Skylar Capriola is a biology/pre-med student at Lansing Community College (please see more of his biography below)
It has become an epidemic that has soared to heights unimaginable over the last decade. In 2008, it reached the peak of its destruction claiming 36,450 lives, just 3,000 deaths short of motor-vehicle fatalities. It’s not a virus, or even a street level drug of the likes of cocaine or heroin. Better yet, it’s legal, written off and prescribed by our health officials. It’s an addiction in the form of a pill that takes to the mind and pulls the individual in, and puts their will in a vice-grip.
The drugs I am speaking of are opiate painkillers such as Vicodin and Oxycodone. For a drug to be considered an opiate, it has to be derived from the poppy plant, the same plant that is refined to eventually make street level drugs such as heroin. Its addiction potential can result in an overdose.
Doctors are ultimately the ones responsible for the prescribing of these medications, no matter if it be them personally signing the prescription, or their assistants. With that addiction potential often resulting in death, prescription painkillers should be regulated more effectively by the use of Prescription Drug Monitoring Programs and Electronic Prescribing.
The Food and Drug Administration set out to tighten the prescribing of opiate medications as of 2013, by banning nurse practitioners or physician assistants from prescribing the drugs. Still the plan was criticized. Dr. John Mendelson would state that “more stringent controls will eventually lead to different problems, which may be worse”, like making it tougher for those that truly are in chronic pain to get their medication.
When a drug accounts for two-thirds of all the overdose related deaths in the country, tighter restrictions begin to seem like the right route to take. There is only one way to help stop this problem, and it starts with being strict in every area of the prescribing process. Those that are truly in pain will still be able to get their medication; they’ll just have to undergo a few extra steps when getting their prescriptions refilled. At the same time, this would certainly limit patients from going out and looking for more than one doctor to receive prescriptions from, better known as “doctor shopping”.
The Department of Health and Human Services criticized electronic prescribing funding, and the technology itself. The HRSA goes on to say that doctors in small practices, the inner city, or in rural areas believe that the cost of the electronic prescribing system is too expensive to receive a positive return on their investment. However, the cost is very affordable, running about $2500 a year, and that’s on the high side. Also doctors are concerned with the hardware that includes system errors, which can result in patients receiving the wrong medication or dosage. Not only is the cost affordable for doctors, but there is a quick return on their investment.
A study done in Massachusetts found that doctors who did use electronic prescribing software could save $0.70 per patient per month, which translates to $845,000 annually per 100,000 patients filling prescriptions. Electronic Prescribing software has also been proven to be more consistent than handwritten prescriptions. Rainu Kaushal, a professor at Weill Cornell Medical College, led a study in 2010 that revealed for every 100 paper prescriptions there was a staggering 37 errors, compared to just 7 per 100 when using e-prescribing software.
In California there were six recorded deaths, the killer would strike with quickness; so fast in fact that one case mentions a man sitting down to rest and never gets back up. All six deaths occurred in 18 months, all due to overdosing on prescription painkillers, all of which was provided by a single doctor: Dr. Van H. Vu. In a statement released by Vu he simply stated, “I can’t control what they do once they leave my office.”
Maybe so, but it does state in the Hippocratic Oath: “That I will lead my life and practice my art with integrity and honor, using my power wisely.” When you’re responsible for providing your patients with the best possible care, you inherit the responsibility to know when to say no. In this case I believe Vu underestimated the power that his pen held. When that ink bleeds onto that slip of paper, doctors should be completely confident that they’re doing the right thing. Vu is by no means the only doctor that is responsible for this problem. In fact 71 doctors from three counties in California were responsible for 298 deaths from 2006-2011, each doctor responsible for the deaths of at least three patients.
Deaths from prescription painkillers are now greater than those of heroin and cocaine combined, and in 2010 there were enough painkillers prescribed to medicate every single American adult for a month. What makes this statistic so alarming is that these drugs are readily available. This the reason why I believe most turn to these drugs; those who are addicted to drugs no longer have to make a backdoor deal to get their drugs because they are right in front of them. Fake an injury and you will be rewarded with a drug that is more powerful than any street level drug.
I’ve seen first-hand what opiate addiction can do to a person, as my mom is currently struggling with an addiction of her own. I watched it for five long years. I watched as my mom went from a loving parent who would do anything for her children to a person that would put drugs above life’s basic necessities. When she needed her fix she would simply go to her doctor and complain she was in pain, and just like that she was given a prescription. I can even recall her using a month’s supply in a 10-day period, and even then she was able to obtain a prescription with ease from her doctor. He never asked what happened to an entire month’s worth drugs. He acted as if he didn’t even have the slightest suspicion of abuse. He would just put the pen to the slip of paper and sign.
Sometimes I felt my mom just had a free pass when going to her doctor. Oftentimes he would let his Physician Assistant handle my mom’s evaluation, giving him the power to sign for the prescription.
As of now the addiction is in such a bad state that even after being hospitalized for overdosing, she still won’t get the help necessary to treat her addiction. She was found unconscious by my younger brother, all due to choking on her own vomit, and it nearly took her life.
Not only has it affected her but it has affected every single loved one around her. Unless you go through it, you can’t begin to imagine the pain that comes with this disease. Having to answer your younger siblings questions of why. Why doesn’t she get help? Why do we have no food in the house? Or even, why did the electricity get shut off? All of this could have been prevented with just some precaution from her doctor. Still, even after this, I have hope that this is a problem that can be contained.
This is a problem that won’t be solved entirely but there is a promising solution that I do purpose that all states should carry out. That solution is that all states should adopt the Prescription Drug Monitoring Programs or PDMPs.
PDMPs are electronic databases that are run by the state. The databases would be used to track the prescribing and dispensing of controlled prescription drugs to patients. These databases are also designed to monitor the information for suspected abuse, and can give a prescriber or pharmacist critical information in regards to a patient’s prescription history.
Since the doctors themselves can’t examine every patient thoroughly and therefore make an accurate decision whether or not to prescribe a patient painkillers, this would help them also, basically doing the work they cannot do, which is monitor a patient’s prescriptions. Going this route would even solve the “doctor shopping” problem by giving doctors the information in regards to patients seeing multiple doctors at the same time. Thirty-seven states including Michigan have fully operational PDMPs.
At this point, we can choose between two avenues: act now and have the problem contained, or let this epidemic continue to kill thousands of people every year.
It is apparent that this problem isn’t going to be fixed in a matter of months or even years, but there are solutions that offer a great deal of promise. Bottom-line is doctors aren’t doing their jobs as efficiently as they should be. Instead of just prescribing pills, more should be taken into consideration when these prescriptions are given out, like a patient’s medication history.
Again, it is something I have seen, something that I have been a part of. I’ve seen the thin line that is addiction, and it is extremely easy to cross. The facts are there; there is no way of denying just how out of control this problem has become. When a doctor signs that slip of paper without accessing a patient fully, they are potentially putting their patient’s life in danger. When a drug takes more lives than heroin and cocaine combined, you can make the case that it shouldn’t even be legal in the first place. Nobody should have to watch a family member, or a friend slowly commit suicide.
<hr />Skylar Capriola was born on August 3, 1992, in Detroit, Michigan, the oldest of five children. His ancestry is Sicilian and Native American. He moved to Lansing as an infant, where he lived until his early teens, then his family moved to Mt. Pleasant where he graduated from Mt. Pleasant High School. He left home at the age of 18 to obtain his associates degree in Biology from Lansing Community College, and eventually he will be taking up Pre-Medical Studies. As of 2013, he currently holds a 3.68 GPA and was recently awarded the Writing 122/32 Blue Ribbon Award that recognizes an outstanding portfolio submission.
Other Notable Activities: Along with two colleagues, he led an Idle No More Rally at the State Capitol Building, standing up for Indigenous Peoples Rights.
Works Cited
“Doctor Shopping.” Dictionary.com. n.d. Web. 10 Apr. 2013.
Glover, Scott, Lisa Girion, and Liz Baylen. “Legal Drugs, Deadly Outcomes.” LA Times. 11 Nov. 2011. Web. 31 Mar. 2013.
“E-Prescribing Promises Quick ROI, Lower Medication Costs.” E-Prescribing.org. 28 Oct. 2009. Web. 21 Apr. 2013.
“Hippocratic Oath.” Cornell.edu Web. 3 Apr. 2013.
“Opioids and Opiates (Prescription Painkillers).” DartMouth.edu. 2013. Web. 1 Apr. 2013.
“State Prescription Drug Monitoring Programs.” U.S. Department of Justice/Drug Enforcement Administration. Oct. 2011. Web. 18 Apr. 2013.
Stross, Randall. “Chicken Scratches vs. Electronic Prescriptions.” NY Times. 28 Apr. 2012. Web. 21 Apr. 2013.
Tavernise, Sabrina. “F.D.A. Likely to Add Limits on Painkillers.” New York Times. 25 Jan. 2013. Web. 1 Apr. 2013.
“Transforming Opium Poppies into Heroin.” Frontline. n.d. Web. 14 Apr. 2013.
Tucker, Miriam E. “Pain pill overdoses exceed deaths from other drugs.” Internal Medicine News 15 Nov. 2011: 51. Academic OneFile. Web. 2 Apr. 2013.
“Prescription Painkiller Overdoses” CDC.gov. Nov. 2011. Web. 2 Apr. 2013.
Thanks for sharing this story.
First of all thank you for such a well written article. You shared much needed information which clearly comes from a place of solid experience. To lose your mother on a daily basis to drug addiction must be unpeakably difficult. I hear the sorrow in your writing and you are correct, we need to hold more people accountable. There is a MAPS program in Michigan that is regulated through the Department of Licensing and Regulatory Affairs that physicians can use to see if one of their patients has been getting prescriptions elsewhere for the same drug they are requesting. There are pain clinics that offer alternatives, but often once someone is addicted to these opiates they do not want the help, as they don’t want to leave the ‘high’ or they are afraid of the pain coming back. There is a physician in Ypsilanti, Dr. Herbert Malinoff, who I have worked with and he specializes in helping people break this kind of opiate addiction. He hospitalizes the patients and weans them off the opiates under medical supervision and monitors a transition to another non-narcotic medication. My heart goes out to you as you watch your mother making terrible destructive choices, knowing you are unable to change it. She is an adult and all you can do is take care of yourself and set good boundaries for your relationship. Kudos to you for all of your accomplishments in spite of all your sufferings and lack of support.