Lake Effect essayist Nilesh Patel looks at the death of a well-known hockey player two years ago as evidence that change is needed inside and outside of sports:
I wish I had known about Derek Boogaard before he died.
The 28-year old Canadian was a fan favorite in the National Hockey League when he lost his battle to addictive prescription painkillers two years ago.
Sadly, Boogaard’s story isn’t unique. Millions of Americans – from professional athletes like Boogaard to the car pool mom across the street – are fighting for their lives and may not even realize it.
Prescription opioid abuse is the fastest growing drug addiction in the country today. In 2010, there were enough painkiller prescriptions written to medicate every American around the clock for a month.
Think about that. We could medicate every American 24/7 with painkillers. And the numbers are growing. Prescription-related drug deaths are up more than 400 percent in the last 11 years. ER prescription drug-related cases total about half a million annually.
Patients want quick solutions to their medical problems. As a physician, I am expected to maintain a high level of patient satisfaction. Unfortunately, “patient satisfaction” is sometimes an oxymoron as it relates to a slow-but-steady treatment regimen, which is often the best approach.
In the world of instant online surveys and social media postings, anything less than immediate gratification may cause vocal (and viral) patient dissatisfaction. This contributes significantly to the over-prescription problem.
Change should start with my brother and sister physicians. We must guard against an over-reliance on prescription painkillers as a default in treating pain. We must find the root causes of pain problems and treat them with the best possible options, even if it takes longer to see results.
Lawmakers can also help. Under HIPAA, the patient privacy act, I am not allowed to tell anyone if I suspect a patient is abusing painkillers, or “doctor shopping” to inappropriately obtain even more drugs. Patient privacy must be sacrosanct, but don’t silence me when the next Derek Boogaard walks into my office. A law which “protects” a person at risk protects no one. Give doctors a chance to make a difference in our communities.
Finally, to my patients, you have a role in this as well. A potentially addictive drug is not a panacea. At best, it’s a stop-gap measure. You must push yourselves to lose the excess weight. To stop smoking. And to walk regularly. Even a small amount of exercise can minimize pain.
Derek Boogaard’s family is suing the NHL for negligence in their son’s death. If there is an upside to his loss, it is that the suit could force a long overdue paradigm shift in how powerful painkillers are prescribed.
The loss of any child, especially one so talented, is tragic. But there is a small window of hope for the Boogaard family their loss will be a bellwether event for the rest of us.
Let Derek Boogaard’s fatal overdose from prescription painkillers be the last. If that can happen – and this I believe with my heart – he will not have died in vain.
Dr. Nilesh Patel is a partner with Advanced Pain Management clinics, and practices in Milwaukee in Green Bay.
Essayist Dr. Nilesh Patel offers solutions to the growing opiod abuse problem.
Essay on Prescription Drugs
Prescription drugs are just as addictive as illegal drugs and are easier to acquire. The only difference is that if you have health insurance, you are only paying a co-payment for your medication and not the street price for it. The more you use a prescription drug the more of a tolerance your body builds up to it, thus leading to an increase in dosage and a possible addiction.
There are many prescription drugs available today and some classes of drugs are more abused than others such as opioids, central nervous systems depressants, and stimulants. Let us look deeper into these prescription drug classes along with who is at higher risk than others and possible ways to treat and prevent addiction.
The most commonly abused classes of prescription drugs are opioids, central nervous system (CNS) depressants, and stimulants. Opioids are used in the medical field to treat pain, diarrhea, and coughing. Opioids originate from the opium poppy and some are considered narcotics.
Opioids affect the body by attaching to receptors in the brain and blocking the transmission of pain messages to the brain (NIDA, 2001, p 5). Morphine and codeine are the most popular opioid prescription drugs. Morphine, in small doses, acts as a sedative or pain reliever but in larger doses, acts as an anesthesia. Codeine is much milder than morphine and is used in cough-suppression syrups. The symptoms of withdrawal from opiods are restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes, and involuntary leg movements.
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CNS depressants are used for treating sleeping disorders, tension, and anxiety. CNS depressants affect the body by slowing down brain activity through actions on the gamma-amino butyric acid [GABA] system and produce a calming effect (NIDA, 2001, p. 5). Some examples of prescription CNS depressants are benzodiazepines and barbiturates. Benzodiazepines are a tranquilizer-type drug that is used to treat anxiety, panic attacks, and various phobias. Barbiturates, in small doses, can calm nervousness and in large doses, can cause drowsiness or sleep. Unlike opioids, withdrawal from CNS depressants can cause death from the physical exhaustion and collapse of the cardiovascular system (Carroll, 2002, p. 70).
Stimulants are used to treat ailments such as obesity, narcolepsy, and attention deficit disorders. When a stimulant is released into the body, it enhances brain activity, causing an increase in alertness, attention, and energy (NIDA, 2001, p. 5). Some examples of prescription stimulants are methylphenidate and amphetamines. Methylphenidate, also known as Ritalin, is used to treat attention deficit-hyperactivity disorders. Amphetamines are used for treating narcolepsy and weight loss in the medical field. Abusing stimulants can lead to hostility and paranoia over time. If high doses are taken then it can lead to high body temperatures, an irregular heartbeat, and a potential risk of cardiovascular failure or lethal seizures.
The most high-risk people susceptible to prescription drug addiction are teens, the elderly, and women. Teens go through many changes that can lead to experimentation, self-esteem issues, and individualism. This journey can lead to addictions to stimulants and painkillers. Not all teens who become are addicted are “trying to find themselves”, some are athletes who are injured and become addicted to painkillers. In the teen years, acceptance is highly sought after among peers leading to a high risk of addiction from peer pressure.
Elderly people today are usually on numerous, “prescription medications approximately three times as frequently as the general population and have been found to have the poorest rates of compliance with directions for taking the medication” (NIDA, 2001, p. 6). As you become older, more parts of your body start to shut down, thus one needs a prescription or two per body part, thus leading to numerous mixed medications. Some elderly people find it hard to read the small print labels on the prescription bottles and confuse the dosage of their many medications.
Studies show that, “women are more likely than men to be prescribed an abusable prescription drug, particularly narcotics and anti-anxiety drugs” (NIDA, 2001, p.7). All through life, women are taught there is a pill to fix most problems. For example, if you have stomach cramps related to premenstrual syndrome, you are told to take Midol. If you do not want children right away, you are told to take an oral birth control pill. Women are known to visit their doctors for ailments sooner than men and usually leave with a new prescription. The frequency of popping pills daily can be habit forming, and if given a strong prescription, can lead to abuse.
Addictions can be treated by behavioral treatments, pharmacological treatments, and detoxification. Behavioral treatments are forms of counseling, contingency management, and cognitive behavioral therapies. Pharmacological treatments are using drugs to counteract the effects of the drug and using drugs to relieve withdrawal symptoms or to help curb cravings.
Sometimes, combinations of both behavioral and pharmacological treatments are needed to help an addiction. Detoxification is an extreme method that is done before other treatments and can only be effective if followed by long-term behavioral or pharmacological treatments. It requires the patients to receive general anesthesia and sleep for hours while their body goes through the withdraw symptoms. Patients usually have no recollection of the detoxification process and when they wake up, they will be free from the physical dependence on the drug.
The healthcare providers, pharmacists, and the patients can help in preventing prescription drug-addiction. Healthcare providers can monitor how often patients are changing doctors to follow-up and see if they are changing doctors frequently to get more prescriptions. Doctors can assist by asking their patients screening questions during their yearly exams such as what medications they are taking, how frequently, and what for. Pharmacists can assist by educating the patient on how to take the medication correctly and to look out for forged prescriptions. The patients themselves can help prevent addiction by asking about drug interactions with their current medications, not increasing or decreasing medication amount without a doctor’s approval, and by not taking other people’s medications. Prescription drugs are addictive, but not everyone becomes addicted because they take the prescription correctly.
Prescription drugs can be addictive or a dependency for people; it is just a matter of knowing the difference. Addiction to drugs means you are dependent on a drug to fulfill your physical and emotional needs. While a dependency means your body developed a tolerance for the drug and needs the drug to function because if you stop taking it then you will have withdrawal symptoms (Geier, 2003). Many people do not get over their addictions successfully and often die trying.
They are unable to get to the root of their addiction because they are in denial. Most will fall down and pull themselves up. While others catch themselves before they completely fall and turn their life around. Everyone is different when it comes to addiction and abuse, but for those who do fall down the rabbit hole help is available, so reach out to someone soon.
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