Prescription Drug Abuse on the Rise in America

Chicago Tribune

At colleges across the country, students are taking pills they've sneaked from home, tossing them into bowls and swallowing handfuls with a chug of beer or a sip of a margarita.

It's called "pharming," for the pharmaceuticals ingested. In office towers, workers sitting at computers are barraged with spam e-mail offering prescription drugs at low prices, no prescription required. "No physical exam," promised one message widely circulated last week, touting painkillers, stimulants, tranquilizers and anti- depressants.

The face of drug addiction is changing in America, from cocaine or heroin addicts snorting or shooting up to teenagers and grandmothers popping pills purchased at the local pharmacy or delivered through the mail in plain packages.

Rush Limbaugh turned a spotlight on the epidemic this month when he admitted being hooked on prescription painkillers and told his radio audience he intended to get help.

Prescription drug abuse is the fastest-growing type of substance abuse in the United States, a phenomenon fed by aggressive drug marketing, Americans' habit of taking pills for any ailment, physicians' tendency to overprescribe and the Internet, which is expanding the availability of drugs exponentially.

About 6.2 million Americans, including disproportionately high numbers of young people and the elderly, abuse prescription drugs, according to government data released in September. More than 14.5 million people report they've taken such drugs for non-medical purposes during the past year.

Meanwhile, 2.4 million people in 2001 started abusing pain relievers--the drugs Limbaugh allegedly asked his housekeeper to buy for him--almost a fourfold increase over the 628,000 reported as abusers in 1990, according to the U.S. Substance Abuse and Mental Health Services Administration. Prevention efforts increase

The problem is so acute that parents may need to start locking their medicine cabinets, just as liquor cabinets were locked decades ago to keep children away from booze, said Joseph Califano, president of the National Center on Addiction and Substance Abuse at Columbia University. Former New York Mayor Rudolph Giuliani has turned his attention to the issue and next month is expected to announce a new national organization, Prescription Action Alliance, aimed at preventing and controlling this type of substance abuse. Law enforcement, medical professionals, drug companies and government agencies are to participate.

For many people, popping pills may appear to be a more sanitized, less stigmatized way to get relief from the stress of daily life. Instead of dealers on mean streets, frequent sources are doctors duped by patients or pharmacies responding to call-ins for fake prescription refills. Califano, a former Cabinet secretary, cites 2002 figures for legal prescriptions in the U.S.: 153 million for narcotics, such as Vicodin, Percocet or OxyContin; 53 million for tranquilizers such as Xanax or Valium; 23.5 million for stimulants such as Adderal or Ritalin; and 5 million for sedatives such as Soma.

On top of that is an unknown quantity of counterfeit prescription drugs streaming into the country through the Internet and other sources, often of unknown quality and diverted to the underground market. Officials from the Food and Drug Administration, Secret Service, Justice Department and pharmacy groups met last week in Washington to develop strategies for keeping counterfeit pills out of the country. OxyContin, which some experts call "prescription heroin" because of its similarity in effect to that illegal narcotic, illustrates the expanding scope of the problem. The powerful narcotic, meant for people with chronic and severe pain, has moved into urban and suburban areas from rural areas where authorities first began tracking its abuse several years ago. Abuse of OxyContin "has taken hold across the country," said Dr. Andrea Barthwell, deputy director of drug demand reduction for the Office of National Drug Control Policy.

OxyContin is one of the drugs that Limbaugh allegedly took in large quantities. A criminal probe in Palm Beach County, Fla., involving dealers who reportedly supplied Limbaugh is under way; it is not clear whether the radio commentator will face prosecution. Next step heroin?

There are an increasing reports of OxyContin users turning to heroin when they no longer can get prescription drugs, and some concern that OxyContin abuse may be a precursor to the heroin epidemic sweeping parts of the country, said Robert Lubran, director of pharmacologic therapies at the Substance Abuse and Mental Health Services Administration.

The Drug Enforcement Administration reports that OxyContin is a "highly abused substance" in Illinois while also noting concerns over the illegal use of other narcotics such as Vicodin, Lorcet and Lortab, and the rising illegal distribution of Ritalin, a stimulant, and Valium, a tranquilizer. Purdue Pharma, which manufacturers OxyContin and co-markets it with Abbott Laboratories, is spending more than $200 million educating health-care professionals about the drug, running ads on radio and television warning parents not to make it available to teens, distributing fraud-resistant prescription pads, researching ways to make OxyContin less addictive and developing systems to track and control abuse more quickly. Fresh hurdles surface

But the rise of the Internet as a source of illegal prescription drugs presents new challenges. At least 2,000 Web sites now sell prescription drugs, the FDA estimates.

Traditionally, investigators have looked for geographic "clusters" of drug-related problems--whether admissions to emergency rooms or to jails--to identify physicians who may be overprescribing, buyers who may be doctor-shopping and other drug scams. With the Internet, though, clusters aren't readily detectable.

In the past several months, authorities have seen "a new and troubling evolution of this business," from the Internet sale of lifestyle drugs such as Viagra and diet aids to the pervasive marketing of all kinds of prescription drugs, said William Hubbard, assistant commissioner at the FDA. The FDA and the Drug Enforcement Administration last week teamed to form a task force, Operation Gray Lord, that will aggressively pursue outfits that market prescription drugs illegally over the Internet. Doctors who prescribe drugs over the Internet based only on customers' answers to e-mail questionnaires also may be targeted.

While some Web-based outfits are legitimate--filling prescriptions written by patients' doctors online for a reduced price--many are rogue pharmacies, offering to be both doctor and drug salesman to anyone with a credit card. They're typically secretive, rarely listing their full corporate names, business addresses or the names of doctors and pharmacists they employ.

Easy access

Many are based in foreign countries. Most require only that the shopper fill out a short online questionnaire and provide no oversight of the often dangerously addictive drugs they so easily distribute. "Basically, you can get as much as you want of anything if you know how to do it," said Dr. Daniel Angres, director of Rush Behavioral Health, a treatment program with several sites in the Chicago area. "It's so frightening. None of us wants to think about it in terms of where it might go."

Several Chicago-area treatment clinics report that 10 percent to 25 percent of their clients abuse prescription drugs obtained from the Internet, up from almost none just two years ago.

"It's so easy. You don't have a doctor saying, `I'm not going to write their prescription anymore,'" said addiction specialist Jake Epperly, president of Midwest Rapid Opiate Detoxification Specialists in Chicago (this sentence as published has been corrected in this text). "I've worked in addictions for 24 years and I've never seen anything like it."