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news
Over-the-counter
drugs overly abused
By Jo Appleton
On-line Forty-Niner
After spraining
her back while working out at the gym, Joanna Mahdi was prescribed
medication to ease the pain while she was healing.
Once Mahdi, a 22-year-old Cal State Long Beach student, began
taking the pain killers she felt less pain but said she also
felt so dizzy and relaxed that she was afraid and eventually
stopped taking the pills completely.
"I was buzzing," Mahdi said. "I felt real relaxed
and good, but it was scary. It was like my whole body was
a wave of motion because I was so relaxed and my body was
numb. But when I went to sleep ... it was kind of hard to
wake up. That's why I stopped taking it. I kept thinking that
if I go to sleep, I might not wake up one day."
The pain killer prescribed for Mahdi is in a class of prescription
drugs called opioids, which the National Institute of Drug
Abuse called one of the three most commonly abused classes
of prescription drugs.
Opioids include such drugs as OxyContin, Vicodin and Demerol,
and are commonly prescribed to treat chronic pain, pain that
has lasted more than six months.
The two other classes of prescription drugs under the institute's
spotlight are central nervous system depressants, such as
Valium, Librium and Xanax, and stimulants such as Ritalin
and Dexadrine.
NIDA reported that an estimated 1.6 million Americans used
prescription pain relievers non-medically for the first time
in 1998. This number represents a significant increase since
the 1980s when there were generally fewer than 500,000 first-time
users per year.
Prescription drug abuse is a growing trend, especially among
adolescents and young adults, according to NIDA. The most
dramatic increase in new users of prescription drugs for non-medical
purposes occurs in 12- to 25-year olds.
Although Mahdi had to suffer through the pain, stopping the
medication may have been the best thing she could have done.
Chronic pain is a fairly common cause of the development of
dependence and tolerance to opioids, said Dr. Ronald J. Dougherty.
"The use of opioids to control pain should be of short
duration, less than 30 days," Dougherty said. "Long-term
use of these agents may produce behavior that impacts the
patient and family members and causes problems that are more
difficult to treat than the pain itself."
Rapid increases in the abuse of prescription drugs in the
United States led NIDA to begin a public health initiative
last year to inform the public, doctors and pharmacists of
the consequences of abusing commonly prescribed medications.
In 1999, an estimated 9 million people age12 and older used
prescription drugs for non-medical reasons, NIDA reported.
The key is to "educate before you medicate," said
Ray Bullman, executive vice president of the National Council
on Patient Information and Education, one of the organizations
that joined with NIDA on the prescription drug awareness campaign.
Physicians write a prescription in more than two-thirds of
all doctor visits in the United States, more than any other
intervention method, Bullman said.
"While these prescription drugs benefit the lives of
millions of people everyday in the U.S., when used incorrectly,
either mixed with alcohol or otherwise not as prescribed,
they can be dangerous, addicting and even deadly," said
Dr. Alan I. Leshner, NIDA director.
Opioids work by attaching to receptors in the brain and spinal
cord, blocking the transmission of pain messages to the brain.
Using pain killers as prescribed for a short period of time
can cause drowsiness, constipation and slowed breathing.
However, if used over a long period of time, pain killers
have the potential for tolerance, physical dependence, withdrawal
and addiction. If a large, single dose is taken, severe respiratory
depression or death may follow, NIDA reported.
The second class of commonly used prescription drugs is central
nervous system depressants, typically prescribed for anxiety,
panic attacks and sleep disorders. They work by slowing brain
activity and producing a calming effect. In larger doses CNS
depressants are used as an anesthesia.
Like pain killers, CNS depressants have negative long-term
effects on the body, such as the potential for tolerance and
physical dependence which can cause withdrawal and addiction.
NIDA reported that reducing or discontinuing use of a CNS
depressant can cause seizures resulting from a rebound in
brain activity.
The third class of prescription drugs commonly abused is stimulants.
Physicians often prescribe stimulants to treat narcolepsy,
attention-deficit hyperactivity disorder, depression and asthma.
Stimulants, the opposite of depressants, stimulate brain activity
causing an increase in alertness, attention and energy.
These effects are what have college students using Ritalin
as a "study drug," said Kandi Durball, a licensed
vocational nurse at CSULB. She said she often sees students
come into the clinic with the shakes after taking too much
of an over-the-counter stimulant and combining coffee with
it.
On-site pharmacist Alba Thompson warns never to take other
people's medication because you may be taking another medication
and combining the two together may cause adverse effects.
Ritalin, which is prescribed for patients with ADHD, is probably
the prescription stimulant most sought after by students on
the black market, said Lawrence Harvey, registered nurse and
clinical coordinator of nursing at CSULB.
"If one drug becomes the one for doctors to earmark as
being misused, people find another one to use," Harvey
said. "It's a constant battle."
At CSULB's Student Health Services clinic on West Campus Drive,
most prescriptions are for colds, minor infections, allergies
and headaches, Thompson said. She also said the campus pharmacy
does not carry any type of maintenance medications for ongoing
care needs.
However, the pharmacy does carry stronger types of pain medication,
according to Dr. Fred Nakamura of Student Health Services.
"We do have other medication that have potential for
addiction," he said.
For example, Florinal, a mild type of CNS depressant combined
with pain medication is frequently prescribed for students
with headaches or who are stressed out, Nakamura said.
"We try to be very careful with these drugs," he
said. "It's so much better not to be exposed to a drug
than to get addicted and get out."
To help prevent such unnecessary exposure, NIDA, in conjunction
with several national physician and pharmaceutical organizations,
released a series of research reports that highlighted the
health dangers of prescription drug abuse. To further awareness,
they distributed 400,000 postcards to bookstores, restaurants,
clubs and gyms and handed them out at college campuses.
"We're trying to get better control [of prescription
drug abuse] but we don't seem to have significant change,
regardless of our efforts," Nakamura said.
He is disappointed with that fact but said it is unrealistic
to think otherwise because prescription drugs are available
just about anywhere these days and are far too easy to obtain.
"Our society is such in this country that these drugs
are easy to get," Nakamura said. "If you can buy
it, you can get it."
A pharmacist for 25 years, Thompson said prescription drugs
are there for our benefit as long as they are not abused.
Asked if she would take the remaining pain killers prescribed
for her Mahdi replied, "If I had really bad muscle pain
and my doctor said it was OK, that's it. But nah, I wouldn't
take them just to take them. No way."
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