Misuse of Prescription Drugs: A Research Study

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From the Website of the National Institute on Drug Abuse
Dr. Lora, Volkow, Executive Director
June 2020

Misuse of prescription drugs means taking a medication in a manner or dose other than prescribed; taking someone else’s prescription, even if for a legitimate medical complaint such as pain; or taking a medication to feel euphoria (i.e., to get high). The term non-medical use of prescription drugs also refers to these categories of misuse. The three classes of medication most commonly misused are:

  • opioids—usually prescribed to treat pain
  • central nervous system [CNS] depressants (this category includes tranquilizers, sedatives, and hypnotics)—used to treat anxiety and sleep disorders
  • stimulants—most often prescribed to treat attention-deficit hyperactivity disorder (ADHD)

Prescription drug misuse can have serious medical consequences. Increases in prescription drug misuse over the last 15 years are reflected in increased emergency room visits, overdose deaths associated with prescription drugs, and treatment admissions for prescription drug use disorders, the most severe form of which is an addiction. Overdose deaths involving prescription opioids were five times higher in 2016 than in 1999.

Misuse of prescription opioids, CNS depressants, and stimulants is a serious public health problem in the United States. Although most people take prescription medications responsibly, in 2017, an estimated 18 million people (more than 6 percent of those aged 12 and older) have misused such medications at least once in the past year. According to results from the 2017 National Survey on Drug Use and Health, an estimated 2 million Americans misused prescription pain relievers for the first time within the past year, which averages to approximately 5,480 initiates per day. Additionally, more than one million misused prescription stimulants, 1.5 million misused tranquilizers, and 271,000 misused sedatives for the first time.

The reasons for the high prevalence of prescription drug misuse vary by age, gender, and other factors, but likely include ease of access. The number of prescriptions for some of these medications has increased dramatically since the early 1990s. Moreover, misinformation about the addictive properties of prescription opioids and the perception that prescription drugs are less harmful than illicit drugs are other possible contributors to the problem. Although misuse of prescription drugs affects many Americans, certain populations such as youth and older adults may be at particular risk.

Adolescents and Young Adults

Misuse of prescription drugs is highest among young adults ages 18 to 25, with 14.4 percent reporting non-medical use in the past year. Among youth ages 12 to 17, 4.9 percent reported past-year non-medical use of prescription medications.

After alcohol, marijuana, and tobacco, prescription drugs (taken non-medically) are among the most commonly used drugs by 12th graders. NIDA’s Monitoring the Future survey of substance use and attitudes in teens found that about 6 percent of high school seniors reported past-year non-medical use of the prescription stimulant Adderall® in 2017, and 2 percent reported misusing the opioid pain reliever Vicodin®.

Although past-year non-medical use of CNS depressants has remained fairly stable among 12th graders since 2012, use of prescription opioids has declined sharply. For example, past-year non-medical use of Vicodin among 12th graders was reported by 9.6 percent in 2002 and declined to 2.0 percent in 2017. Non-medical use of Adderall® increased between 2009 and 2013, but has been decreasing through 2017. When asked how they obtained prescription stimulants for non-medical use, around 60 percent of the adolescents and young adults surveyed said they either bought or received the drugs from a friend or relative.

Youth who misuse prescription medications are also more likely to report use of other drugs. Multiple studies have revealed associations between prescription drug misuse and higher rates of cigarette smoking; heavy episodic drinking; and marijuana, cocaine, and other illicit drug use among U.S. adolescents, young adults, and college students. In the case of prescription opioids, receiving a legitimate prescription for these drugs during adolescence is also associated with a greater risk of future opioid misuse, particularly in young adults who have little to no history of drug use.

Older Adults

More than 80 percent of older patients (ages 57 to 85 years) use at least one prescription medication on a daily basis, with more than 50 percent taking more than five medications or supplements daily. This can potentially lead to health issues resulting from unintentionally using a prescription medication in a manner other than how it was prescribed, or from intentional non-medical use. The high rates of multiple (co-morbid) chronic illnesses in older populations, age-related changes in drug metabolism, and the potential for drug interactions make medication (and other substance) misuse more dangerous in older people than in younger populations. Further, a large percentage of older adults also use over-the-counter medicines and dietary and herbal supplements, which could compound any adverse health consequences resulting from non-medical use of prescription drugs.

Find Help Near You

The following can help you find substance abuse or other mental health services in your area: www.samhsa.gov/find-treatment. If you are in an emergency situation, people at this toll-free, 24-hour hotline can help you get through this difficult time: 1-800-273-TALK. Or click on: www.suicidepreventionlifeline.org. A step by step guide on what to do to help yourself, a friend or a family member on the Treatment page.

Narcotics Anonymous National Hotline: 1(877) 276-6883.

Children Suffer in Families of Addicted Parents or Siblings

Kids of Addicted Parents

One group that doesn’t get the robust advocacy it needs is young children experiencing the impact of addiction in their family. Kids can be profoundly impacted by a parent’s or sibling’s addiction, and they grow up at greater risk of developing addiction themselves. And yet, insurance doesn’t cover care and prevention efforts for such children or the family, and children and families generally get scant mention in policy plans like the 2020 National Drug Control Strategy or relevant federal budgets (see here and here). That’s why advocates like our Jerry Moe and Sis Wenger, the CEO of the National Association for Children of Addiction, say children are the first hurt and the last helped.

National Children of Addiction Week just wrapped up, and we spent the week advocating for “kiddos,” as some of our Children’s Program counselors like to say. Jerry spoke in Ohio and did interviews with media from nearby West Virginia, two states hit hard by the addiction crisis. Lindsey Chadwick and our Children’s Program in Colorado hosted an art show featuring the drawings and paintings of young children growing up in families affected by addiction, and discussed it on a Denver TV station. And, Jerry fielded online, anonymous questions in real-time during a Reddit AMA (Ask Me Anything) hosted by NPR. That Q&A lives on—please help advocate for children by sharing it with others who may have questions about how to support kids affected by addiction in their family. Jerry will continue to answer questions over the next couple of weeks.

Find Help Near You

The following can help you find substance abuse or other mental health services in your area: www.samhsa.gov/find-treatment. If you are in an emergency situation, people at this toll-free, 24-hour hotline can help you get through this difficult time: 1-800-273-TALK. Or click on: www.suicidepreventionlifeline.org. Also, a step by step guide on what to do to help yourself, a friend or a family member on our Treatment page.

 

Narcotics Anonymous National Hotline: 1(877) 276-6883
Alcoholics Anonymous Website: https://www.aa.org
You can also visit https://www.allaboutcounseling.com/crisis_hotlines.htm

NIDA 2019 Achievements

From the Blog of Dr. Nora Volkow,
Executive Director, National Institute on Drug Abuse

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Original Date January 24, 2020

As NIDA sets its sights on new goals and objectives for 2020 and beyond, I like to reflect on how far we have come in our research efforts, especially as they concern the opioid crisis, one of the biggest public health issues of our era. Although deaths from synthetic opioids like fentanyl continue to rise, glimmers of hope are starting to appear. Provisional numbers show that overall overdose deaths have held steady rather than increasing since 2018, and a massive federal investment toward finding scientific solutions to the crisis promises to further turn the tide against opioid and other drug use disorders.

The biggest news of the past year is the grant awards in the Helping to End Addiction Long-termSM Initiative, or NIH HEAL InitiativeSM. In Fiscal Year 2019, 375 grants, contracts, supplements, and cooperative agreements totaling $945 million were awarded in 41 states. As part of this aggressive, trans-agency effort, NIDA is funding research on prevention and treatment of opioid use disorder, including developing new treatments and expanding access to those that already exist.

The HEALing Communities Study led by NIDA in close partnership with the Substance Abuse and Mental Health Services Administration is testing the implementation of an integrated array of evidence-based practices in various healthcare, behavioral health, justice, and community settings in 67 hard-hit communities across four states. Objectives of the study include increasing the number of people with OUD receiving medications for their disorder, increasing naloxone distribution to help reverse opioid overdoses, and reducing high-risk opioid prescribing, with the goal of reducing opioid overdose deaths by 40 percent in those communities over of the next three years. Effective strategies learned from this project can then be exported to other communities.

Other HEAL projects are aimed at finding ways to address the prevention and treatment needs of the most at-risk populations. Grants to 12 institutions as part of the Justice Community Opioid Innovation Network (JCOIN) will create a network of researchers in 15 states and Puerto Rico to study ways to scale up and disseminate evidence-based interventions in a population with extremely high rates of OUD and overdoses, including evaluating the use of the different medications for OUD in jails and prisons as well as in parolees suffering from OUD. In a separate set of projects, NIDA is funding research aimed at preventing the transition from opioid use to OUD in young adults, including projects targeting rural and American/Indian communities.

NIH HEAL money has also allowed NIDA to greatly expand our Clinical Trials Network and, in partnership with other Institutes, is additionally partially supporting pilot studies in preparation for a large-scale study of brain health and development across the first decade of life. The HEALthy Brain and Child Development (hBCD) study, along with the already-underway Adolescent Brain and Cognitive Development (ABCD) study (not funded through HEAL), will contribute in innumerable ways to our understanding of brain development and the many factors influencing risk and resilience for substance use during childhood and adolescence.

Science Highlights

In 2019, researchers at NIDA-funded Yale University made significant strides toward understanding biological predictors of addiction and relapse. Using functional magnetic resonance imaging and machine learning, Sarah W. Yip and colleagues found that functional connectivity among a number of brain regions predicted chances of achieving abstinence in patients receiving treatment for cocaine use disorder. Their results, published in the American Journal of Psychiatry last February, could lead to new approaches to treating cocaine addiction by intervening directly in those pathways.

Genetic approaches are also yielding important insights in this area. An analysis of genome-wide association studies (GWAS) published in Nature Genetics last January identified hundreds of gene loci associated with tobacco and alcohol use and related health conditions. Genes involved in dopaminergic, nicotinic, and glutamatergic signaling were among those identified. Another partially NIDA-supported GWAS study published in Nature Neuroscience in July identified an association between expression of the gene for the cholinergic receptor nicotinic α2 subunit with cannabis use disorder in brain tissue from a large Icelandic sample.

NIDA-supported basic science is also shedding important light on opioids and the brain’s opioid signaling systems. Research published in June in ACS Central Science provided new insights while raising new questions about the drug kratom. Its active ingredient mitragynine acts as a weak partial agonist at the mu-opioid receptor (MOR), but new findings by a team that included researchers at Columbia and Memorial Sloan-Kettering found that the drug’s analgesic properties are significantly mediated by a metabolite produced when mitragynine is consumed orally, called 7-hydroxymitragynine. In mice, at least, this compound seems to provide analgesia but with fewer respiratory-depressing and reward-associated side effects than other opioids such as morphine. These findings point toward the potential of this drug in pain research as well as the need for further research on the pharmacology of kratom’s constituents, their toxicity and potential value in the treatment of OUD.

Although the MOR system is most commonly associated with pain and pain relief, other receptors are also involved.  One important dimension of pain is the negative affect commonly associated with it, and NIDA-supported research published in Neuron in March found that the kappa-opioid signaling system, specifically in cells located in the shell of the nucleus accumbens, are involved in processing pain-associated negative affect. This discovery could perhaps provide new targets for treating the emotional distress associated with many pain-associated syndromes.

Other Developments

Translating addiction science into new treatments and treatment tools is another area where NIDA is having an impact. For example, in the past few years, NIDA has been extremely successful in winning interest for biotechnology investment in devices and other products to address the opioid crisis and addiction more generally. Historically, addiction is a market that has scared away pharmaceutical companies and investors, who viewed it as small and risky and one that would not lead to recovery of investment. However,  NIDA’s medication development program expansion along with NIDA’s Office of Translational Initiatives and Program Innovations (OTIPI) are turning this around. OTIPI, which I highlighted previously on this blog, uses a wide array of funding mechanisms to support startups in developing or adapting devices, apps, and other technologies in ways that can better deliver treatment to people with substance use disorders and related conditions.

NIDA science continues to contribute knowledge to help guide policy. One example is from our annual Monitoring the Future (MTF) survey, which in 2019 showed steep increases in the use of vaping devices both for nicotine and for marijuana among teenagers.  The survey also revealed that a large proportion of teens vaped because they liked the taste. When these vaping data (along with those of the National Youth Tobacco Survey) were released last November, it prompted the makers of the popular Juul devices to pull their mint flavored products from the shelves, and it prompted the FDA to finalize their enforcement policy on flavored vaping (e-cigarette) products.

Find Help Near You

The following can help you find substance abuse or other mental health services in your area: www.samhsa.gov/find-treatment. If you are in an emergency situation, people at this toll-free, 24-hour hotline can help you get through this difficult time: 1-800-273-TALK. Or click on: www.suicidepreventionlifeline.org. Also, a step by step guides on what to do to help yourself, a friend or a family member on our Treatment page.

Narcotics Anonymous National Hotline: 1(877) 276-6883.

The Opioid Issue: Part 1

Part One: Dangerous Prescriptions

The opioid crisis seems to hit everyone, everywhere, regardless of socioeconomic class, geography, age, profession, or religious affiliation. Overdosing on drugs, especially opiates and heroin, is now the most common cause of death for Americans under fifty years of age. I spent forty years embroiled in active addiction. It started innocently with a case of beer, but quickly led to marijuana, cocaine, and inhalants. The longer I struggled, the more hopeless I became. Friends stopped calling me or inviting me to parties. Family felt they could no longer trust me given the hundreds of broken promises and countless runs on their medicine cabinets for opiates. Although I was able to stop drinking and taking street drugs in 2008, I battled with benzodiazepines (Xanax, Ativan) and oxycodone for another eight years. I am blessed presently with nearly two years without taking narcotics.

Opiates in Pill Bottles

This epidemic has reached every corner of the United States. This is the first in a series of blog posts regarding opiate addiction in America. This series will address dangers of opiate prescriptions, collateral damage, impact on the nation’s foster care system, homelessness and addiction, troubling developments in drug rehabilitation, addiction and crime, and a Christian response to the crisis.

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Current medical opinion indicates the reason the U.S. is experiencing a disastrous epidemic of opioid abuse can be summed up in two words: pain avoidance. In the 1990s there was a proliferation of health care professionals trying to address the symptom [of pain] and not so much the underlying causes of the pain a person has. In 2015, opioid-related deaths stole the lives of over 33,000 Americans. To put this number into perspective, this outnumbers fatal car crashes and gun deaths during the same year. According to the federal government, in 2016 the nation mourned close to 64,000 deaths from drug overdoses. Two-thirds of those involved the misuse of opioids. Karl Benzio, M.D., a Christian psychiatrist and member of Focus on the Family’s Physicians Resource Council (PRC), fears the toll could reach 80,000 deaths in 2018.

We wouldn’t be here if opioids weren’t so effective. Americans want something for their pain—regardless of whether that pain is physical, mental, or emotional. We live in a psychologically compromised society that is impatient and entitled, whose citizens feel there should be no pain in life. Accordingly, greater demands have been made on providers to eliminate all pain with medication. The problem is—and I know this all too well firsthand—once a patient gets a taste of the relief, some develop a dependence that leads them down a dark path. Ironically, that path leads only to deeper struggles. For some, the exit will only come in the form of fatal overdoses as opioids shut down the body’s ability to breath.

It is time we start helping patients deal with life’s pain and its root causes head-on, rather than masking it through medication.

How it All Began

Chronic Pain The Silent Condition

The current crisis can be traced back nearly forty years. Medical researcher Hershel Jick and graduate student Jane Porter of Boston University Medical Center analyzed data from patients who had been hospitalized there. Close to 12,000 had received at least one dose of a narcotic pain medication during their stay. Of those, Jick and Porter’s analysis found only four had developed a well-documented addiction. Jick sent the findings to the New England Journal of Medicine, who published his analysis as a letter to the editor in 1980. “Despite widespread use of narcotics [sic] drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction,” Jick wrote. Unfortunately, this quote was given far more merit than it deserved. Moreover, the conclusion had not been subjected to peer review.

In 1990, Scientific American called the Jick/Porter research “an extensive study.” About a decade later, Time proclaimed it “a landmark study.” Most significantly, Purdue Pharmaceuticals, maker of the popular narcotic OxyContin, began a promotion asserting less than one percent of patients treated with their time-released opiate medication OxyContin would become addicted. In the 1990s, pain was correlated with a greater probability of a patient having ongoing health issues. So the medical community elevated it to the position of the fifth vital sign along with heart rate, blood pressure, body temperature, and respiratory rate. The medical community, thinking that reducing pain would help long-term patient satisfaction, health and outcomes, started to prescribe more pain meds.

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The ’90s also saw the development of stronger and more effective opioid painkillers. As the decade drew to a close, the opioid epidemic was ignited. It took some time for most of the country to realize the metaphorical fuse had been lit, but the numbers back up this concern. According to the U.S. Department of Health and Human Services (HHS), between 2000 and 2017 opioid prescriptions increased 400 percent. Between 2000 and 2010, misuse involving noncompliance with prescription instructions or using medications prescribed for another person doubled. Now, the results are playing out in heartbreaking fashion nationwide, which are impossible to ignore. Overdose deaths—116 per day, according to federal statistics—are shaking Americans of all incomes, ages, and ethnicity. From the rural back roads of Appalachia (Kentucky, West Virginia) to the urban sprawl of New York and Los Angeles, the epidemic is cutting a path that threatens to leave no family unscathed.

The Blame Game

It’s become quite popular (if not convenient) to lay the blame for the epidemic squarely at the feet of the big pharmaceutical companies. For example, according to an article in the Los Angeles Times in May of this year, more than 350 cities, counties, and states had filed lawsuits against makers and distributors of opioid painkillers. The LA civil action accuses drugmakers and distributors of deceptive marketing aimed at boosting sales, claiming the companies borrowed from the “tobacco industry playbook.” One of the companies most frequently put under scrutiny has been Purdue Pharma, maker of OxyContin.

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In May The New York Times called Purdue “the company that planted the seeds of the opioid epidemic through its aggressive marketing of OxyContin.” The Times article uncovered a disturbing report on OxyContin compiled by the U.S. Department of Justice, which found that Purdue Pharma knew about and concealed significant incidents of abuse of OxyContin in the first years after the drug hit the market in 1996. The article further noted that Purdue Pharma admitted in open court in 2007 that it misrepresented the data regarding OxyContin’s potential for abuse.

Overdose Deaths Not Just Related to Opiate Prescriptions

Government reports have recently stated that today’s increase of fatal opioid-related overdoses is being driven by abuse of heroin and illicit fentanyl. A study prepared by the National Institute on Drug Abuse last September found that overdose deaths from heroin and other drugs laced with fentanyl increased 600 percent between 2002 and 2015. Street dealers have increasingly been cutting their drugs with fentanyl—a particularly dangerous and relatively inexpensive substance 50 to 100 times more powerful than morphine—to boost their profit margins. In most cases, the users don’t even realize they’re buying fentanyl-laced products.

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It is important to note that although many people believe Big Pharma is complicit in fueling the epidemic and should shoulder the loin’s share of the blame, Dr. Benzio sees it differently. “Pharmaceutical companies only make the meds,” Benzio says. “Only about 6 to 8 percent of people who take an opioid will misuse or overuse it in a destructive way. It is the doctors who over-prescribe and a society that is looking for a quick fix and can’t tolerate any discomfort [that’s to blame].”

The Road Ahead

The opiate epidemic may have grown somewhat quietly, but the nation’s attention is riveted to it now and policymakers aren’t sitting still. In 2016, Massachusetts became the first state to limit the duration for painkiller prescriptions at seven days. Since then, more than two dozen other states have also established limits. In my home state of Pennsylvania, Governor Tom Wolf initiated a statewide prescription drug monitoring system to help prevent prescription drug abuse. Of concern is the practice of “doctor shopping,” which involves a patient visiting multiple doctors and emergency departments in search of opioids. Unfortunately, this is something I did quite often while in active addiction. This practice often necessitates filling prescriptions at multiple pharmacies. The governor’s new policy includes the monitoring program, a standing order for naloxone (Narcan, used to reverse the effects of an opiate overdose), a patient non-opioid directive (which allows patients to opt out of opioid pain medicine in advance) a “warm hand-off” where ER attending physicians and other providers can set up a face-to-face introduction between a patient and a substance abuse specialist, and revised prescribing guidelines relative to opiates.

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At the federal level, President Donald Trump declared the opioid crisis a public health emergency in 2017, and formed a commission to fight it. Meanwhile, HHS now has a multi-pronged strategy to get the crisis under control, including getting better data through research and improving prevention, treatment, pain management, and recovery services. The federal crackdown is estimated to cost $13 billion to $18 billion over the next two years. Dr. Benzio believes this is “a good start,” but said providers must resist the urge to automatically jump to the quick fix of narcotics for those in pain. “There are many ways to combat pain through physical therapy and fitness, relaxation, better sleep and nutrition,” says Benzio. It seems likely that we will not get a significant handle on opioid abuse until the core issues that lead people to the drugs are addressed.

The Christian Perspective

W. David Hager, M.D., a member of the PRC, notes three principle root issues in addiction: rejection, abandonment and abuse. Hager has been a facilitator for the Christian program Celebrate Recovery. He said, “Unless we enable [people] to identify their root issue and deal with it first, the rates of relapse are high. When they are able to deal with their root issues by offering forgiveness, making amends, and seeking a personal relationship with Jesus Christ, we find that large numbers are able to enter and maintain sobriety.” That is why the Church has the unique ability to make a difference in combating the opioid crisis.

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“We have to convince faith-based communities to get their hands dirty, to get involved and realize that this is an issue,” Benzio says. He suggests inviting laypeople to develop a working knowledge of dopamine, the brain chemical that provides the pleasure-inducing sensation many who use drugs are seeking. “There is only one [higher] power that can sever synapses in the brain that have been stimulated by a substance to achieve [a certain] dopamine level,” he adds, “and that’s the power of the Holy Spirit.”

Exactly how Christians appropriate the Spirit’s power to take on the opioid crisis will vary from case to case. The point, Benzio and Hager say, is that this needs to become a top-of-mind concern for the Church. But are North American churches up to the mission of addressing opioid use among their members? Pastors are in a unique position to proclaim and demonstrate the Gospel to individuals struggling with addiction. Many are too ashamed to confess an addiction to pain medication. As the opioid crisis deepens, so must the response of the local church. If the Christian church has anything to offer those hurting from drug addiction, it is hope and community. I was only able to break the bondage of addiction over my life through the Power in the Name of Jesus.

Power in the Name of Jesus

Programs such as Narcotics Anonymous and Celebrate Recovery have been extremely effective in changing lives, but it’s not always enough. Addressing the root of addiction is one of the most effective long-term solutions, which for Christians is about the heart. The church must be willing and capable of seeing those struggling with addiction as not merely a program of the church’s community outreach; these individuals are children of a God who loves them no matter their current condition. I believe America’s recovery can find its roots in the local church.

What does love look like? It has the hands to help others. It has the feet to hasten to the poor and needy. It has eyes to see misery and want. It has the ears to hear the sighs and sorrows of men. That’s what love looks like. -St. Augustine

 

 

Celebrities We Lost to Overdose

It is a tragedy when anyone dies of a drug overdose. Drugs are no respecter of persons. It takes anyone at anytime, killing without prejudice. Why do humans like to get high? One answer is that drugs provide shortcuts to religious and transcendental experiences. If something can be ingested, injected, inhaled or absorbed into the human body, it can be abused. In the United States alone, nearly one-third of the population either abuses drugs or has a relationship with someone who is chemically dependent. Other countries face a similar problem.

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Nearly half of drug abuse in the United States involves the misuse of prescription drugs. This is not only deliberate misuse, such as forged prescriptions, Medicaid fraud, and black market sales, but also errors made by physicians and accidental misuse of prescribed drugs—especially by the elderly. Many observers have become concerned about the astonishing increase in the use of Ritalin, a physician-prescribed drug given to American children diagnosed with attention deficit hyperactivity disorder (ADHD).

Many widely-used chemical substances damage the brain, heart and lungs of the user, as well as the bodies of the user’s unborn children. Drug use contributes to the leading causes of death in the world—heart disease, stroke and various types of cancer. It also generates an incredible financial burden for society. The total cost of substance abuse in America has been estimated at more than $240 billion per year. According to the World Health Organization, approximately one out of five hospital beds in the United States is occupied by someone with substance abuse as a contributing factor, and nearly 50 percent of all preventable deaths are related to some aspect of substance abuse. Substance abuse and its consequences are major medical and social problems.

Today, the medical model of addiction dominates the thinking in much of the Western world. This model suggests that people who abuse chemical substances or have behavior-related problems are victims of faulty genes that produce internal chemical imbalances. This can promote the notion that people have little control over their lives, and at times is used as an excuse for lawlessness by wildly mixing up moral responsibility with diagnosis. Indeed, much conventional wisdom about substance abuse undermines personal responsibility.

Factors Preventing Substance Abuse:

  1. Purpose in life
  2. Strong system of values
  3. Positive parental example
  4. Close relationship with parents
  5. Positive peer influences
  6. Academic achievement
  7. High educational aspiration
  8. Regular school attendance
  9. Regular church attendance
  10. Realistic long-term goals
  11. Knowledge of consequences
  12. Hope of a reward

It is alarming how many celebrities who have died secondary to drugs and alcohol over the years.

  • Corey Monteith, age 31, who played Finn Houston in the Glee TV series, was found dead in his Vancouver hotel room after taking a lethal cocktail of heroin and booze.
  • Sid Vicious, the bassist for the punk rock band Sex Pistols, died in his sleep after partying with heroin the night of his 1979 release from New York’s Rikers Island. His drug dealer that fateful night was his mother.
  • Dee Dee Ramone, Ramones founding member, bassist, singer and songwriter, died of a heroin overdose. Police found a syringe and five balloons of heroin near Ramone’s body.
  • Kurt Cobain, the Nirvana front man, was found in 1994 at his Lake Washington home. Although he shot himself—a suicide note was found—a high concentration of heroin and a small amount of diazepam was found in his bloodstream.
  • Peter Farndon, the founding member of The Pretenders, was found in his bathtub by his wife following a heroin overdose.
  • Lenny Bruce, standup comedian, died in 1966 after overdosing on heroin.
  • Jim Morrison, front man for the Doors, died on July 3, 1971, at age 27. He was found in a Paris apartment bathtub, reportedly dead from a heroin overdose after snorting what he thought was cocaine.
  • Jimi Hendrix was arrested in 1969 for possession of heroin, but was acquitted after claiming the drugs were planted in his belongings. He died of a heroin overdose the following year.
  • Hillel Slovak, founding member of the Red Hot Chili Peppers, died on June 27, 1988 of a heroin overdose.
  • Elvis Presley died at age 42 on August 16, 1977 after being found unresponsive in his upstairs bathroom. Cause of death was cardiac arrest secondary to an overdose of prescription drugs, including codeine, Valium, morphine, and Demerol.
  • Chris Farley died in 1977 after a night of partying with a hooker. An autopsy revealed a cocaine and morphine overdose.
  • John Belushi, of Saturday Night Live fame, was found dead in his room at the Chateau Marmont hotel in 1982 from speed-balling: injecting a combination of heroin and cocaine.
  • Whitney Houston, 48, was found unconscious and submerged in the bathtub of her suite at the Beverly Hills Hotel just hours before a pre-Grammy party. She died of an accidental overdose of cocaine and other drugs.
  • Corey Haim, the former child star who played in The Lost Boys, died of an accidental drug overdose. It was determined that he’d been obtaining prescription drugs through various aliases.
  • Janis Joplin died of a heroin overdose. She was found wedged between a table and the wall with a cigarette in her hand.
  • Heath Ledger, 28, who won a posthumous Oscar for playing the Joker in The Black Knight, was found unconscious in his bed by his housekeeper. Ledger died of acute intoxication due to taking six different prescription drugs.
  • River Phoenix, 23, who was scheduled to perform on stage with the Red Hot Chili Peppers, died from an overdose of heroin and cocaine.
  • Philip Seymour Hoffman, Oscar winning actor who starred in over 40 films, was found dead of an apparent heroin overdose on February 2, 2014. He had been clean for 20 years. Hoffman was 46.
  • Len Bias, pro basketball player, died of a cocaine overdose in 1986.
  • Christopher Bowman, professional figure skater, died of a overdose of cocaine, diazepam, alcohol, and cannabis.
  • William Holden died at 63 after he fell and bled to death following a night of intoxication.
  • Michael Jackson died in 2009 of an accidental overdose of lorazapam and propofol administered by his private physician.
  • Marilyn Monroe died in 1962 at age 36 from an overdose of barbiturates. Officially ruled as a private suicide, although several conspiracy theories still persist.
  • Amy Winehouse, a talented singer with a unique take on jazz, died in 2011 at age 27, from alcohol intoxication.
  • Prince died of an accidental fentanyl overdose in 2009.
  • Anna Nicole Smith succumbed to an overdose of methadone and medication for anxiety and depression in 2007.
  • Tom Petty died from a fatal combination of fentanyl and oxycodone in 2017.
  • John Entwistle, bass player for The Who, died of a heart attack due to a cocaine overdose in 2002.
  • Len Bias, Boston Celtics second overall NBA draft pick, suffered cardiac arrhythmia after an accidental cocaine overdose, and passed away in 1986.
  • Truman Capote died of liver failure secondary to drug and alcohol abuse in 1984 [Ironically, he was brilliantly played by the late Philip Seymour Hoffman in Truman.]
  • David Kennedy, fourth son of Robert F. Kennedy, died from  an overdose of cocaine, meperidine, and thioridazine in 1984.
  • Judy Garland died in 1969 secondary to a barbiturate overdose.

Concluding Remarks

If you know someone who is struggling with active addiction, please talk to them about treatment. If you need help, contact your local Al-Anon chapter. If you are stuck in the bondage of addiction, there is hope. First things first: Contact your local chapter of Alcoholics Anonymous or Narcotics Anonymous. I struggled with active addiction for forty years. Step One says, “We admitted we were powerless over alcohol, and that our lives had become unmanageable.” Drug overdose is the leading cause of death in the United States, with 64,000 deaths last year alone. President Donald Trump said in the State of the Union Address this week that 700 Americans die every day from drug overdose.

The Accidental Addict

Up until a few months ago, Susan started her day by getting high. She’d crush a cocktail of drugs that included Oxycontin and Roxicodone, two forms of the narcotic painkiller Oxycodone, and then snort them so they’d get into her system faster. Within hours the symptoms of withdrawal would set in. An unbearable panicky feeling, muscle cramps, diarrhea and nausea. So she’d quickly snort another round. If there were no drugs left, she’d find a way to get more. Either from someone she knew or by buying them from a dealer.

This scenario wouldn’t seem shocking if Susan were a junkie living on the street, but that’s not the case. She’s a 32-year-old, well-educated, middle-class mom holding down a job as a nurse. Her spiral into addiction started seven years ago, when she was 25 and often in debilitating pain. After finally being diagnosed with fibromyalgia, she was relieved to have a name for her condition and a prescription to ease her suffering. “The Oxy didn’t just take away the pain. It gave me energy and helped me feel less stressed,” says Susan. “When I took those pills, it was like I could get everything done.” But soon the drug stopped giving her that false sense of control, and she needed to take more and more just to feel normal. When popping pills wasn’t working, she started snorting them. By the time Susan realized her drug habit had become a problem, this real-life “Nurse Jackie” was powerless to quit.

Chances are, you know a Susan even if you don’t realize it. “After alcohol and marijuana, prescription pain relievers are the most widely abused drugs in the United States,” says John Coleman, PhD, president of the Prescription Drug Research Center. Why are pills so ripe for abuse? They’re easily available. Last year, 139 million prescriptions were written for hydrocodone-containing drugs like Vicodin (up from 112 million just four years ago), making them the most-prescribed drugs in the country. They’re also highly addictive. Especially painkillers like Vicodin, Percocet and Oxy, which come from opium or a synthetic version of it. They are actually chemically related to heroin, but without the stigma. “People who would never dream of trying an illicit street drug may be prescribed Vicodin or Percocet for pain relief after a car accident,” says Coleman, “and after just a few weeks they can end up dependent on these drugs.”

“About 10 percent of the population has a genetic predisposition to addiction, whether it’s to painkillers, alcohol or substances like nicotine,” says Russell Portenoy, MD, chairman of the Department of Pain Medicine Palliative Care at Beth Israel Medical Center in New York City. “A personal or family history of alcohol or substance abuse suggests that you may be one of those people.” Other risk factors include suffering from a psychiatric condition like depression, anxiety or bipolar disorder, or having experienced past trauma such as sexual or emotional abuse.

Unfortunately, most people who become addicted to narcotics can’t stop on their own. That’s what Susan is in the process of doing. Her wake-up call came one morning when she realized she’d finished a month’s worth of her prescription in less than a week. This time, instead of trying to get more pills, she decided she’d had enough. She sat on the bathroom floor, sweating and shaking. She opened the phone book and called one rehab center after another until she found one with a bed open for her. She went in to treatment the following morning.

Addiction is defined as the compulsive need for and use of a habit-forming substance (such as heroin, alcohol or narcotic pain medication) characterized by tolerance and by well-defined physiological symptoms upon withdrawal. In other words, persistent compulsive use of a substance known by the user to be harmful. If you’re struggling with addiction, please pick up your phone book or go online and find the number for Narcotics Anonymous or Alcoholics Anonymous. Don’t wait 30 years to seek help like I did. Know this: If you find that when you drink or take narcotics you cannot control the amount you consume or, if when you want to, you find you cannot stop, then you are at that jumping-off point where it will never get better. Only worse.