Investigators claim that Medicare officials have been extremely slow in recognizing and acting on this evidence. Gregory D. Kutz, the director of forensic audits and special investigations, says their analysis determined that around 170,000 Medicare recipients had visited five or more practitioners in the medical field to receive prescriptions such as OxyContin and Percocet.

In one case, a recipient in Georgia obtained a 150-day Oxycodone supply in just 27 days by visiting four different doctors resulting in seven prescriptions. Throughout the course of one year, the women received a total of 3,655 oxycodone pills from 58 different prescribers and had filled them at over 40 pharmacies.

Senator Thomas R. Carper of Delaware stated that federal dollars, which are intended to help the elderly and poor, are being abused and used instead to feed addictions or to fill the wallets of drug dealers. Prescription drug abuse is now causing increased expense to taxpayers and also threatening the health of Medicare beneficiaries.

Medicare’s drug benefits are managed by privately owned insurance companies that are under contract with our government. Their drug plans gave out almost 57 million prescriptions for opiates last year. This number increased by 11 million from just 2007 – a 24 percent increase.

Investigators argue that we could reduce fraud and prescription drug abuse by simply using electronic health records and electronic broadcast of prescriptions among pharmacies to keep better track of patients’ medical history. Medicare officials argue that high use of pain medications isn’t necessarily an indicator of abuse but rather a poor coordination by medical care in treating pain symptoms.

The bad news is that adolescents are particularly vulnerable to making the poor choices which can lead to addictions in adulthood. The CASA report notes that an alarming 75% of teenagers have experimented with alcohol, tobacco or drugs of some kind (legal or illegal). Alcohol tops the list of substances tried by teenagers at least one time with 73% of teens admitting to drinking on at least one occasion. Cigarettes were owned to being tried at least once by 46% of high school age kids. Both alcohol and cigarette use have declined slightly among teens since 1999, while reported use of smokeless tobacco, marijuana and prescription drugs appears to be on the rise. Misuse of prescription medications for ADD and Oxycontin is growing among adolescents. Of the 75% who admitted trying substances, a dismaying 20% are already addicted.

That 20% of the teens are addicted is troubling enough, but the 75% who are experimenting should cause similar concern. That is because the CASA data backs up former research strongly connecting early substance use to substance dependency in adulthood. Statistically, 90% of Americans who are addicted to alcohol, tobacco or drugs tried the substance during their teenage years, most before the age of 18. Research says that fully one fourth of those who experiment with a substance at a young age will be addicted to that substance in adulthood, while only 1 out of 25 who experiment after age 21 form an addiction.

Another reason that adolescents ought to be considered at risk for addiction is purely biological. The teenage brain is still developing in the area which carries out decision-making, judgment and self-control. Because it is not completely developed it is more susceptible to the negative effects of harmful substances. Teens who use drugs risk impaired development and greater likelihood that they will make the poor choice to continue using. For this reason, CASA researchers say that substance use of any kind is dangerous.

The good news is that teen substance use and abuse is very much preventable. Substance use and/or abuse should not be considered normal teenage behavior. It isn’t. One way to prevent it is to change the culture of expectation. The most powerful agents of change in a teens’ life are his parents. Parents who guard their children and are engaged with them on a daily basis can stand between the teen and substance use. The greatest risk factors for addiction among teens are trauma and abuse. Parents who work hard to maintain safe, loving environments with regular dialog about the dangers of substance use can have greater influence than the surrounding culture which is neglectfully unaware.

Efforts which predicated declines in alcohol and cigarette use need to continue and to extend to the new substance dangers that young people are encountering. Society has a vested interest in preventing teenagers from exposing themselves to addiction since judicial costs associated with alcohol and substance abuse run in the billions of dollars. Parents, however, cannot afford to wait for society as a whole to step in. Parents who caringly establish boundaries and expectations can prevent substance use now and addiction later in their teenager’s life.

Called psychotropic drugs, the medications – including antidepressants, hypnotics and anxiolytics – may actually further the health problems of elderly people, instead of other types of medications that may not carry the same risks.

For example, the drugs may lead to loss of balance. Falling causes brittle bones to break, resulting in a long-term inability to remain active – and can heighten the chances of hospitalization or secondary health complications. Medications to calm anxiety, such as benzodiazepines, can cause daytime sleepiness that prevents adequate nighttime sleep, contributing to a depressed state. Anxiolytics and hypnotics can also render older persons more unsteady on their feet, contributing to higher anxiety levels as well as a risk for falling.

The research findings, highlighted in a ScienceDaily report, suggest that in Sweden alone, around 20 percent who are 75 years old or older are using prescription medications that may be unsafe or inappropriate. Adding to the drugs’ complications is the fact that older persons may respond at heightened proportions to the drugs’ side effects than younger people.

While improvements have been noted, such as a decline in potentially unsafe psychotropics between 2000 and 2008, researchers still believe the problem may be worse for lower-income elderly persons and warrants larger research to address the drugs’ use as a public health problem.

More specifically, the Treatment Episode Data Set (TEDS) recorded the first, second and third substance of abuse among those admitted to substance abuse treatment in that ten year period. It found a fourfold increase (from 2.2 to 9.8 percent) in the nonmedical use of prescription pain relievers among those admitted for treatment during that time. This included the use of pain relievers such as hydrocodone, oxycodone, morphine and other morphine-like medications.

TEDS indicates significant availability of pain relievers and pervasive misuse of them across the United States and in all walks of life. The increases in pain reliever use were found to have occurred across all demographic categories including age, gender, race, ethnicity, education, employment and geographic region. How individuals gained access to the pain relievers varied, but the majority of those in this set of data were apt to obtain these substances without prescription and from a friend or relative for free.

The information given in this TEDS study included drug use in individuals over the age of 12 who are admitted to substance abuse treatment facilities. The pain reliever use cited by those in this study included primary, secondary or tertiary use (first, second or third preference among substances used). It is significant, however, that the misuse of pain relievers was second only to the use of cannabis among all who were studied.

While use of pain relievers increased across the board, there were dramatic increases in pain reliever use among certain groups. Specifically, in the age group 18 to 34 there was an increase in those who reported use from 1.5 percent in 1998 to 13.7 percent in 2008. Other notable increases occurred among those identifying themselves as Non-Hispanic White (from 3.2 percent in 1998 to 14.4 percent in 2008) and American Indian. This last group was 6 times more likely to use pain relievers in 2008 than in 1998. Geographically, the percentages of admissions for pain reliever abuse increased almost fourfold in all U.S. areas except the West which showed a slower but significant increase as well (1.9-6.1%).

Among other populations that showed a significant increase in the nonmedical use of pain relievers were individuals with a co-occurring psychiatric disorder. These numbers rose from 3.4 percent reporting pain reliever abuse in 1998 to 14.4 percent in 2008. Also, previous treatment did not seem to have an impact upon the rising numbers of those who report use of pain relievers during later episodes of treatment. The proportion of those who had been in substance disorder treatment previously and returned to a program also showed an increase in pain reliever use over the years. Similarly, the proportion of those who use pain relievers and who are new to substance abuse treatment have steadily increased as well during the 10 year period from 1998-2008.

If you believe someone you care about is using increasingly risky amounts of pain relievers, a drug intervention may be something to consider.

On February 9, 2010, a Wisconsin teen died after overdosing on oxycodone (generic OxyContin). One area resident is fed up with teen prescription drug abuse and asserts that dangerous narcotics must be kept under lock and key in order to combat the problem; he claims that no other remedy would be as effective. To this end, Ken Kidder has begun a drive that would require locks to be installed on medicine cabinets in family homes.

Kidder’s interest in combating drug addiction stems from personal experience. His son, Greg, died at age forty-four and had battled drug addiction for most of his adult life. He started experimenting with drugs at age 13.

Coincidentally, Kidder is particularly qualified to discuss securing medicine cabinets. A tree cutter by trade, Kidder is also a master woodworker. He claims that installing medicine cabinet locks is simple, as most cabinets can be secured by using a power drill and insertable locks. The 69-year-old activist has volunteered to give area residents demonstrations on how to install the locks. Kidder has also raised one hundred dollars for the “cabinet lock-up” cause, in conjunction with a local Boy Scout troop. He used the money to buy six keyed locks at a local hardware store, which he will install for free for families with limited resources. Going forward, Kidder hopes to join forces with local building contractors, school districts, police departments and volunteer organizations to develop a community-wide cabinet lockup program.

The idea of a locking medicine cabinet is not entirely new. A Google search reveals locking medicine cabinets already being sold on Amazon.com and Linens ‘n Things. With a price tag of $180, Blomus’s attractive glass and steel locking medicine cabinet is imported from Germany and would blend seamlessly in any modern bathroom.

Prescription Drugs Must Be Disposed of Properly to Avoid Tragedy

While it is important to properly secure prescription drugs that are currently being used by family members, it is equally important to conduct a periodic review of medicine cabinet contents to identify out-dated or unnecessary prescriptions. Unfortunately, once the drugs are identified it is not entirely clear what should be done with them as flushing them into the water supply often causes residual levels of narcotics to remain in recycled drinking water. To address the disposal issue, the Oklahoma Bureau of Narcotics has started a novel prescription drug take-back program in twenty-six locations around the state. Residents can bring their old or unused prescription drugs to the location and law enforcement officials will take custody of the controlled substances and dispose of them safely.

http://gazettextra.com/news/2010/mar/12/overdose-death-prompts-effort-ensure-prescription-/
 

A recent News Journal Online report captured the trend of an American society that is more medicated in general than ever before and one that is growing as a result of a system that doesn’t truly keep track.

"This is the most serious problem facing law enforcement at this time," Volusia County Sheriff Ben Johnson said during a recent interview posted in the News Journal Online. "It’s more serious than crack cocaine."

Statistics from the state Health Department show that nine people die of prescription-drug overdoses each week in Florida. The state has been at the forefront of the debate over prescription drug abuse as it is one of the few that does not monitor the number of prescription pills sold.

Florida passed a law last year that could impact the “doctor shopping” problem by limiting the number of pills that can be distributed to patients in a set time period. Other legislation that is still pending is designed to prevent convicted felons distributing pills and increasing access to patient records by the state Health Department.

"They think they still have the pain, but the pain stopped years ago," Circuit Judge Joseph Will, who runs the local drug court, said. "Pretty soon, they’re taking the pills just to stay normal, to be able to function."

"The thing that frustrates me is these are legal drugs being approved by the FDA and manufactured by drug companies," Will said. "The manufacturers and the FDA should be tracing where these pills are going. They ship them out in boxcars. Somebody should be accountable for how many they sell and which doctors are prescribing."
 

The research, presented at the American Academy of Pain Medicine’s 26th Annual Meeting, provides early published data analyzing information gathered from California’s prescription monitoring program, known as the Controlled Substances Utilization Review and Evaluation System (CURES).

Over 34 states currently have prescription monitoring programs in place in an effort to address prescription drug abuse, addiction, and diversion. One goal of the PMPs is to prevent individuals from "doctor shopping," where they obtain multiple prescriptions from multiple healthcare providers, which they subsequently fill at multiple pharmacies. To date, there is limited published data demonstrating the frequency of multiple provider episodes for controlled substances.

Analyzing de-identified prescription data from the CURES program, researchers at the University of California, Davis found that approximately half of the multiple provider episodes or "doctor shopping" cases involved more than one occurrence. Researchers also report that approximately 13% of these occurrences involved prescriptions for opioid prescriptions, followed by 4% for benzodiazepines, followed by stimulant amphetamines (1.4%) and diet amphetamines (0.8%)

Lead researcher and AAPM Director at Large, Past President (2005), and AAPM Chair of Legislative and Regulatory Affairs, Scott Fishman MD, comments, "These preliminary data suggest that multiple prescribing of controlled substances is a real problem. The AAPM has long advocated for PMPs that make useful data available to prescribers at the point of care so they can help mitigate this problem. As our regulators and legislators seek solutions for minimizing prescription drug abuse, this study should help elucidate the value of PMPs that partner with clinicians in appropriate monitoring."

The data also showed that the greatest association with multiple provider episodes occurred when an individual was simultaneously receiving prescriptions for different classes of controlled substances, while using multiple prescribers to obtain other controlled substances. Individuals who obtained opioids from multiple providers were 10 to 21-fold more likely, respectively, to also receive benzodiazepines or amphetamines from multiple practitioners. Similar results were obtained with benzodiazepines and amphetamines.

The study also found that individuals "doctor shopping" for opioids were younger and resided in larger metropolitan areas.

Opioids are easily abused as they produce a sense of well-being or a high that makes the user feel as if they have achieved a high. The problem is that users continue to seek this high and addiction can develop while an individual also puts themselves at risk of accidental overdose.

To help try and curb this use and abuse, the United States Food and Drug Administration last year ordered several pharmaceutical companies to develop plans to help reduce inappropriate use.

While such efforts may help this growing epidemic, the very thing that makes the drugs work on reducing pain is also what leads to the addiction. Opioids work by attaching to specific receptors in the brain and blocking the perception of pain. Over time and long-term use, the drugs can cause physical and chemical changes in the brain’s pathways.

"Somewhere between 5 and 10% of people who take opioids regularly become addicted," said Dr. Nora Volkow in the LA Times. Dr. Volkow is director of the National Institute on Drug Abuse at the National Institutes of Health.

Aside from the problems of addiction, the risk of accidental overdose is very high with opioids. When too much of the drug is taken, breathing can slow and even stop completely. According to the Centers for Disease Control and Prevention, fatal poisonings that involve these medications more than tripled from 1999 through 2006 from 4,000 to more than 13,500.

Data from the 2007 National Survey on Drug Use and Health shows that more than 5 million Americans are currently using pain-relieving medications such as Vicodin, OxyContin and Percocet for non medical reasons.
 

The Office of the National Drug Control Policy indicated that everyday, 2,500 teenagers, ages 12-17, will abuse prescription medication for the first time. Access to prescription medications like Vicodin and OxyContin is often far too easy: 70% of teens who abused say they got the prescription drugs from family and friends (National Survey on Drug Use and Health).

To combat this growing problem, Dr. Drew and his team designed the Rx Locker, a locking storage device designed to hold up to four prescription pill bottles and still fit inside a standard medicine cabinet. A chromed metal combination lock provides convenient access for the user while ensuring secure storage and privacy. The Rx Locker is available now at www.RxLocker.com.

Dr. Drew recently spoke to about the issue of prescription drug abuse among teens when he visited “The Bonnie Hunt Show.”

"All too often the medication prescribed by a doctor to parents and grandparents are being accessed by their kids. We need to keep these medications locked up and send a message to our children that they are potentially dangerous. Locking up Rx medications is the only way to ensure that their access will be restricted only to those with prescriptions. However, a practical, affordable and simple solution to this ever-increasing problem has not existed until now," Dr. Drew said.

Teens aren’t the only ones being hurt by the unfettered access to prescription pills. Young children can accidentally find and ingest medications where even a small dose can be deadly. According to National Poison Prevention Week, each year unintentional poisonings from medicines and household chemicals kill about 30 children and prompt more than 1 million calls to the nation’s poison control centers.

Dr. Drew Pinsky is a practicing medical doctor who is board certified in internal and addiction medicine. He is also the executive producer and host of several television series including "Celebrity Rehab with Dr. Drew," "Sober House" and "Sex Rehab with Dr. Drew" as well as the host of the nationally syndicated radio show "Loveline." He is the author of “Cracked: Putting Broken Lives Together Again, When Painkillers Become Dangerous” and the New York Times bestseller “The Mirror Effect: How Celebrity Narcissism is Seducing America.”

Flash forward to a situation where your teen, in the company of other teens, has a discussion about drugs, availability of drugs, quick highs, and easy access. The conversation will inevitably get around to who’s parents have what kinds of drugs at home and can the teens get some. Think this doesn’t happen? You’d be wrong. Results from the 2008 Monitoring the Future Survey, sponsored by the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH) show that 15.4 percent of 12th graders reported using a prescription drug nonmedically within the past year. Vicodin, according to the 2008 report, continues to be abused at “unacceptably high levels.” The category of drugs abused includes amphetamines, sedatives/barbiturates, tranquilizers and opiates (other than heroin). Many of the drugs abused by teens are prescription (for someone else) or available over-the-counter (OTC).

Where do teens get their drugs? You guessed it. They’re readily available in homes. Let’s take a look at some of the kinds of drugs teens most commonly abuse.

Classes of Prescription Medications Abused by Teens

According to NIDA, commonly abused classes of prescription medications include opioids (prescribed for pain), central nervous system (CNS) depressants for anxiety and sleep disorders, and stimulants for attention-deficit-hyperactivity-disorder (ADHD) and narcolepsy.

Opiods – These include hydrocodone (Vicodin), oxycodone (OxyContin), propoxyphene (Darvon), hydromorphone (Dilaudid), meperidine (Demerol), and diphenoxylate (Lomotil).

CNS Depressants – The list includes barbiturates such as pentobarbital sodium (Nembutal), and benzodiazepines such as alprazolam (Zanax) and diazepam (Valium).

Stimulants – Popular stimulants include amphetamines (Adderall), dextroamphetamine (Dexedrine), and methylphenidate (Concerta and Ritalin).

Note that this list is not all-inclusive. For a more complete listing of prescription drugs, including category and name, commercial and street names, DEA schedule and how administered, and intoxication effects and potential consequences, see the NIDA Prescription Drug Abuse Chart.

According to the Partnership for a Drug-Free America, every day, 2500 teenagers use a prescription drug to get high – for the first time. Why do they do it? According to the Partnership, their desire to get high outweighs their perception of any potential risks. Some 60 percent of teens who have abused prescription painkillers started before age 15. Another frightening statistic is that 12 to 17 year olds abuse prescription drugs more than they abuse crack/cocaine, ecstasy, heroin, and methamphetamine combined. And while marijuana is the illegal drug of choice for many teens, there are as many new abusers aged 12 to 17 of prescription drugs as there are of marijuana.

Tips to Prevent Teen Prescription Drug Abuse

Other than completely purging the household of all prescription and OTC medications, what other ways are there to safeguard your teens and help prevent prescription drug abuse? Here are several ideas:

• Lock ‘em up. – In the housing market, the axiom is “location, location, location.” The same could be said for prescription medications. In this case, however, the tip is to keep all prescriptions secure in the home. Once they’re not readily available, easy to surreptitiously filch and pocket, the problem of immediate access is solved. Keep all prescription medications in one location, and make sure to secure it with a lock. No, this isn’t too extreme. Remember, you are the parent. You need to control all the medications in the home. Period.

• Inventory and count everything. – Start now and take a complete inventory of every medication in the home. Write down what the medication is and what condition it’s for, who takes it, how often, brand and generic names, expiration dates, and so on. Then, count every pill in each of the containers. This inventory and counting is a practice you should repeat weekly. The idea is to stay on top of quantities. When and if you notice some missing, it’s a sign that something’s not right and needs addressing further.

• Check expiration dates and discard old prescriptions. – Using your handy inventory sheet, go through and check the prescriptions with expired dates. Discard all those prescriptions safely. Do not flush them down the toilet or drain unless you are specifically instructed to do so. Guidelines from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the White House Office of National Drug Control Policy have the following recommendations for proper disposal of prescription drugs:

o Take the prescription drugs out of their original containers. Conceal or remove any personally-identifiable information from the container labels, including prescription number. Use black indelible marker or scratch off information. Place the empty drug containers, now devoid of personal identification, in the trash receptacle.

o Mix with coffee grounds, kitty litter or other undesirable substances and place in a sealed container before dumping in the trash receptacle.

o Inquire about community prescription take-back programs. These are an excellent and safe way to dispose of expired or unwanted prescription drugs.

o Many communities hold hazardous waste collection events that collect drugs at a central location and dispose of them safely. Make use of these services.

o Contact your pharmacist for proper disposal methods and locations.

• Be informed about drugs of abuse. – Before you can have intelligent conversations with your teens (and adolescents) about the dangers of prescription drug abuse, you need to educate yourself on the types of drugs that are currently being abused in this population. Know the latest drug abuse trends and be mindful of the kinds of drug-related incidents going on in your community and your teen’s school.

• Talk to your teens. – Get in the practice of having candid and open discussions with your teens (and adolescents) about prescription and OTC medications. Let them know the rules and what you expect from them. Keep dialog open, especially if the subject of drug abuse comes up after a television news report, public service announcement, or your teens mention a drug incident involving their friends or at school. Don’t limit the discussion to just prescription drugs, since street or illegal drugs are also highly addictive – and nearly as readily available. Make sure you mention how dangerous abuse of prescription medication can be, as well as abuse of OTC medicines. Let them know that abusing prescription narcotic painkillers can be as dangerous as abusing heroin. Also, and this is very important, instill the point that prescription medications taken as directed by the person for whom they are prescribed can be very beneficial, but when taken as a means to get high, they have very unpredictable and potentially harmful effects. Research shows that teenagers mistakenly believe that taking prescription medications for nonmedical purposes is safe. They believe that experimentation with such drugs is safer than trying street drugs. Since abuse of medications can be lethal, set clear expectations with your teenagers, letting them know that they are not to take medications under any circumstances without your knowledge and/or permission.

• Lead by example. – Our children are sponges, soaking up impressions about appropriate behavior, habits, beliefs and expectations. One of the most effective tools in parents’ arsenal to prevent abuse of drugs (prescription, OTC, and illegal) is to lead by example. Don’t let your teens see you pop a pill every time you have a slight headache, sore back, or your “nerves” are getting to you. That sends the wrong message: that it’s okay to use a prescription drug to make everything feel better. In fact, many prescription opioids are only intended for short-term use, and they’re not supposed to take all the pain away, just to ease the most severe pain. But, back to the lead by example recommendation – let your teens see that you are responsible about taking prescription medications. Keeping careful inventory, disposing of expired and/or unwanted medications, only taking prescription medications as prescribed, and “walking the talk” shows your teens important modeling behavior.

What to Do If Your Teen Gets in Trouble

Despite following all the precautions, having open and candid dialog, there may be situations where your teen gets in over his or her head regarding prescription drugs. It may be that they were at a party and someone slipped something into a soda or bottle of water. It could be that they followed the rest of the group and experimented with someone’s mother’s tranquilizer or a relative’s ADHD medication.

You may get a phone call from a concerned friend. Or, you may see warning signs in your teen such as lethargy, inability to concentrate, poor motor movement, glazed eyes, vomiting, increased heartbeat, increased body temperature, or other symptoms. Remain calm. Ask your teen, if he or she is coherent, what they took, if they know it. If not, ask what was going on in general, including whether or not others took something in a pill form. If you’ve kept an open line of communication with your teen, you’re likely to get an honest answer. The first thing to do, depending on the substance ingested and the severity of the symptoms, is to contact your doctor, Poison Control Center, or take your teen to the hospital. The prescription and/or street drug and alcohol needs to get out of your teen’s system – and the sooner, the better.

After the drug(s) have been purged, take steps to trace the incident back to the source. Who is responsible for the drugs being at the scene? Was it covert or overt? When you have the names, contact the parents of the individual(s) who supplied the drugs. Chances are your teen isn’t the only one affected. One suggestion is to band together with other concerned parents to present a united front on the issue. It’s also a good idea to insist that your teen stay away from the teen or teens involved in supplying the drugs. Be prepared for a little resistance on this, however, especially if the teen(s) are popular. Once again, you are the parent. It’s up to you to be the one in charge.

If the prevalence, use and abuse of prescription and/or street drugs and alcohol continue, get professional help in the form of counseling for your teen. Prescription drug abuse, if caught early, can be treated successfully. Residential treatment centers or outpatient facilities should be carefully screened to ensure that they specialize in treating teen addictions. Check all credentials and licensing, and inquire about insurance coverage, length of stay or duration of treatment, and any special financing, grants or scholarships available.

To locate a treatment facility for substance abuse (including prescription drug abuse), visit the SAMHSA Substance Abuse Treatment Facility Locator, or call them at 1-800-662-HELP.

Finally, never give up on your teens. They look to you for guidance and need you when things get tough (and when they’re fine). As parents, use your unconditional love for your teens to give them the best possible preparation for life. Be a good example, and be there for them always.