Wednesday, June 10, 2009

Drug Problems

According to a report in The Tennessean, Clarksville, Tennessee pastor Shane West was sentenced to three years probation today after pleading guilty to charges related to his addiction to prescription drugs. The story once again should point attention to the most significant and urgent, yet largely misunderstood and ignored, drug problem in our culture today.

The most significant drug problem in our day does not involve illegal drugs such as marijuana or cocaine or heroine. The biggest problem relates to addiction to prescription pain killers such as Oxycotin, Hydrocodone, or Loritab. The problems of addiction affect all age groups and all portions of the socio-economic spectrum, and they entrap large numbers of people who, prior to addiction, lived productive, law abiding lives. The stories of Rush Limbaugh and other celebrities always receive national attention when they arise. In Tennessee, a couple of years ago the sheriff of Williamson County made headlines when he was arrested for obtaining prescription narcotics illegally. In Dallas, the pastor of a megachurch made similar headlines a few years ago.

The problem also finds its way into the homes of the very poor. A friend -- a nurse practitioner in Tennessee -- has described for me the frequency of Medicaid eligible callers to her office seeking prescription narcotics, which she never agrees to provide to new patients. The callers nearly always decline to make an appointment for an examination.

The true scandal of this is apparent when one realizes that this addiction usually comes about because patients follow their doctors' orders. Medical treatment guidelines almost always stipulate that patients should not receive Schedule II narcotics for more than two weeks for chronic pain due to the risks of addiction, yet many patients receive such drugs for extended periods of time. As approximately 10-12 percent of patients are susceptible to addiction, these prescribing patterns put those patients at risk.

As an example of these irresponsible prescription patterns, consider the drug Actiq. That drug, which is dispensed in the form of a lollipop, was approved by the FDA for use by terminally ill cancer patients who have difficulty swallowing ordinary pain pills. In spite of that rather specific intended use, this expensive ($2,400 for a months supply) pain killer is prescribed so frequently to workers' compensation patients that in 2006 only three other drugs accounted for more expense to the system.

State governments have attempted to respond to this crisis (and in this instance, that word would seem to apply) by adopting guidelines regarding physician prescriptions of narcotics. While this has had some impact, there is a long way to go. For far too many people, chronic back pain or pain following surgery is the beginning of a path leading to addiction and its frequent side effects -- job loss, financial ruin, jail, or sometimes suicide. It is a problem of which we all need to be aware and watchful.

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