From amoxicillin to Adderall: a child's journey to prescription drug abuse

As a pharmacist, I can't even begin to count the number of prescriptions I filled for amoxicillin.  The majority of them were in the form of the familiar pink suspension that kids get for various infections, mostly for colds and ear infections.  That is where children are introduced to me, the pharmacist, purveyor of pure drugs.  As an attorney, however, I defend clients against charges related to what are called "dangerous drugs."  Both are pure, scientifically designed, sterilely prepared, prescription medications.  Yes, Rx drugs can be both beneficial and dangerous, depending on the use, and context of the situation they are being referenced.  Ever since we heard the phrase "when you have your health, you have everything" Rx drugs have been an integral part of the picture.  The potential for abuse is also as old as the first ingestion of the most common drug of all: alcohol.

Prescription drugs offer the user a false sense of safety lead to impunity of use.  Rarely do people consider any deleterious side effects, let alone fatal complications when the ingest a substance prescribed by a trusted physician and dispensed by a friendly pharmacist.  Unwittingly, these medical professionals are now becoming the new suppliers of substances used to alter peoples minds and moods... really no different than any illicit drug known to man.  Teens and young adults are the latest segment of the population being identified as abusers of Rx drugs.  In a recent article by Reuters, young people have increased their access to controlled drugs by 50% in the last 15 years.  The main Rx drugs being abused are pain relievers in the opiate class (Vicodin- generic name hydrocodone with acetaminophen, Oxycontin - generic name oxycodone, Percocet - generic name oxycodone with acetaminophen).  As a matter of fact, generic Vicodin is the number one prescribed drug in the United States!  Other drugs being prescribed and abused are the stimulants: mainly Adderall; and, the anti-anxiety meds of the benzodiazepine class: xanax - generic name alprazolam, Valium - generic name diazepam, and Konopin - generic name clonazepam.

Just yesterday I was speaking to my good friend and colleague, Dr. Stephen Sroka, an expert on motivating young people to choose safe alternatives to sex, drugs and violence.  Steve was saying that kids aren't using Adderall to get high, but to get higher grades!  I have experienced this personally when I was in college.  My friends and I used any sort of stimulant, from coffee on up, to stay awake and cram for finals.  The Reuters article also cites a survey claiming 36% of college students share their prescription drugs.

The need is plain to see: we must educate health care professionals on drug seeking behavior, substance abuse and addiction.  There will always be plenty of business from legitimate patients to make sure these professionals meet their financial needs, and they don't have to resort to supplying kids, or anyone else, with dangerous drugs.  Just like amoxicillin overuse has lead to antibiotic resistant bacteria, so too has overprescribing of pain killers, stimulants and benzodiazepines.  They need to know the harm they can potentially be causing and that people can fake symptoms very easily.  The other key element is that drug treatment must be available on demand.  Only about 10% of the people seeking treatment in the US can find a bed in a treatment detox, residential facility or outpatient program.  Education and treatment, two things that can't be overused.

Marijuana, Mary Jane, Pot... whatever you call it... it means MONEY!

OK, so it was just a matter of time.  Marijuana use has been increasing for the last century.  Medical marijuana (MM) use has been on the rise and in the news for the last decade.  Legalization has been the talk of the town for the last few years.  That means the profitability of pot was only a toke away.  A new trade group, the National Cannabis Industry Association, will primarily lobby lawmakers, on behalf of MM businesses.  The MM field has made its mark and now it will get even bigger with the help of legislatures.  Who would have guessed weed would be the new distributor of "green" in Washington and statehouses around the country!?  Somebody has to help these money hungry politicians mellow down slow.


Colorado has also decided it wants to be the first state to regulate production.  This has been attempted in New Mexico to some degree of success already.  Of course, since the drug starts out in the form of a plant, and most of the time is marketed that way (there are other dosage forms: candies, elixirs etc), it is very difficult to determine potency.  It could vary widely throughout parts of the same bud or leaf.  Arguably, there will have to be ranges of 9-tetrahydrocannabinol (THC), the active ingredient, for various strains and dosage forms.  Colorado wants to have inspectors and labeling standards set up by early next year.  They obviously want to make John Denver proud and emphasize the "Rocky Mountain High."  It makes sense financially.  Some state has to be the first and 'go to" place.  Might as well be Colorado.  California won't be far behind... besides, they grow more - pot is second largest cash crop, right behind grapes - and they have a bigger budget deficit!


Now, as a drug counselor/social worker, I am most concerned about the damage pot will cause to our youth.  It is truly a "gateway drug" and many kids I treat talk about it being safe as it is "God's herb."  Safe is the last thing I would call it, especially when mixed with other drugs (that includes alcohol, the number one drug of abuse in this country) and/or driving.  Once the lobbying groups start putting money in the lawmakers pockets, legalization and low marketing standards are sure to follow.  If the legislatures around this country really think long and hard about the damage marijuana can cause and the influence it has on kids, they will need to counteract that effect with taxes on pot, to pay for prevention and treatment programs.  The number of people needing help learning about or stopping marijuana abuse will rise exponentially.  The beverage alcohol lobby has gotten away with murder for years, by convincing lawmakers to keep alcohol taxes as low as possible to not deter sales.  Please, don't let pot lobbyists blow smoke in the eyes of the people who can levy high taxes on a product that does more harm than good.

Darvon and Darvocet die a slow death

The prescription drug that comprises Darvon and Darvocet, generic name propoxyphene, has finally been recalled by the brand name and all generic manufacturers.  It was a long time coming.  Propoxyphene has long been associated with many untoward side effects, the most dangerous of which is liver damage.  Additional MINOR side effects include constipation; dizziness; drowsiness; lightheadedness; nausea; vomiting.
SEVERE side effects that occur when using propoxyphene are severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); anxiety; cold or clammy skin; confusion; excessive sweating; hallucinations; loss of appetite; loss of consciousness; mental or mood changes; seizures; severe drowsiness or dizziness; severe or persistent stomach pain; vision changes; weakness; yellowing of the skin or eyes.


These side effects have been known for years since the drugs approval by the Food and Drug Administration (FDA) and introduction to the market by Lilly in 1957.  Considered to be in the opioid class of pain relievers, there have been many safer alternatives available, namely aspirin, acetaminophen, codeine, morphine, hydrocodone and the entire class of opioids.  Many people who are allergic to some opioids were not allergic to propoxyphene.  That spurred its use despite a limited and low therapeutic pain relief index.  Most of those people would have found enough pain relief from plain aspirin of acetaminophen, the active ingredient in Tylenol.


The FDA allowed the drug to stay on the market in 2009, despite a panel of experts who conducted a safety review, and voted 14-12 against doing so.  In a half-hearted attempt to save face, the FDA required drug-makers to add a warning to packaging, which stated that taking too much of the drug could be fatal.  The results of the most stringent testing showed significant changes to the electrical activity of the heart.  Those changes are linked to potentially deadly abnormal heart rhythms.


The bottom line is that the FDA does not have the best interests of the public in mind if it continues to allow drugs to be marketed that cause dangerous side effects.  One death is too many.  The FDA has been a boon to plaintiff lawyers who sue the drug companies for these infractions.  Unfortunately, the amount the drug companies pay out to the few plaintiffs who do bring suit is much lower than the money they have made during the lifetime of the drug on the market, and thus people will continue to be harmed needlessly.