Common Medication: Use or Abuse

Prescription narcotics are the most used and abused medication worldwide. Every day in America, 78 people die from an opioid overdose. In the United States, more people now die from opioid painkiller overdose than from heroin and cocaine combined. As of 2016 Brown County, Minnesota has a total population of 25,331 and a total prescription count of 34,285 – the rate per 1,000 residents is 1,353.5. In the state of Minnesota, more than 3.5 million opioid prescriptions were reported was dispensed in 2016 with hydrocodone/acetaminophen, oxycodone, and tramadol ranked as the top three. According to Rich Hoffman, Brown County sheriff, “In the last two months, Brown County police officers confiscated at least 200 pounds of prescription medication that was being sold illegally.” In 2010 the National Survey on Drug Use and Health estimated 2.4 million Americans used prescription drugs non-medically for the first time within the past year, which averages to approximately 6,600 initiates per day.

Most drugs affect the brain’s “reward circuit” by flooding it with chemical messenger dopamine. This reward system controls the body’s ability to feel pleasure and motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. This overstimulation of the reward circuit causes the intensely pleasurable high that can lead people to take a drug again and again. Drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Marie Larsen, the manager of Substance Abuse Services, said: “The main challenges that a substance abuser faces are from social media and society. Today most movies have chemical use in them, and even when they are driving they see bars on every block. And then there is the lack of support – they’ve burned bridges with most people who would normally support the person.” Long-term use can also cause changes in other brain chemical systems and circuits as well, affecting functions that include: learning, judgment, decision-making, stress, memory, and behavior.

According to the book Street Drugs, the most common types of medications that are being abused are opioids, stimulants, and benzodiazepine. Opioids are usually prescribed for pain relief. Commonly prescribed opioids include hydrocodone, oxycodone, morphine, fentanyl, and codeine. According to Marie Larsen: “In 2005 there was a huge meth spike, and all the little ‘ma and pa shops’ and the big systems making meth got shut down and sentenced to ten years in prison. So the meth supply wasn’t there for those who were addicted to it. The meth withdrawals were so horrible that they went to the doctor and said that they were in so much pain, not telling the doctor that they are having meth withdraws, so they got prescribed opioid painkillers; pretty soon the opioids took off. This is called cross-addiction.” The Opioid rate per 1,000 in Brown County is 605.2. In 2015 there was a total of 3,871,005 Rx dispensed, and in 2016 there was a total of 3,536,939 Rx dispensed-within one year the total Rx dispensed dropped 8.6%. 

The second most common are the stimulants, which includes dextroamphetamine, and methylphenidate. Stimulants have chemical structures that are similar to a family of key brain neurotransmitters called monoamines, which include norepinephrine and dopamine. Stimulants increase the amount of these chemicals in the brain. This, in turn, increases blood pressure and the heart rate, constricts blood vessels, increase blood glucose, and opens up the pathways of the respiratory system. In addition, the increase in dopamine is associated with a sense of euphoria that can accompany the use of these drugs. In 2015 there was a total of 1,439,748 Rx dispensed, while in 2016 there was a total of 1,500,030 Rx dispensed-within one year the total Rx dispensed increased 4.2%.

Finally the third most common are the benzodiazepines, which are depressants that produce sedation- by slowing down the central nervous system-, induce sleep, relieve anxiety and muscle spasms, and prevent seizures. Benzodiazepines are associated with the amnesia, hostility, irritability, and vivid or disturbing dreams. Alprazolam and diazepam are the two most frequently encountered benzodiazepine on the illicit market. In 2015 there was a total of 1,656,330 Rx dispensed, while in 2016 there was a total of 1,594,138 Rx dispensed-within one year the total dropped 3.8%.

Chronic pain affects an estimated 100 million Americans or one-third of the United States population, and it is the primary reason Americans are on disability. Although many treatments are available for pain, the number of prescriptions for opioid pain relievers has increased dramatically in recent years. Jolene Hansen, from the Nova House in New Ulm (an Intensive Residential Treatment Service offered to individuals who are in need of a structured setting), stated, “I think opioids themselves are a beast. The opioid addiction is one of the worse because after these people go through treatment they have to start all over: from finances, paying for a house, keeping a job, and even being a parent to their children.” Opioids have long been used to treat acute pain and are among the world’s oldest known drug. The opium poppy is the source of the following natural alkaloids: morphine, thebaine, codeine, papaverine, and noscapine. Semi-synthetic opioids like heroin, oxycodone, hydrocodone, and hydromorphone are synthesized from naturally occurring opium products such as morphine, and codeine. Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these compounds attach to certain opioid receptors, they can effectively change the way a person experiences pain. In addition, opioid medications can affect regions of the brain that mediate what we perceive as pleasure, resulting in the initial euphoria that many opioids produce. They can also produce drowsiness, cause constipation, and depend upon the amount taken, depress breathing. Taking a large single dose could cause severe respiratory depression or death. Overdose symptoms of opioids are: constricted pupils, cold and clammy skin, confusion, convulsion, extreme drowsiness, and slowed breathing. Leah Luke from Brown County Family Services stated “Looking at the number of teens who are abusing opioids is low. However, we know that more teens are doing it- we just aren’t getting their referrals. Their parents might be covering for them or the county might just be saying that they don’t have an opioid problem when they actually do.”  Leah Luke also added, “Opioids are getting harder to get, but at the same time it’s still a huge problem.” According to Doctors Jeffrey Rayl, opioid users aren’t like alcoholics, they are more on the down low, so they do get away with abusing opioids. The unlucky addicts who do get caught by the police get sent to detox. However, only 1.3% of the referrals to detox is because of heroin or opioid abuses. 

Recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. Even people with severe and chronic substance use disorders can, with help, overcome their illness and regain health and social function. This is called remission. Being in recovery is when those positive changes and values become part of a voluntarily adopted lifestyle. While many people in recovery believe that abstinence from all substance use is a cardinal feature of a recovery lifestyle, others report that handling negative feelings without using substances and living a contributive life are more important parts of their recovery. Some types of recovery programs include the following: recovery-oriented systems of care, recovery support services, and social and recreational recovery infrastructures and social media. Thankfully, New Ulm Medical Center does have substance abuse services. Between Mankato and New Ulm they treat about 110 people in residential and about 350 people in out-patient per year. Both of the cities do have family group sessions, but some of the families are not willing to go, and some can’t make it. With the residents, they tend to get a good family outcome, but when it comes to the out-patient it is really hard to get their families there – whether they are done dealing with the addiction or if they don’t have the time. About 80% of the time, most families are just done dealing with their loved one’s addiction.

According to New Ulm Medical Center ER Doctor Jeffery Rayl: “You have to watch this population. They are Fragile. The ones who are getting treatment are getting rid of the only thing they know. I have had 75% success rate in treatment-which is unheard of.”  A huge problem with treatment is there simply aren’t enough beds, some places have a three-month waiting list. Jolene Hansen did say, “Another problem with treatment is not everyone is able to drive, doesn’t have a car, or can’t pay for a taxi, so they don’t go to the treatment because they have no way of getting there.” On the positive side, treatment is a warm place, so when it gets cold Marie Larsen does get more treatment referrals. On the other hand, Marie Larsen did state “the relapse rates are extremely high, the most current data is about 90% relapse-weather they use once or they go back to their addiction full time. When I’m talking with someone in treatment, I always tell them that if they focus they can be that 10% that doesn’t relapse; otherwise they’ll get discouraged and give up. From what I see people tend to relapse when they don’t disconnect from old using relationships. If they remain contact with people who still use, it is really hard to say no when they ask you to join them. They end up getting stuck in the process of ‘I don’t want to turn them down, they’ll end up calling me names that I don’t want to be called.’ So they fall back into the addiction.” 

Doctors should take note of rapid increases in the amount of medication needed or frequent, unscheduled refill requests. Doctors should be alert to the fact that those misusing prescription drugs may engage in “doctor shopping”—moving from provider to provider—in an effort to obtain multiple prescriptions for their drug(s) of choice. According to Jennifer Eckstein, from New Ulm Medical Center, “The New Ulm ER will not treat anyone who comes in with chronic pain. The ER will refer them to someone else. This is one attempt to lower the number of opioids that are prescribed.” Patients can take steps to ensure that they use prescription medications appropriately by following the directions as explained on the label or by the pharmacist, being aware of potential interactions with other drugs as well as alcohol, never stopping or changing a dosing regimen without first discussing it with the doctor, never using another person’s prescription, and never giving their prescription medications to others, storing prescription stimulants, sedatives, and opioids safely. Drug use and addiction are preventable. Teachers, parents, and healthcare providers have crucial roles in educating young people and preventing drug use and addiction. 

In Brown County, there is the Underage Substance Abuse Coalition, USAC, program. Abigail Schwab, the USAC program director, said-“I try to work within the school, and community to try to get the word out there, that we can’t have our teens doing this stuff. We have really been trying to get the word out about USAC as well and we are starting to slowly team up with the Brown County Fair to see if we can work on some smoking policies there. Getting presentations to the school and working with the schools. I want to get the youth involved.