How Your Prescription Medication Could Lead to Addiction

Other webinars in series:

• Opioid Addiction in the United States (Part 1)
• Why Naloxone is Important and How to Use It (Part 2)
• Keeping Your Children Safe When Taking Medication (Part 4)

Videos:

• Risk Factors for Opioid Use Disorders
• How Opioid Abuse Impacts Quality of Life

Articles:

• Is the Opioid Crisis Only an American Issue?
• Common Opiates & Intended Use
• Common Signs of Opiate Abuse

Welcome to the Community Education Series hosted by The Recovery Village and Advanced Recovery Systems. Hello everyone. I hope you’re doing well. Welcome to “Mind Your Meds with Miss America.” It’s our third installment of our webinar series that we’re hosting during mental health awareness month. I’m Alison Walsh, I’m with Advanced Recovery Systems, and we are thrilled to be able to do this, and we’ve had a great couple of weeks. We’re looking forward to continuing the conversation.

If this is your first experience with Advanced Recovery Systems, welcome. We are a national behavioral health care organization focused on the treatment of addiction and mental health, and we’ve been able to not only provide inpatient resources, but also outpatient and telehealth services across the country. We’ve got programs in five states, almost six now, we’re getting ready to open in New Jersey in July, but we also are really focused on treating both adults and adolescents. So if you know anybody that needs our resources, please don’t hesitate to reach out. Even if we can’t be of service, we are absolutely happy to connect individuals that are looking for help with those services in their areas.

I also have on the call today, before I have the chance to introduce Miss America, I have Stacy Henson. She’s a licensed clinical social worker. She is on our team as well. So if there are clinical questions that come up during Camille’s presentation today, please don’t hesitate to use the chat, and ask away and we’ll make sure that we circle back around and answer your questions either during the presentation or after. Again, we’re here to be a resource for you as well. Without further ado, I have the honor, once again, of introducing you to Miss America. Camille Schrier, the floor is yours Camille, welcome back.

Again, I always have some kind of tech issue at the beginning of my presentation, but welcome everyone. If you are tuning in for the first time, if this is your first webinar that you’ve gotten to watch with me, I’m Camille Schrier, I’m Miss America, but aside from Miss America, I’m also an advocate for medication safety and abuse prevention. That is one of the most important jobs that I get to do throughout my year.

My social impact initiative is called Mind Your Meds, and that is because I am a doctor and a pharmacy student in Virginia. I’m taking time off to be Miss America. So today we are going to be talking all about addiction and the abuse of prescription drugs. I think that a lot of people think that just because medications are being given to them by a doctor that it makes them totally safe, totally inherently risk-free.

Part of the reason that I really love pharmaceuticals and medicine is the fact that we have these chemicals that can completely change people’s lives. Like things that couldn’t have been cured 100 or 200 years ago can be cured with a simple dose of amoxicillin now, or a couple of days worth of antibiotics, and with great power comes great responsibility.

I think I said that in other webinars, and I think that it’s important that even though we have these medicines that can help us in so many ways, it doesn’t mean that they’re free of risk to be able to impact our lives and hurt us.

And so that’s really the most important thing about today. I always like to go back to this, to start every single webinar because fatal overdoses top really any of the other normal causes of death that we might think of that might be a tragic accident. So whether it be murder, roadway fatalities, death as a result of a firearm injury, opioid overdoses specifically, but in general, fatal overdoses are a huge issue in our country.

If you look at that number, 70,237, that is an astronomical amount of people. That’s in one year, just in 2017 like, we look at the numbers from the coronavirus pandemic that’s happening in our country, and in reality, we’ve had a pandemic of drug abuse for over a decade, decades in our country and throughout history. So I really like to spend some time bringing light to that because it’s something that I think gets overshadowed by things like coronavirus when we need to, that’s important too, but we also need to talk about things that have been happening for a long time.

This goes back to the same thing. 130 Americans die every day from an opioid overdose. These are lives that could be saved. These are potentially lives that are being taken because they started on a prescription medication; not all, but some. That’s really important to think about. This is my overwhelming statistic for today, and I read this, and this is from Drugabuse.gov, which is a government resource. I didn’t make this up. I promise, and I read this the first time and I was really just shocked by it.

About 80% of people who use heroin first misused prescription opioids, but it doesn’t necessarily mean that they weren’t prescribed prescription opioids. They could have misused someone else’s prescription opioid. But if you think of these medications they’ve gotten out in the market, they were developed by pharmaceutical companies. However, 80% of people that use heroin first misused those particular products.

And that really shocked me, and I think as someone who’s going into pharmacy and hoping to be a pharmacist, I feel a real sense of responsibility because I could potentially be that person handing the medication over-the-counter to a patient who could abuse it or who could give it to somebody else who could abuse it, could sell it. So much responsibility that you have in the pharmaceutical industry, but also in pharmacy.

So what even is prescription drug abuse? Sometimes I look at things and I’m like, I think I know what that is, but do I really know what that is? So prescription drug abuse is actually broader than you might think. It would be taking a medication in a manner or dose other than prescribed or taking medications prescribed for another person.

So, other, like a dose other than prescribed, and not by accident. It would be like intentionally taking two or three times your medication for a purpose that wasn’t just to feel the way that the doctor told you to. If you feel like you’re not getting the effect of the medication that you’re looking for, it’s always important to go back and consult your doctor; your doctor will adjust your dose as necessary.

But if you are needing to take more for some other reason, that can be a sign of prescription drug abuse in a manner other than prescribed. There are many people who have potentially taken medications in a way other than prescribed in the way of either crushing them and inhaling them, dissolving the coating on the outside… A lot of medications have protective coatings that allow them to be long term release, but if you dissolve that coating, you get a much quicker effect. That’s, that would be an example of a manner other than prescribed, or taking medications prescribed to another person.

This seems benign in the sense of, “Oh, you have a headache. I’ll give you something X, Y, and Z”. Never, ever take another person’s medication. Don’t ever give anyone your own medication. I feel like when we have medication that’s in our possession, we have a huge responsibility to protect other people from that, whether it’s our kids or pets or other people that we come about.

So prescription drug abuse can be a little bit more complex than what we would originally think.
Why do people abuse prescription drugs? If you just think of prescription drugs like amoxicillin, when you get an ear infection or strep, people don’t particularly misuse that kind of prescription, and we’ll go into some of the ones that are the most abused. But teens and adults alike can misuse prescription drugs for reasons like to, get high, relax and relieve tension, reduce appetite, increase alertness, experiment with mental effects, maintain addiction and prevent withdrawal. This is a huge piece as well, accepted by peers or social norms and to trying to improve concentration, academic, or work performance.

I will tell you from a personal note. I didn’t see a lot of prescription drug abuse really in my life at all. I started to see it when I went to college and that last point is probably the one that I saw the most in my age group in college. Other kids had medication that kept them up, or they were using it to treat diagnoses like ADHD, and kids would share that medication to allow them to stay up all night studying. That is not something that we ever want to do, and I was actually really appalled when I would see people do that. It’s kind of scary.

Definitely time management: don’t take medication. How about you manage your time? I think that would be a lot more effective. And sleep is also so incredibly important, so that entire situation was just incredibly not healthy and so many reasons.

We talked about preventing withdrawal, and this is really, really important. So dependence versus addiction. I talked about this in one of my other webinars, but I think it’s really important to remind everyone of, there’s these two pieces.

There’s kind of the compulsion to take more medication, maybe because of the way that your brain chemistry changes, but there’s also a physical dependence that can actually happen when you’re taking certain medications like opioids. And if you don’t take them, and you continue, you will get sick, you will feel terrible, you’ll feel like you’re fighting the flu. This is a huge piece of maybe why people would end up taking more medication, or maybe they had a prescription and now they’re hooked on it in terms of physical dependence; they have to continue taking more.

So there’s really two sides of this, but it’s important to remember that there can be a physical dependence upon these substances, more so than just a compulsion to want to take them to get high, which is kind of what people usually assume, but we forget about that physical dependence piece in so many ways.

So what are your risk factors for being someone who potentially could abuse prescription medication? We all have a certain risk to develop an addiction to a prescription depending on what we get, but some people have a higher risk than others. So if you are a person with an addictive personality, if you maybe have addictions or have experienced addictive behaviors to other substances like alcohol or tobacco, or family history of this.

If you have certain pre existing psychotic psychiatric conditions and can’t speak today. If you’re in an environment, I feel like this is a really big one. If you’re in an environment where there is drug use, if this is the norm in the group that you are in or in the social area that you are, that can be a huge risk factor and I would highly suggest that if you find yourself in those places to find a new place to find your friends or whoever the people around you are. Sometimes that’s more difficult if that’s family members, but the further away you are from those types of situations, the better off you’ll be and the lower risk you’ll be at.

If you have really easy access to prescription drugs, we’re going to talk about this. Just having prescriptions in the home medication cabinet, can make it easier for other people who maybe aren’t prescribed that medication to get it. And just a general lack of knowledge plays a role. I feel like as a student pharmacist, one of my jobs when I become a pharmacist is to fully empower my patients with the knowledge of the medication that they’re getting. I’ve gone to school for many years to then learn all of the medications and understand what I’m giving those people, but I think that they have a right to understand the medications and the risks associated with them when I hand that medication to them and they’re about to take it.

So that’s definitely a big thing, and if you ever are interested in learning more about whatever medication you’re taking, always ask that pharmacist. They’re there for a reason. They do not mind talking to you. They actually, well, we are all big nerds, and we love talking about medicines, so definitely ask that pharmacist. Same with over-the-counter medications too. You can always ask.

Some of the most abused prescription drugs, then. I mentioned, you probably wouldn’t abuse amoxicillin, which is an oral antibiotic. It’s pretty simple. You take it. I’ve taken it many times when I’ve got strep throat. No one really abuses that because it doesn’t have any of those potential effects that we talked about. Why people abuse prescription medication. There are a couple of groups of medications that are more highly abused because of their effects that they give. Number one is opioids. This is the one that I talk about most frequently. They come in many different brand names and generic names, but some of the most recognizable names you might see are, Oxycontin, Percocet and Norco. These are three brands that are very frequently prescribed for pain, whether or not it’s for chronic pain, for people that are post-surgery, and we’re going to talk about them a lot.

Some stimulants like Adderall and Ritalin. These are the ones that I very frequently saw misused in college for children or not children, some were young adults at that point, but sometimes we act like children in those senses that other kids would take to stay up all night.

These are usually used to treat ADHD and can be really effective in treating those diagnoses, but if you don’t have that it will make you stay up all night and people use that and abuse it to study.

Other anti anxiety medications and sedatives, like Xanax, Valium and Ambien. So those are a couple. Xanax and Valium kind of make you feel a lot more calm, and Ambien is something that helps you go to sleep, and those can be addictive as well.

So the consequences just for each of these, they each have different things that they do to our bodies. Opioids, which we talked a lot about, can cause low blood pressure, slowed breathing rate potential to stop breathing or get into a coma if you’re in an overdose situation, definitely something that can happen if you abuse these drugs.

Stimulants, they kind of do the opposite. They cause dangerously high body temperature, heart problems, high blood pressure, seizures, tremors, hallucinations, aggressiveness and paranoia. So almost the complete opposite of opioids, they’re a very different type of chemical.

And then those anti-anxiety medications and sedatives can cause some memory problems, low blood pressure, slowed breathing again, overdose, coma and death. Abruptly stopping can cause withdrawal symptoms. So that was kind of what we were talking about with the physical dependence, and that can include nervous system, hyper activity and seizures. So if you’re abusing these medications, they have an intended purpose and they’re usually pretty good at that intended purpose. But if we’re using them in the wrong way, we can really face some dangerous situations.

So we’re going to focus specifically on opioid abuse, which is something that I spend a lot of time on as Miss America. Just a couple of different forms of opioids. We mentioned a few of them, the Oxycontin and the Percocet, there’s also Norco, but there’s lots of different forms of prescription opioids, and actually there’s really only one opioid that we hear about frequently that’s a completely illegal, non-prescription opioid, and that is heroin. But even things like fentanyl have a prescription use.

And technically when we think about prescriptions, it’s a medicine that maybe can be dangerous, but has an intended use in treating a disease, or a certain condition. And that’s controlled by something called the DEA. So if you see on that Oxycontin bottle up the top, it says Oxycontin, and then it has a big C in it with two little lines.

That means it’s a class two controlled substance. Which is right below class one. Class one would be everything that you are completely, completely not allowed to have. It’s illegal. It’s like heroin. It’s things that have no intended medical use, but it also has to do with danger. This is a very complex subject that I’m going on a tangent on. Either way, opioids can be really dangerous, so most of them are controlled at a really high level, but they do have intended uses in certain ways and in certain dosages.

We hear a lot about them, but sometimes if people get addicted to prescription opioids, they may find themselves seeking heroin at some point.

We talked about that statistic in the beginning, that 80% of people that used heroin first, misused one of these other prescription opioids before, and so that’s the point of this slide before I go onto my tangent of how the DEA works.

So what is happening in our country? We are having a huge spike in prescription opioids. Now, this doesn’t go out as far as I would like, but it was the best representation of the data that I was looking for. Over time, you look at 1991 on the far left, all the way up to 2011 on the far right. We have had a huge spike in prescriptions of opioids that are being written and being filled in the United States. There’s a lot of reasons for that, but it’s really concerning.

We have started to see a decline in the last, probably since, I would say that the peak was around 2012 or 2013 and it started to decline from there. Lots of reasons for this, but the more prescription opioids that are being written, the more people are becoming addicted to them, and then that kind of just spirals, because then that will feed some of the heroin usage in our country. This can continue to feed prescription drug abuse, and these are medications that can be extremely dangerous.

When we look at these prescription numbers increasing, it’s definitely something that we want to pay attention to and that we can be concerned about.

I could spend an hour talking about this entire topic, but I’m going to give you the really condensed version. You might’ve heard of that medicine, Oxycontin in the news recently. It’s become a really hot button issue. The company that makes Oxycontin is being sued by many states. It’s called Purdue Pharma. They are the inventors and the manufacturers of that particular medication.

They’ve done a lot of things that have been considered unethical. Some of them they’ve already been charged with, so for example, they marketed this drug across the United States in a way that wasn’t totally truthful.

We know that it has a huge addictive potential. We know that now a lot of people knew that about opioids to begin with, but in 2007 the company pleaded guilty to a felony related to falsely promoting Oxycontin as a less-addictive and not likely to produce tolerance or physical dependence or symptoms of withdrawal compared to other pain medications, even though this drug drug was twice as strong as morphine.

So they kind of bent the truth and kind of tricked people a little bit into thinking that it was not as dangerous as it was. Doctors were writing it for their patients not really fully understanding or being kind of misled. So that was a huge issue from an ethical perspective.

And then a company started to build relationships with doctors and medical organizations, and they started to create these treatment guidelines for pain, and it encouraged the writing of more and more of these prescriptions. It was a really great marketing technique, but not necessarily ethical for the patients that were then taking it, and they were starting to target specific vulnerable populations where they felt like they could sell more products.

This is a huge, huge topic. You can learn a lot more about this on the internet. This is a great docu-series to learn about this. Dan is now a friend of mine, his name is Dan Schneider. He is the protagonist. It is a docu-series about his life.

In this documentary on Netflix called The Pharmacist, he does a lot of investigative work trying to understand and fight this, the unethical pieces of opioids, more so than just the actual medication itself, but the way that it was prescribed, doctors that were intentionally prescribing more than necessary for financial benefit, for example.

There’s a lot of different pieces of this entire issue, and this is a great place. If you have a couple hours on the weekend, I think it only takes about four hours to watch the whole thing. It’s hugely informative if you’re more interested in this topic, but the moral of the story is the companies that were producing these medications were not being forthright, and it actually got a lot of people addicted to these medications and led a lot of people to really have some struggles in their life.

So over-prescribing, we talked about this a little bit. I liked this little image from the CDC. It’s this guy saying, “I was given a prescription opioid pain medication that lasted a lot longer than pain itself,” and this happens all the time. Maybe you’ve gotten dental surgery. My mom had a shoulder surgery a couple of years ago and she got 30 full days of opioids.

Now, some laws have changed in certain states and in certain areas about how many opioids or how many days worth of opioids you can get, but it still happens that people get way more than what they need.

And so that would either maybe encourage you to take all of it, which could potentially lead to addictive potential or physical tolerance or dependence. Or, then you have extra laying around your house, and that can be dangerous too because it can be misused by other people. This happens less frequently now, but it still sometimes happens.

Opioids are also given as a first line of treatment for pain, and especially for people that maybe had a really horrible surgery and they need to make sure that their pain is controlled. There are other ways that we can control pain. In some cases, opioids are correct. I think they would be the right line of treatment, but not in all cases. So it’s always important to talk to your doctor and consider alternatives. If they become the thing that you have decided that you’re going to take with your doctor, that’s completely up to you and your doctor, but just remember that there are other options.

And thinking about doctors, despite serious risks, prescribers wrote nearly 67 opioid prescriptions for every 100 Americans in 2016. That’s a huge amount. They’re continuously being written. Some would be appropriate, but some are not necessarily appropriate, and that’s where this has to be balanced correctly.

We said the company was not necessarily forthright in the way that they were marketing these medications, and that they have really high addiction potential.

You might think that you can’t be addicted to a medication that you get from your doctor, but you absolutely can. It’s important to discuss that with your doctor when you are taking a medication that you’re concerned that you could potentially find an addiction to. This is definitely a discussion that you have to have and don’t feel silly asking, especially if you are getting medication and you’re not sure of its addiction potential, then it’s always better to ask.

Your doctor should be willing and excited to be able to answer those questions for you because that’s you taking control of your own healthcare.

And that’s something that I am really passionate about is the more knowledge that you have, the more control that you have upon your own health. So definitely, anyone taking prescription opioids, anyone can be addicted and become addicted to them. Well, especially if you’re taking them for longer periods of time or higher doses, that can increase the risk for addiction, overdose, or death.

It can also become a risk factor for heroin addiction because if you become addicted to your prescription medication, you no longer are able to get that prescription medication and you are still physically or mentally craving that medication that you were taking. It can turn some people to use an illicit opioid like heroin, so that sometimes that can cross over.

And here’s the thing. We know this. We talked about this. Addiction is not trivial to overcome. It’s not like, “Oh, I just stopped taking it. Yeah I’m all better”. That’s so, so far from the truth. Addiction is mental, it’s physical, emotional, psychological, it’s chemical in your brain, and it’s complex. So once people face these issues, it’s really hard to overcome.

We talked about withdrawal. This is a side effect of physical dependence. So when we think about someone with a physical or psychological addiction to these medications, this can be really, really severe. So once you’re taking these prescription medications and you try to stop them, sometimes you want to continue taking more solely for the reason of not facing this withdrawal because it is so uncomfortable, and I cannot imagine what it is like to go through that, but it’s something that I absolutely feel for anyone who has to experience withdrawal.

Preventing prescription drug abuse: there are some ways that we can help with this, and it’s some ways that if you’re ever taking a prescription drug, what can you do to make sure that you’re protected?

We talked about potentially asking about alternative pain relief. Ask if you can start with Tylenol or Motrin or other over-the-counter pain medications. Your doctor will tell you if that’s appropriate for you, but that’s always a potential option to talk about. Physical therapy, ice and heat, massage, acupuncture, sometimes nerve blocks kits for really extreme pain, or surgery if there’s something that can be corrected to relieve your pain. These are all things that you should talk to your doctor about if that’s something that you are considering.

And if you decide on opioids, it’s really important to know how to take them safely, and this is something that you can talk to your doctor or your pharmacist about. Your pharmacist should 100% be able to explain this to you, but the biggest piece of this is to take your medication exactly as prescribed. Read the label, understand, and if you don’t understand, ask your pharmacist to explain to you how frequently and how much you should be taking.

Never take more than what you’re told to take. If you feel like you’re not getting the pain relief or effect of whatever medication it is, go back to your doctor and discuss that with them. Tell them what you’re going through and they’ll make the decision of what should happen. If you have a history of substance abuse, definitely tell your doctor that before you take this. If you start to feel like you’re getting compulsive in taking these medications, or you feel like when you don’t take them, you don’t feel well, talk to your doctor. Never give them to anyone else. Never, ever, ever. You can put someone’s life at risk.

If you have leftovers, we talked about that. Having extra, dispose of them properly. Many times your pharmacy will help you dispose of them.

Also, you should never combine them with alcohol or other drugs. If you’re unsure, ask a pharmacist or a doctor. You never want to mix medications.

Storing medications: lock them up, lock them up, lock them up, especially with opioids or these particular highly abused medications. Keep them away from young children, and really anyone, because that’s another risk factor for abuse. If others are able to access these medications, it can be tempting, especially for maybe curious teens or young people. Just keep that from happening. Just put it away. Lock it up. You can prevent poisoning in young children.

The other thing is these medication organizers here, the little colorful ones. Those are not safe necessarily, unless they are locked up because they don’t lock. So if you separate your medications out, make sure to lock that entire thing away as well.

How do you safely dispose of your medications? If you have extra, get rid of them. They’re not helping you in your house. Don’t save them for later. Get rid of them because you are putting potentially other people at risk, and there’s a couple of ways you can do it. Disposal bins are in many pharmacies and so you can bring your medications there, and sometimes police stations will take them back. Well, there’s also some other things that you can do at home. Deterra bags have a special chemical that completely deactivates all of your medication, so then you can actually just throw it away in the regular trash, and even if someone finds it, it doesn’t actually matter. The medicine doesn’t work anymore.

And same with the RX destroyer. You can get that on Amazon. You just put it in the bottle of the medication and it completely inactivates it. You can also do, if you’re in a pinch, things like coffee grounds, dirty kitty litter, things that make the medication completely not of interest to anyone who might come across it.

And if you are struggling with addiction, either yourself or if you have someone in your family, these are some wonderful resources to reach out to.

The government resource, the Substance Abuse and Mental Health Services Administration: they have a treatment hotline that I have here, and then absolutely The Recovery Village as well. Addiction is complex. We talked about that and it’s definitely important to make sure that you’re seeking help.

So, that is a little bit about your prescription medications. I hope you learned a little bit more. I know I didn’t learn a lot of this until I went to pharmacy school, so I feel like it’s important to share.

Thank you, Camille, and as always, so much information that needs to be shared that you are able to share with our audience, and I think these are some really helpful tips too, especially with the disposing of medication, because for those that are taking it once we’re done or don’t need it anymore, it’s very common to just leave it in the medicine cabinet where we need to be more proactive and do our part in removing it from our environment. Because you never know who’s going to come in contact or who’s going to accidentally take it or intentionally take it, right? So it’s our responsibility to do that.

I think you’ve given some great recommendations on that throughout the webinar so thank you for that. And as always, we want to continue this conversation. Of course, we’ve got one more webinar with Camille next week and we’re really going to be talking next week about keeping our kids safe, which I know as a mom of three little ones is an area that I’m very focused on and can’t wait to hear more next week with you as well. So that’s great.

And then, and as always, thanks Camille. We appreciate you so much and thank you so much for what you’re doing throughout your year of service. You’re amazing. And thanks for helping me share all of this fun information. This has been such a great way to get all the messages across. We’re so grateful. So thank you.

Have a great rest of your day. Bye everybody. Thank you for watching this video. We hope you enjoyed the presentation.