 percent of people in the United States abuse prescription drugs, and many of them are adolescents.
The three classes of prescription drugs that are most commonly abused, according to the National Institute on Drug Abuse, are opioids, which are most often prescribed to treat pain; central nervous system (CNS) depressants, which are used to treat anxiety, seizures, sleep disorders and alcohol withdrawal; and stimulants like Adderall and Dexedrine, which are prescribed to treat the sleep disorder narcolepsy and attention-deficit hyperactivity disorder (ADHD).
Seth was a rising hockey star for the Ventura Mariners, but in the last few years he has had his problems. He began using Vicodin to combat the pain in his back and his other hockey injuries, and soon graduated to eight or 10 tabs a day of OxyContin, a potent narcotic that goes for as much as $80 a pill on the street. Even though Seth’s dad Dan owns a prosthetics company that pretty much guarantees him a job, Seth had to steal to make his daily “nut” of Oxy. OxyContin has basically turned Seth into a criminal who will do anything to get his drug, and he’s now in rehab to get his life back together.
Opiates or related drugs called opioids are extracted from the seeds of the poppy plant or synthesized in laboratories. These prescription narcotics include morphine, codeine, hydrocodone (Vicodin, Norco), oxycodone (OxyContin, Percodan, Percocet), and hydromorphone, the ingredient in Dilaudid (an Elvis Presley favorite), and related drugs. Many addicts prefer oxycodone and hydromorphone to street heroin.
OxyContin was initially nicknamed “Hillbilly Heroin” because it first began to be stolen and abused in poor, rural parts of New England and Appalachia. OxyContin use and abuse have spread like a California mountain fire. In some areas 50 percent to 90 percent of those seeking treatment for substance abuse name OxyContin as their primary drug of abuse.
Opiates act on the most primitive of our brains, sometimes referred to as the “lizard brain” because we share it with reptiles. The lizard brain focuses on survival, and it’s responsible for pain and fear.
The most significant aspect of opiate addiction is the tolerance, which is the condition of needing more and more of the drug to obtain the desired effect. Vicodin addicts regularly consume over 50 pills a day in the later stages of addiction.
It’s almost impossible to kick opioids on the street.
The beginning of treatment is detoxification, medically supervised withdrawal from the drug. Addicts almost always resume their addiction if they don’t get counseling and commit to some sort of support group.
The hottest detox treatment today is a hybrid drug called Suboxone (buprenorphine hydrochloride and naloxone hydrochloride), a pill that block the effects of opiates and helps with cravings.
In 1980, Trey was stressed by his job as an advertising copywriter, and he was having what he began to recognize as “major, embarrassing panic attacks.” Trey requested his name be changed to protect his privacy.
So he visited his family physician in Thousand Oaks, and asked for a mild tranquilizer that “isn’t addictive like Valium, something to relieve the stress.” The doctor told him about this “great new drug” called Xanax that was “amazingly effective in treating anxiety and panic attacks, with none of the bad effects of Valium or the barbiturates.”
Trey, who describes himself as “a malignant alcoholic and addict” began popping the pills like bonbons, until he finally felt solid enough to stop taking them when his fourth prescription ran out. What followed was the most horrific three days of his life.
On the first day he lost all coordination in a softball game. On the second, he couldn’t feel the top of his head, which felt like it was going to explode. His experience was “like a constant, world-class-panic attack.” He couldn’t drink enough alcohol to relieve any of the anxiety, and he couldn’t sleep. He tried walking and running until he was exhausted, and this provided only minor relief. He finally called his brother, who had been addicted to Valium and heroin. His brother told him that he was suffering withdrawal from the Xanax, and that the only cure was to “re-up your prescription before you die or have a seizure.”
Although going back to the Xanax stopped the major “kick,” for six months after that Trey could not write his own name or hold out his hand without severe tremors. “It took me a year to get back to normal, but out of fear of going through that horror again, I stayed addicted to Xanax for 18 years. I finally successfully kicked when I was locked up in Ventura County in 1998.” Upon his release, Trey went to Khepera House rehab in Ventura and has been in recovery ever since. “I exercise and go to meetings, and I haven’t had a panic attack or even severe anxiety in 10 years,” Trey maintains.
Of the top 20 most abused drugs, according to the Drug Enforcement Agency (DEA), benzos (Xanax, Klonopin, Ativan, Valium and “unspecified benzodiazepines”) hold five of the slots.
Benzodiazepines, or “benzos,” are mind-altering drugs discovered in 1954 that slow down the central nervous system and have sedative, anti-anxiety, anti-seizure, and muscle relaxant qualities. Benzodiazepines are invaluable in the short-term treatment of alcohol DT’s and alcohol withdrawal. They are incredibly useful in the treatment of anxiety, panic attacks and seizures if you’re not prone to addiction. It’s very hard to die of an overdose on benzodiazepines, unlike barbiturates, which fell out of favor after the death of Marilyn Monroe in 1962.
But benzodiazepines, which were and which include drugs like Valium, Librium, Ativan, Xanax and Klonopin, are also among the most viciously addictive drugs known to man.
Benzos are known as “solid alcohol” in the recovery community because alcoholics usually love them, especially when they’re hung over or when they stop drinking. They also help relieve the anxiety of methamphetamine or cocaine.
There are two major advantages of benzos over the older tranquilizers. First, when taken as prescribed by honest doctors, benzos enable people to function almost normally, and usually without falling asleep in the daytime. Second, it’s very hard to die of an overdose on benzodiazepines, unlike barbiturates, which were looking very dangerous in the aftermath of the deaths of Marilyn Monroe and other celebrities.
Benzos make you feel like “a wet noodle,” according to users, and the fast-acting Xanax and Ativan can relax you and lift your mood in 20 minutes. Conversely, when they leave your system, the anxiety is actually worse, and you need more over time.
When taken continuously, benzos eliminate anxiety at its most primitive level, and it’s precisely this quality that makes them so addictive.
Like opioids, It’s almost impossible to kick benzos on your own.
Treatment for benzo addiction must address two issues. First of all, there is a very real physical addiction as described by Trey above.
And because they’ve been using a “chemical crutch,” many benzo addicts can’t deal with even minor anxiety when they try to quit, even when the physical withdrawal symptoms have disappeared. The psychological symptoms keep many benzo addicts addicted to their dying day. The ones who do recover are usually brought down slowly over a period of time with gradually diminishing amounts, and commit to an aftercare program like intensive outpatient and 12-step support groups.
Soma and Ambien
These are two of the fastest growing drugs of abuse. The muscle-relaxant Soma and the sleeping pill Ambien are benzo-like drugs that have an amazingly high potential for abuse, and soma can
be fatal in overdose. The treatment is the same as that of benzodiazepines.
Oscar was diagnosed with attention deficit/hyperactivity disorder (ADHD) when he was a grade-schooler in Oxnard. His teachers strongly suggested he be put on meds, and after conferring with a psychologist and their family physician, Oscar’s parents placed him on Adderall, a potent medication containing four kinds of amphetamines.
Oscar’s behavior improved a little at first, and he was able to focus a little better on his schoolwork, but soon he began sharing his pills with his classmates, and trading for other pills like Vicodin and Xanax to “even out the high.”
Oscar is now 20 and a patient at a Pasadena rehab for addiction to several substances. His “drug of choice” is Adderall or Dexedrine, another potent ADHD drug, but he’ll “take crystal meth (methamphetamine) in a pinch.”
While normal people get that wired, jaw-clenching, gotta-be-somewhere-else feeling from speed, those with ADHD, goes the theory, are somehow made calmer and more capable of focusing than they were before. Amphetamines like Adderall, Dexedrine, and Vyvanse, it appears, have a paradoxical effect on those with ADHD.
But all of those drugs are still speed. And maybe amphetamines are not the ultimate cure for ADD (attention deficit disorder) and ADHD.
While the Attention Deficit Disorder Association believes that “most cases of stimulant abuse are among adolescents and adults who are not being treated for ADHD,” there are those who believe that ADHD drugs are creating a whole new generation of speed freaks.
In 2006, more than half a million adolescents aged 12-17 used nonprescribed stimulants (National Survey on Drug Use and Health [NSDUH]). They got them from their ADHD schoolmates and on the street, because Adderall and Dexedrine and, recently, Vyvanse are now “hot” street drugs.
Adderall and Dexedrine produce a high similar to methamphetamine, or crystal meth, which, in its purest form, is also an amphetamine. In fact, many kids prefer the prescription drugs because they deliver a smoother high, and they know what they’re getting.
Professionals who work in rehabs are reporting an inordinately high percentage of patients who were diagnosed with ADD and ADHD. Not all of these diagnoses appear to have been legitimate.
Amphetamines are great drugs — for about two weeks. Prescription stimulants popularly have been referred to as “study drugs,” and they do help, on a short-term basis, with alertness and retention. In fact, armies all over the world have long been using speed to help their soldiers stay alert.
But after a couple of weeks speed starts to warp the personality, create anxiety and a false sense of urgency, and cause users to do stupid things. Long-term abusers often end up toothless, homeless, or in jail, because speed eventually distorts judgment in matters of eating, hygiene, and personal responsibility.
Managing amphetamine dependence treatment is difficult because, like benzo users, speed freaks have stopped trusting their internal resources and believe they can only function with the help of a chemical. Although the physical dependence is minor compared to opiates and benzos, abusers become depressed and suicidal when many quit, and the psychological withdrawals can last for months. A support program is a must after rehab or detox.
There is an epidemic among us, and it is cunning, baffling and powerful.
Children and adolescents are the primary victims of this epidemic. But the prescription drug scourge also acutely affects women and the elderly, two groups that, until recently hit, had been far less prone than young men to addiction. Women are two to three times more likely to be prescribed drugs such as sedatives; they are about two times more likely to become addicted. And seniors simply take more drugs than the rest of us.
The danger, of course, is that an incredibly high percentage of Americans are going to become addicts if awareness is not heightened, and if something is not done.
Tighter controls are not the only answer. Drug companies have to be more forthright, and they need to develop more specific, safer drugs, instead of falling back on proven money makers. Physicians have to be more aware and more responsible, and in some cases more honest. Parents have to more vigilant and better role models. Most important, we all have to re-think the “Better Living through Chemistry” attitude that seems to lie at the core of this epidemic.
George (Butch) Warner, MA, MFTI, CADCA is an addiction specialist and therapist at Pasadena Recovery Center.