The Rhinelander Daily News - Online news and information for the Rhinelander, Wisconsin region

According to a recent report released by the Substance Abuse and Mental Health Services Administration (SAMSHA) based on statistics from the National Surveys on Drug Use and Health (NSDUGH) between 4 and 6 percent of residents in northeastern Wisconsin over the age of 12 have abused prescription pain relievers in the past year and for the first time ever prescription drugs have surpassed marijuana in use by first-time abusers nationwide. The report calls the abuse of prescription pain killers a growing problem and states that prescription drug use is second only to marijuana in rates of abuse.

A separate report issued by the National Institute on Drug Abuse (NIDA) states that 20 percent of the national population has used prescription drugs for non-medical purposes at some point. The Drug Enforcement Agency (DEA) released statistics that showed Americans purchase 90 percent more painkillers today than they did in 1997.

The story behind the statistics is apparent; the front line of the war on drugs has moved from the streets to hospitals, pharmacies, and medicine cabinets.

Rick Lodholz is an AODA case manager at the Tri-County Human Service Center.

He uses his experience as a recovering addict and his training as a counselor to help addicts along the path to recovery. He views the problem of prescription drug abuse as part of the overall scourge of addiction.

“There’s really not a lot of difference between an addict of prescription drugs and an alcoholic. A drug is a drug is a drug,” Lodholz said.

Lodholz has seen addicts attracted to the whole gamut of prescription drugs. His experience tells him that different individuals are attracted to different drugs.

“There’s not anything that’s more prevalent than anything else. It’s all up to the individual,” Lodholz said. “I was a downer freak more than I was into amphetamines.”

Lodholz, recovered for over 20 years, said people have been abusing prescription drugs for decades, but in the last ten years he has seen a steady increase in the availability of prescription drugs.

“What’s new about it is there’s a lot more available,” Lodholz said. “We have kids growing up in households where the parents are using these medicines. We have kids being prescribed these medicines.”

The ubiquity of prescription drugs and the availability of medical information on the Internet create an environment in which addicts are increasingly adept at abusing the system.

he ubiquity of prescription drugs and the availability of medical information on the Internet create an environment in which addicts are increasingly adept at abusing the system.

“It’s easy to talk doctors into a prescription because doctors and therapists rely on self-report,” said Lodholz. “It’s common for addicts to become adept at misleading doctors. One of the issues is that the addicted community shares information about who is a soft touch.”

What Lodholz says prescription drug addicts have in common with other addicts is the disease of addiction. He used his own experience to illustrate the point.

Lodholz suffered a heart attack last December and found himself in the hospital.

“I was one month shy of 20 years of sobriety and the instant that doctor told me they were going to give me morphine my whole body was rejoicing. Now that’s messed up,” Lodholz said. “It’s the most insidious disease because the brain will reward you for things that feel good.”

Dr. Gurkirpal Sikka, the director of Ministry Health Care’s Pain Clinic in Rhinelander, has worked as an anesthesiologist and pain relief doctor for 25 years. He has been extremely active in addressing the hospital’s participation in the struggle to contain prescription drug abuse.

Sikka has worked with the NORDEG task force, with the AODA coalition, and directly with local schools to educate the community on the risks of prescription drug abuse. He has been equally active within the medical community.

“We’re working on the doctors but doctors are a hard breed to change,” Sikka said. “At the same time the patients are becoming more sophisticated about fooling doctors.”

Surgeons and cancer doctors, in particular, have become accustomed to issuing pain relief prescriptions and are rarely trained in dealing with addicts. At the same time, Sikka said, addicts thoroughly research symptoms on the Internet so they can accurately represent them to doctors.

At the same time there is an economic pressure on some pain patients to distribute their prescriptions illegally. A patient on Medicare could receive a month’s supply of pain medicine for as little as three dollars, and each pill could have a street value of as much as $15.

Sikka said that the shift in the pattern of distribution of pain medicine dates back to a ten-year-old finding by the Joint Commission on Hospital Accreditation that showed hospitals were under-prescribing pain medication. Since that time hospitals have treated pain as a fifth vital sign.

But pain is the only subjective vital sign, so doctors rely on their patients to accurately assess their pain on a scale of 1 to 10, checking and re-checking at regular time intervals after doses are administered.

Sikka said while detecting an individual abuser can be difficult, detecting patterns of abuse is not.

“If someone comes to me on four occasions and says to me, ‘your patient is abusing medication,’ then I know I have to be more careful,” said Sikka.

At the Pain Clinic, Sikka’s staff uses a patient contract when they prescribe controlled substances that requires patients to use only one pharmacy and to list the pharmacy at the time of receiving the prescription. Sikka’s staff impresses on patients that if they are going to receive narcotic pain killing drugs, they must also follow through on the other prescribed measures of pain relief, including physical therapy, counseling, anti-inflammatory drugs and the effort to increase their activity. Sikka said life activity is the most important sign of recovery and the goal of pain therapy.

Sikka is also working with the hospital’s administration to develop what he calls a “quality control” mechanism for the doctors.

“What do I do if I find a bad physician? We are looking for a mechanism where a pharmacist can call the hospital and report failures,” Sikka said. “Nobody wants to tell the doctor that the doctor is writing wrongly.”

The relationship between doctors and pharmacists is crucial to stamping out the problem of prescription drug abuse.

Sikka said Rhinelander has benefited greatly from a close-knit and responsible community of pharmacists who have been proactive about dealing with the issue.

“I think the pharmacists have done very well,” Sikka said. “They’ve made a good collaborative effort.”

Corky Stoxen of Stoxen Professional Pharmacy has been active within Rhinelander’s community of pharmacists in addressing the issue.

“We’ve never had to be this careful in my lifetime. It’s gotten more exciting in the past five or ten years,” Stoxen said. “We’re such a small community we used to keep a really good handle on it and we still can.”

Stoxen said for many years, the pharmacists relied on phone calls and word of mouth to identify customers who were abusing the system, but as the problem grew, that process became too time-consuming. Working in conjunction with law enforcement personnel from the NORDEG task force, area pharmacists developed a way of sharing the information systematically without violating patient rights.

“We decided over the years that it was too labor intensive to call around to all the pharmacies every time we had a prescription,” Stoxen said. “We sat down and put our heads together to expedite this kind of thing. It’s helping a lot. If nothing else, if people know we’re doing it, maybe they’ll stop trying to abuse the system.”

An drug investigator from the Oneida County Sheriff’s Department who asked to speak anonymously, said prescription drug abuse now represents between 60 and 70 percent of their case load. Prescription drugs pose a different kind of enforcement problem than illicit street drugs because of the role of the medical system in their distribution pattern.

“The fact that the drugs are prescribed makes it harder because people can go to the doctor to get them,” the investigator said. “The best way for us to deal with the problem is to work with doctors and pharmacists to show them how these people operate.”

According to the investigator, once a prescription has been obtained for an illegal purpose, the drugs are disseminated quickly.

“As soon as these people get the prescriptions, they’re gone with hours. They’re sold,” the investigator said. “A lot of the time the handover happens right in the pharmacy parking lot.”

The investigator said a primary enforcement emphasis has been educating doctors and pharmacists about the problem and teaching them to report crimes.

“We’re basically teaching the doctors and pharmacists the ways they can report crimes to us without violating patients’ rights,” the investigator said.

The investigator said local drug enforcement officers submit more prescription drug abuse charges than are regularly prosecuted, a fact that points to society’s readiness to excuse prescription drug users.

“Everybody needs to realize how serious this problem is and get on the same page,” the investigator said. “We’re actually further along than a lot of other organizations in the state, but it’s still a learning experience right now.”

The investigator said tips are a crucial part of finding traffickers of prescription drugs, so doctors and pharmacists will remain on the front line of the issue.

“We are not the first line of enforcement,” the investigator said. “The doctors and the pharmacists are. They’re the ones who have to create awareness and police the issue amongst themselves.”

Stoxen said Rhinelander’s small size protects it from the systematic and widespread abuse of the pharmacy system that has plagued bigger cities in recent years.

“I don’t know of anybody in this neck of the woods filling prescriptions illegally,” Stoxen said. “It’s really difficult to do that for long without getting caught. If I was going through hundreds of thousands of units of Vicodin in a town this size, there would be an alarm.”

Stoxen echoed Dr. Sikka’s belief that the economic incentive of re-selling prescription pain medicine is growing.

“These pills on the street sell for a lot more than they sell in the pharmacy, even at the retail cost,” Stoxen said.

But the supply of prescription drugs is not the root problem, the demand is.

Pat Dugan is an outpatient counselor at Ministry Behavioral Health who counsels recovering addicts. Dugan said he regularly encounters three types of prescription drug addicts.

“There is a small subset of people who will develop a physical addiction because they’ve been on narcotic drugs for such a long time to control pain,” Dugan said. “They’re not drug addicts but they have developed a physical addiction. If they are properly detoxed, life goes on.”

Dugan said another subset of people are “pseudo-addicts” who have been under-prescribed pain medicine and show the addictive behaviors in order to obtain medication.

The last type of prescription pain abuser is the “true addict.”

“Now we have a person who more often than not has a genetic pre-disposition to addiction,” said Dugan.

Dugan said 60 percent of addicts show a genetic predisposition to addiction and the best way to obtain the information is through medical and family histories. One of the real problems with prescription drug abuse is when a true addict has a legitimate pain diagnosis.

“They have legitimate pain and an excuse to get drugs,” Dugan said. “This person’s brain is wired differently. Deep in the brain the opioids light up the pleasure centers like no other. They make poor decisions. They can’t see what they’re doing. They develop a sincere illusion and in their own minds, they need and deserve these drugs.”

Dugan said the road to recovery for a prescription drug addict is arduous but not hopeless. He speaks of a rule of thirds.

The first third of patients succeed in recovery their first time through. The second group succeeds after repeated attempts. And the last third never recovers. Still, Dugan said the rate of recovery is equal to the rate of recovery of other chronic diseases like diabetes and asthma.

Dugan relies heavily on the principles of the 12-step program developed by Narcotics Anonymous (NA). Dugan said medical detox is the first step of preparing an addict for recovery.

“These people are notorious for self-medicating and switching from one drug to another,” Dugan said. “The mood-altering drugs are providing the delusion structure for the person.”

After detox is completed, addicts who have pain diagnoses sign opioid contract that outline a specific path for weaning them off narcotic drugs by using other forms of therapy and pain control. But the key step for any addict is a willingness to self-examine and ultimately to admit their powerlessness over addiction.

In the NA approach, that process involves identifying a “higher power.”

“For some people, their higher power is nature,” Dugan said. “Your higher power can be whatever you want it to be but the bottom line is its about finding humility.”

Dugan said addiction must be treated as a no-fault chronic disease to be managed over the course of a lifetime. How long does it take to succeed at recovery?

“24 hours. It takes doing it everyday,” Dugan said.

The second part of Prescription for Disaster, exploring the abuse of prescription drugs amongst school-aged children, will run in Monday’s paper.

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Comments »

Betty Lou wrote on Dec 7, 2008 2:30 PM:

" The pharmacy needs to mind there own business they are paid to fill our prescriptions not judge what they think the patient needs if the doctor writes the prescription it should be filled!! Maybe the doctor should do more research or spend a little more time with the patient... "

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