The soaring overdose death toll from prescription painkillers has become an urgent priority. Ongoing theft in the Department of Veterans Affairs (VA) has drawn attention to the widespread issue. These abuses have been covered by the New York Times, Washington Post, and other major publications. Does that mean new federal drug laws make a difference?
Former President Obama was not convinced: “This legislation includes some modest steps to address the opioid epidemic. Given the scope of the crisis, some action is better than none.”
Drug Theft at the VA Clinic
Government data shows that incidents of drug loss or theft at federal hospitals have jumped nearly tenfold since 2009. In 2016 there were well over two thousand, caused in part by widespread opioid abuse in the U.S.
Doctors and other staff, most employed in the Department of Veterans Affairs (VA), are accused of and in some cases criminally charged with stealing controlled substances for their own use or to sell to substance abusers. In some cases, drugs intended for patients have disappeared. In a recent NY Times article, several high-profile cases were highlighted:
- In Arkansas, three VA employees were charged with stealing prescription medications, including opioids. One pharmacy technician is accused of using his access to a medical supplier to order, and then take, more than 7,000 pills and other drugs. The employees were also charged with conspiring to distribute the drugs, which had a street value of more than $160,000.
- In a New York case a former VA hospice nurse went to prison after admitting to stealing pain medication intended for patients. The nurse stole the drugs to feed his own addiction. He replaced the painkiller with Haldol, an anti-psychotic drug. At his sentencing, family members of hospice patients described the pain and suffering inflicted on dying veterans.
- An anesthesiologist at VA medical center in California plead guilty to theft of public property and possession of a controlled substance while treating a veteran. During surgery, the anesthesiologist passed out in the operating room after taking a sedative, and injecting himself with controlled substances including Fentanyl. The patient, conscious during the chaos, thought something had gone wrong with his surgery.
Narcotic Painkillers – Making It More Difficult to Get
New federal restrictions make it harder to get narcotic painkillers. It also makes it more difficult for veterans who depend on these drugs to treat pain. The new rules mean veterans must return each month to renew their medications. Many were already struggling to get appointments at overwhelmed VA facilities.
Officials say more than half a million veterans are currently on prescription opioids. The VA now says it has been over-medicating veterans. Gavin West, a clinical operations chief at the VA, said there has been an effort to contact veterans to explain the new rules; express concern about opioid use; and suggest alternative options for treatment.
Prescription Limits – Helping or Just More Red Tape
It’s too early to tell, but the laws limiting the number of pills physicians can prescribe are controversial. The American Medical Association argues that doctors and patients should be balancing the need for pain medication against the risk of addiction, rather than lawmakers.
In contrast to the controversy over limits on the number of pills prescribed, there is little resistance to tougher prescription monitoring laws. Today, every state except Missouri has some type of tracking system. Through a database, doctors can check patients’ opioid medication history, and assess the risk of addiction.
Prescription Drug Epidemic
The Centers for Disease Control and Prevention (CDC) has said the US is experiencing “the worst drug addiction epidemic in the country’s history.” Prescription opioids and other illicit drugs have become pervasive. Overdose deaths have increased 137% since 2000. Opioids have caused a 200% increase in overdose deaths.
There are several contributing factors. The National Institute on Drug Abuse (NIDA) lists them as:
- Increases in the number of written prescriptions.
- Marketing by pharmaceutical companies.
- Patient reliance on prescription medication.
Opioid medications bind to the areas of the brain that control pain and emotions. They increase the levels of the feel-good hormone, dopamine. Dopamine produces an intense feeling of euphoria in the brain’s reward system. As the brain gets used to the feelings, it takes more of the drug to produce the same levels of pain relief and well-being. Opioid-induced hyperalgesia (OIH) may occur where taking the pain pills actually make you more sensitive to pain.
The more you hurt, the higher your dose, then you just hurt more – over and over. This leads to dependence and, eventually, addiction. Once the addiction has developed, escaping the cycle of detox and relapse is typically a long-term process.
Detoxing from Prescription Drugs
Narcotic addiction causes changes in the brain. It alters not only the circuits of the mood and pleasure centers but the entire body. Cutting off the supply leads to withdrawal symptoms that can rapidly worsen, even becoming deadly.
Symptoms of opioid withdrawal include:
- Abdominal pain
- Nausea and vomiting
- Body aches
- Agitation or severe negative mood
Knowing the symptoms doesn’t lessen the withdrawal effects that can last from days to weeks. After the intense initial symptoms subside, physical and mental discomfort often hang around.
Opioid withdrawal is so unpleasant, most people will do anything to avoid it. This is a major reason for relapse. During medically supervised detox, medication is used to prevent the symptoms of opioid withdrawal during detox.
Prescription Drug Abuse
Breaking free from prescription drug abuse takes more than willpower. Fortunately, treatment centers are now using medication and counseling to improve the chances of success. Treatment is helping people recover their lives.
Drug replacement therapy is the practice of prescribing drugs to help a substance abuser withdraw or quit another drug. Buprenorphine is used to help addicts reduce or quit prescription pain killer abuse. Studies show that chances of recovery improve when buprenorphine is paired with naloxone. People on these drugs are still opioid-dependent, but they can return to work and function normally in society. At Treasure Coast Recovery we do not want to swap one addiction for another but we approve of the use of drugs during the detox phase of treatment to reduce the cravings and symptoms of withdrawal. Once you complete the detox phase we require that you continue treatment drug free except for medications that are medically necessary like blood pressure medication or heart medication for example. Of course all medications will require a doctor’s prescription in order to bring them with you to treatment.
Coping Tools for a Long, Sober Life
After detox, psychological and social factors are the primary reasons addicts go back to using. Stress and situations that remind the brain of the drug’s pleasure are common triggers. Most people who only detox will relapse if they don’t receive addiction treatment.
In treatment, patients develop tools and strategies for dealing with underlying issues. A long-term plan helps patients prepare for dealing with ongoing cravings and triggers. Underlying mental health issues and co-occurring disorders such as depression and anxiety are addressed.
Therapy Boosting Sober Habits
Participation in therapy or counseling is recommended. During treatment, therapy can take place as an outpatient or in a residential treatment center. Cognitive Behavioral Therapy (CBT) is particularly helpful. It is designed to build awareness of inaccurate or negative thinking. Then patients learn to view challenging situations more clearly and respond more effectively. It’s often a preferred therapy, as it generally requires fewer sessions and is done in a structured way.
Addiction Treatment Stops Addiction Laws Do Not
While new federal restrictions aimed at curbing opioid abuse make it harder to get narcotic painkillers, this will not stop narcotics addiction. Some evidence suggests that the recent crackdown on prescription pain pills abuse had led people to seek out heroin and other illegal drugs. Changes in brain chemistry; agonizing withdrawal symptoms; and almost certain relapse without treatment indicate the need for a multi-faceted approach to improve the chances of recovery. Supervised detox and treatment are the best way to move toward recovery from a narcotics addiction.
If you or a family member is struggling with any prescription or illicit drugs, please call. Admissions Coordinators are her 24 hours a day, nights, weekends and holidays. Stop the cycle and get help now.