LEGAL DRUGS CAUSE THE MOST TROUBLE

I just read a New York Times article, titled "Tiny Town Looms Big on U.S.
Map as No. 1 Source of Disputed Painkiller." It's the story about an
investigation of a physician in a nearby town who prescribes more of a
potent painkiller (OxyContin) than anyone in the country.

In my job as the director of Gaston Memorial Hospital's Psychiatric
Program, one of the most common questions I'm asked is, "Do we have a
substance abuse problem in this county?" The answer is an unqualified yes
and it relates to the article mentioned above. We have several substance
abuse problems, but the one we confront the most is prescription drug abuse!

When I came here 14 years ago, I was warned about the extensive use of a
drug named Dilaudid. It is a common painkiller that was popular some years
ago. Much to my amazement, Dilaudid seemed to be everywhere. I frequently
asked about illegal street drugs such as crack cocaine or heroine and was
told the big problem here is prescription drugs. I'm not sure why a drug
like Dilaudid gained such popularity. Whatever the explanation, it was here
and it was rampant.

Over the years, I've heard numerous debates about "physician controlled
drug dependence" by a variety of doctors. I don't presume to have the
answer and it is a seductive argument. The question is, "Is it better to
treat a person who is disabled with pain and relieve that pain even though
you risk creating an addiction?" or "Is it better not to use the drug and
leave the person disabled?"

This is not a new debate. It's been around so long that it has its own
name, iatrogenic illness. Put simply, that's a situation in which the cure
may be worse than the illness. In this case you have to ask if the risk of
creating dependence is outweighed by the potential of relieving pain and
restoring health.

Many physicians prefer to make that decision on a case-by-case basis.
Others simply refuse to prescribe certain medications and tell their
patients that up front. In the field of psychiatry, the same debate rages
around the use of benzodiazepines (like Xanax, Valium and Ativan).

If you were to spend some time in any area hospital's emergency department,
you'd see numerous folks there because of their misuse of prescription
drugs or use of illegal drugs and alcohol.

A community agency some years ago did a survey of drug use in this county.
The survey left off the most abused substance of all, alcohol. It's legal
and readily available. It's a constant temptation to young people because
of its availability, and many adults don't see anything wrong with it.
Drinking, for many, is simply a way of life.

If you could quantify the destruction created by a drug, however, alcohol
would be the hands-down winner. It has wrecked more homes, lost more jobs,
killed more people and ruined more lives than any drug.

Street drugs are available in Gaston County, but many consumers don't wind
up in the emergency department unless they overdose, are poisoned by an
impure substance or put together a lethal mixture of alcohol and drugs.
Marijuana is commonplace. Cocaine is popular, and crack (a potent form of
cocaine) kills. Among young people, you are starting to see frequent use of
"designer" drugs like Ecstasy.

Using the same philosophy as "the hair of the dog that bit you" in which a
person with a hangover uses alcohol the next day to obtain relief from a
hangover, users of other drugs use prescription drugs to provide "a soft
landing."

The truth is that after a binge, it's difficult to come down, particularly
if you used drugs for days or weeks. The person needs help and that's where
the prescription drugs, often obtained illegally, come in. Abusers take a
painkiller (or other medications) to relieve withdrawal symptoms. Since
they are self-administering, they may not have the expertise to guide this
homemade detoxification plan. Next thing, they've overdosed and that's
where the hospital emergency room comes in. It's not called "emergency" for
nothing.

What's the bottom line? Drug abuse is rampant. It's been around since the
first man discovered that drinking fermented liquids made you high or
smoking certain weeds cause you to have fantastic visions. It's treatable,
but it's expensive and our country has never committed whole-heartedly to
solving this problem. We seem to get hung up trying to figure out who's to
blame.

Prevention seems to work and may not cost as much as treatment.
Unfortunately, it requires everyone to be mindful of substance abuse as an
issue. It requires parents to be good role models and we who work with
young people to talk openly and honestly about drug use and abuse.

It might not be expensive, but it requires a lot of time. Are we as a
county (or country) up to it?