ADDICTION OFTEN STARTS IN HOSPITAL

Some Doctors Aggravate Prescription Drug Abuse

Prescription drugs are suspected in the death of singer Michael
Jackson. If the toxicology report from the autopsy confirms this, he
joins a growing number of people falling victim to prescription-drug abuse.

Public perception is that illegal street drugs are a bigger problem
than prescription-drug misuse, but that's not the reality, says
Calgary psychiatrist Dr. Ronald Lim. So many people abuse and are
addicted to the drugs found in their medicine cabinets, that he calls
it "an epidemic."

Whenever someone high-profile like actress Anna Nicole Smith, and
possibly Jackson, dies because of their prescription-drug abuse, Lim
says, it shines a light on the problem, and that's a good thing.

The most commonly abused prescription drugs are opioids
(pain-relievers) and benzodiazepines, used to treat such things as
anxiety, panic attacks, depression, insomnia and stress, because they
affect the mind, behaviour or mood.

In 2002, the Canadian Centre on Substance Abuse found Canadians were
among the heaviest consumers of such medications -- the fourth
highest per-capita use--in the world.

"Part of the problem is that North Americans expect that there's a
magic pill for everything, and they put pressure on physicians to
give it to them," says Lim, medical consultant for Alberta Health
Services' opiate-dependency program.

In the short term, these drugs are highly effective, but very
addictive, and it's a known fact that 10 to 15 per cent of the
population is at risk for developing substance dependency, he explains.

Since 2005, the rate of new prescription-drug addicts has outpaced
the number of people getting hooked on marijuana, the most commonly
used illegal drug in North America, Lim says.

"People don't think of (prescription drugs) as an addiction because
they're prescribed to them initially, because they're made by a drug
company, and sanctioned by medical professionals," Lim says. "But
that doesn't mean their properties are any different from those of
illicit drugs to the brain."

Prescription drug problems often start in hospitals. Auto mechanic
Patrick Lance, 39, developed his addiction in one, 11 years ago,
after falling off a hoist at work and breaking his back. It took
several surgeries to remove three squished discs and fuse his spine.
Lance, who was living in Calgary then, spent eight months in
hospital, where he became dependent on the morphine he was getting for pain.

"I had a concern when they started giving me morphine, but the doctor
said, 'Don't worry, it won't make an addict out of you,' " Lance recalls.

When he was discharged, the doctor said, "Don't worry, you'll be up
and jogging in no time."

In hospital, Lance had received 300-400 mg of morphine a day, but his
family doctor, who didn't believe in prescribing high doses, cut that
back to 90 mg.

"He said, 'You're going to have to make do with the dose I give you
and you're going to have to take some of the pain,' " Lance says.

"But I just couldn't handle it, the pain was that bad. I was going
through morphine like candy and it wasn't doing anything because I
had built up a tolerance."

He thinks he took about 40 ambulance trips to emergency the first few
months seeking help, but after checking with the doctor who had
treated him in hospital, the emergency physician would come back and
tell Lance they couldn't help him.

"Hospitals addict you and then they show you the door and the most
they give you is Tylenol 3s.Come on! From morphine to Tylenol 3s,
that's a big drop."

While waiting one day to see his surgeon, Lance met a man who told
him about a guy on the street, a former paramedic, could sell him
morphine. The paramedic had lost his job because of his own addiction
to morphine. (Medical professionals have a 15-20-per-cent risk of
becoming addicted because of their easy access to prescription drugs.)

Lance says the street dealer injected him with morphine which, he
says, worked better than pills.

"He injected me and wow! the pain was gone and I was feeling just
great," Lance says. He then taught Lance how to inject himself.

Within two years, he went from an employed and married father of two
young kids, to an addict panhandling on the street after his wife
found needles in his jacket pocket and threw him out of the house.

"She said, 'I don't want a druggie living here,' instead of helping me."

Turned to AADAC

Lance lived in motels until his savings ran out, then he sold his
car. When he couldn't reach a satisfactory settlement with the
Workers' Compensation Board, the morphine addict, who was shooting up
four or five times a day, turned to the Alberta Alcohol and Drug
Abuse Commission (AADAC) for help.

He was added to the list of 180 people waiting for treatment and told
he would probably get help faster in Edmonton. The list in Edmonton
turned out to be just as long, but Lance heard about a Dr. Mat Rose
working with addicts at the inner-city Boyle McCauley Health Centre.

The problem with prescription drug use starts with the physician who
doesn't do a thorough substance use and abuse assessment with a
patient prior to prescribing opiads, mostly, because the system isn't
set up for that, says Rose.

Yet, a predisposition to addiction or substance abuse because of
other problems in a person's past, problems with alcohol, or because
of genetics, is one of the strongest predictors of people developing
addictions to prescription drugs.

Melinda Hollis with the Loussa Counselling Centre, thinks many people
are unnecessarily medicated.

"I honestly think drugs are given out too easily when it comes to
dealing with anxiety and depression. We're told that feeling bad is
not acceptable, so we're the society that's into feeling good and
instant gratification, but feeling bad is a natural part of who we
are, as natural as feeling good, and we need to learn to embrace
that," Hollis says.

She blames pharmaceutical companies, which do a$330-billion business
in the United States annually.

"Drug companies are very big business and doctors are trained to deal
with people with pharmaceuticals, that's what they know," Hollis says.

Physicians like to blame the pharmaceutical industry too, Rose says,
but that's like running over a bunch of people with a fast car and
then blaming the car manufacturer.

"Physicians are both, and often within the same person, too paranoid
and too open-handed with how they prescribe," Rose says. They won't
prescribe morphine because it's morphine, but will prescribe
Percocet, a painkiller stronger than morphine. Or they'll prescribe
morphine and give the patient a three-month supply, because it's
easier than having to see them every week or two, he explains.

People with conditions requiring painkillers who are carefully
screened and monitored, basically never develop an addiction, even
those who are at higher risk, Rose says.

'Lucky to be alive'

"One of the things I drive home to medical students is you're
probably doing the best job for your patient when they leave without
a prescription or when their prescription hasn't been increased,
because it means you spent time telling them that the benefits of a
prescribed medication are outweighed by the risks at this point in
time, and you've probably given them some advice about lifestyle
changes to improve their health," Rose says.

Opiate dependency expert Dr. Ronald Lim says both patients and
doctors have to move away from thinking that every pain needs a
painkiller. "They should think of other ways of managing the symptoms
first," he says. It's one part of a multi-pronged war on prescription
drug abuse.

The first time he saw Rose, Lance told him the truth about things
such as double-doctoring (visiting multiple doctors to get
prescriptions) to feed his addiction, and was immediately put on
methadone, a synthetic narcotic drug similar to morphine, but less
habit-forming, used in narcotic detoxification.

Seven years later, Lance is a recovering addict, living on disability
assistance, in an inner-city group home. He's estranged from his
kids, but hopes that changes once they're 18, if he can get an
opportunity to explain what happened to him.

For now, "I'm trying hard to keep my head above water. I'm lucky to be alive."

REDUCING YOUR RISK FOR PRESCRIPTION ADDICTION - Be a proactive
patient - ask if there is an alternative to drug therapy for your
medical problem. - Tell the doctor about your use of alcohol or
illicit drugs and any family history of substance abuse or addiction.
- - ask the doctor for a rundown of the pros and cons of a drug being
prescribed and how addictive it is. - Tell the doctor about other
medications or natural therapies you're taking that could negatively
interact with a new prescription. - Strictly follow the doctor and
pharmacist's instructions for taking the drug. - Educate yourself
about the drugs you're prescribed. Ten to 15 per cent of the
population is at risk of developing an addiction, but 100 per cent of
people who take a painkiller like morphine, for at least four months,
will develop a physical dependency and will go through withdrawal if
they suddenly stop the medication.

Sources: Dr. Mat Rose, Boyle McCauley Health Centre and Dr. Ronald
Lim, Alberta Health Services