Summary
by Gary Cotton
When our group started our capstone project back in January, we were named the Drug
Overdose Team. The name seemed proper as our original goal was to localize a national
story about the rise of drug overdoses in the nation. According to the New York Times
report, drug overdoses had recently overtaken car crashes as the number one cause of
accidental death in the United States.
We wanted to see how that looked at a hyperlocal level. We split our project into two
major components, a segmented documentary and compiled research on drug and
treatment in Columbia. Our goal was to prove two things, the first being that prescription
drug use and is a rising and prevalent problem in the area. The second is that there are
multiple shortcomings that are contributing negatively to that issue. The team knew that
this would be an immense and probably long term story, but believed an online episodic
piece could peak local interest and could be maintained to raise awareness about a
growing problem while telling multiple stories.
After months of research interviews and analysis for our documentary portion, we’ve
determined “Drug Overdose” is not an appropriate name for our team or project. Our
project evolved after each source lead us to the same conclusion. There is an education,
enforcement, and regulatory gap that fuels a prescription drug culture in Columbia. Our
team attempted to expose this gap in our documentary titled “The Pill Problem”..
We narrowed the focus of the film to education, regulation, enforcement, and recovery.
Through our research, we determined these were the typical preventative measures that
must be failing in light of increased “poisoning” statistics we found in Centers for
Disease Control and Prevention statistics.
Poisoning Graph:
From the years 2000-2007, The CDC noted a significant increase in “poisoning” deaths
between age groups. With each age range from 15-45, the numbers of death more than
doubled. Our hypothesis about the rising prevalence of prescription drug abuse was
confirmed in our “enforcement” angle source Geoff Jones, an undercover police officer,
and from our focus group of students at Rock Bridge High School.
Through connections made through our recovery angle source Heather Harlan, we forged
connections with several former and current drug users. When interviewing these people,
we asked them to recount the origins of their use.
They all started around their pre-teen years. From these early recounts we were able to
come to three important conclusions.
1. All but one of our sources were taught about drugs the Drug Awareness
Resistance Education program.
2. These people were first introduced to powerful painkillers at a young age by
doctor’s prescriptions.
3. These people were easily able to feed their addictions through legitimate means.
We created our regulation angle after research into Missouri’s lack of a prescription
drug monitoring law. Senate bill 710 was being filibustered during the time of our
project. The bill would have established a prescription monitoring program in Missouri
which is one of two states that doesn’t have such a program. This helped shaped the
foundation of our recovery angle. The team wasn’t able to gather significant statistical
information about Columbia’s different recovery and rehab programs. The team was able
to gather significant qualitative information from different addicts who spoke on the ease
of relapsing in Columbia’s drug environment. This lead us to our conclusion that this
story can not be told in a traditional sense.
Our piece so multifaceted there were several angles we didn’t pursue strictly because of
time restraints. Our story about Engler’s prescription drug monitoring program is still
being filibustered in the Missouri State Senate as of May 10, 2012. We also weren’t able
to explore details about Missouri’s funding for school drug programs and recovery
programs. The team had some conversations with Dr. Joseph Meyer of Columbia Pain
Management Center, who said there is significant economic factor that plays into the
overprescription of painkillers. Drug companies sometime pay doctors to attend
conferences and give presentations on in an attempt to influence prescriptions. The story
was pertinent to our piece, but we couldn’t pursue it. With continued time these stories
could be followed up by another group and displayed in our online format. As videos go
viral, more story angles could surface from Columbia residents themselves. It’s in that
community engagement that a conclusion might be found. If residents are able to see the
different drug problems in their community in this entertaining fashion, maybe they’ll be
interested enough influence meaningful change.
###
Introduction: Too many pills
By Austin Alonzo
Bill Morrisey, the head of Kilgore’s Medical Pharmacy on North Providence, said
Americans are taking too many prescription pills.
“I am a pharmacist by nature, and my livelihood depends on those prescriptions, but I
would definitely will tell you that I think that across the board we over prescribe in the
United States,” Morrisey said. “People go to the doctor wanting a pill that’s going to fix
something for them whatever that might be.”
I think people are looking for answers for problems in their life and they’re looking for a
pill that’s magically gonna fix it and that’s really not a good mindset.”
The medical research firm IMS Health conducted a study of the top 25 most prescribed
drugs in 2010. The assortment of antibiotics and treatments for allergies, anxiety, acid
reflux, depression, diabetes, insomnia, pain, high blood pressure, hypothyroidism, high
cholesterol were prescribed 3.995 billion times.
That’s enough for almost 13 prescriptions for every US citizen, according to the US
Census bureau. IMS reported the total prescription of the top 25 drugs increased by 7.79
percent, or 279.7 million more prescriptions, since 2005. Three of the top 25, included
Vicodin, that was the most widely prescribed in 2010. Vicodin was prescribed 131.2
million times, a 16.73 percent, or 21.9 million prescriptions, increase since 2005.
A study published by the US Centers for Disease Control in November 23, 2011’s
Morbidity and Mortality Weekly Report concluded enough prescription painkillers were
prescribed in 2010 to medicate every American adult around-the-clock for a month.
In Missouri the rate of all drug overdoses (13.1 per 100,000 deaths) is higher than the
national average, but the non-medical use of opioid painkillers (4.4 percent of the
population over 12 years of age) is lower than the national average. Paulozzi and his coauthors noted more rural and impoverished counties tend to have more overdose deaths.
But the trend hasn’t gone unnoticed.
In November 2011 a U.S. Centers for Disease Control study declared prescription drug
overdoses a “public health epidemic.” According to the study, 4.8 percent of the U.S.
population age twelve or older used opioid pain relievers for non-medical reasons.
“In 2007 nearly 100 persons per day died of drug overdoses in the United States. The
death rate of 11.8 per 100,000 population in 2007 was roughly three times the rate in
1991,” Leonard Paulozzi, the primary author of the CDC study, wrote. “Prescription
drugs have accounted for most of the increase in those death rates since 1999.”
“[Opioid pain relievers] now account for more overdose deaths than heroin and cocaine
combined,” Paulozzi wrote.
Donald Meyer, a doctor at Columbia Pain Management Center, said this increase is
linked to consumer expectations for how a doctor is supposed to treat a patient.
“When a patient comes to a doctor’s office and seeks treatment, often times they expect
getting some kind pain pill, shot or surgery to make it go away,” Meyer said. “That’s
what they see every day on the television. That’s what the advertising world is pushing,
and that’s what they expect.”
Michael Trapp, a mental health and addiction counselor at Columbia’s Phoenix House
rehabilitation center, said the drugs have a potential for addiction even if taken as
prescribed.
“If I’m having a negative emotion experience with, say, anxiety and I take a pill and I
instantly feel better. That’s a recipe for addiction,” Trapp said
Meyer, as a pain treatment specialist, often sees patients who are dependent on
prescription drugs to treat chronic pain. He said patients often end up this way because
general practitioners paid for by medical insurance and Medicaid lack the training and the
time necessary to adequately treat patients.
“Most of our primary care physicians, excellent physicians, are simply too busy to sit
there and council every day. They have too many people in their waiting room, waiting to
be seen, to be doing that,” Meyer said.
Meyer said some patients fall through the cracks and wind up bouncing from physician to
physician. The prescribing doctors don’t know the patient history and are pressured to do
something to help suffering people.
“I can’t get the resources I need to get Mr. and Mrs. Jones treated appropriately the way I
think they should be treated, but here we are,” Meyer, speaking as a doctor in a
hypothetical situation, said. “I can’t do anything else. They’re miserable. I’m going to
give them a little more, and they give them a little more, and that process plays out over
and over and over again.”
###
Education: Underfunded and Outmatched
By Gary Cotton
For thirty years, the Drug Awareness Resistance Education model was the stamp of
Columbia’s early drug education. In 2009, Columbia Public Schools decided to eliminate
the program. The Missourian reported the school and police department couldn’t afford
to give up the resources for a possibly ineffective program.
According to DARE’s website, in 1998 reports surfaced saying the program wasn’t
working; drug use was going up from 2 to 5 percent in suburban areas. Later, 2.5 percent
became the rallying cry as proponents and opponents of the DARE program wrestled
over whether that number showed an increase or decrease in drug use in youth.
Another report, the National Institutes of Health’s National Institute on Drug Abuse cites
data from the University of Michigan’s 2011 Monitoring the Future Study. The report
concluded that after cannabis, high school seniors used prescription pills recreationally
more than any other drug. Comments from seniors at Rock Bridge High School lined up
with those findings.
“We’re known as the rich, preppy drug school,” one said. “(DARE) was ineffective
because we were too innocent.”
Some of the students suggest introducing drug education programs at a later age. Most
couldn’t remember their lessons, but MU Wellness Resource Center Director Kim Dude
said a different set of problems arise when students learn about drugs later.
“If I go out and educate people that (adderall) makes you more alert, then they might
think, oh, that’s a great idea! I’m going to go try to find some of that,” Dude said.
“Sometimes by educating, you can actually increase use.”
Dude said Columbia educators had been leading up to the decision to halt DARE for a
while. Two years prior to the decision, Dude was a member of the Columbia School
District’s Substance Abuse Task Force. Dude, along with 46 other communications
professionals and educators, formed a think tank for the purpose of curbing substance
abuse in area schools.
“People were very vocal about the DARE program because some thought it wasn’t very
effective,” Dude said. “The difficulty is it’s hard to tell with any prevention program
what you kept from happening.”
While brainstorming with the task force, Dude introduced her method of educating
college-aged students. Social norming is a key peg of Dude’s education plan as she
convinces students their peers aren’t using substances as much as perceived.
In the Wellness Resource Center’s findings, the use of amphetamines and pain killers
weren’t prominent at MU. This was in sharp contrast to the use of stimulants such as
adderall or ritalin, but even those numbers were on a downward trend.
“The reality is students want to do what their peers are doing, and they way overestimate
what their peers are doing,” Dude said. She says messages on the back of T-shirts and on
signs can convey messages about how peers aren’t participating in drug-related activities.
She calls this social norming, which currently on applies to curbing alcohol use. She says
the same rules, however, could apply to prescription drug use.
“When we survey students to find out what they’re actually doing, and when we do a
media campaign about what students are actually doing, students will in fact (use) less.”
Although her system is being used as a model for younger students, Dude still faces some
of the same funding problems that plague K-12 drug education.
“There’s less money,” Dude said. “There are fewer outreach counselors. There are less
grants available. There are going to be fewer grants available for us in the future because
of all the cutbacks.”
According to Columbia School District spokesperson Betsy Jones, preventative programs
like DARE and the Student Resource Officer program are the first to suffer.
“I need more resources,” Jones said. “Through budget cuts we have to be a lot more
reactive than proactive.”
Columbia Police Department Officer John Warner is a former and current supporter of
the DARE program and is the only Student Resource Officer for four middle schools.
SRO officers are a key component of CPD’s Community Oriented Policing initiatives.
Officers are placed in educational settings to engage with faculty and students. The goal:
have a resource for students to ask questions and forge positive relationships with law
enforcement.
Warner said he’s no longer able to connect with his students.
“(I’m) just responding to whatever is happening: assaults, weapons offenses, that and
theft are probably the biggest things at the SRO level,” Warner said. “There’s almost no
relationship that I’m able to develop. The one’s that I deal with are all negative.”
Warner performs the duties once assigned to four SRO officers at Columbia’s middle
schools. He bounces from school to school trying to serve more than 6,000 students.
Warner said he tries to spend the majority of his time at one school per day, but that
rarely happens.
“It’s through budget cuts,” Warner said. “I may not know another model in the country
that’s quite like this.”
During the full swing of the district’s SRO program and DARE, Warner said he hasn’t
been able to teach much about prescription drugs. Although he once had three others to
help him, they couldn’t get past the basics. Regardless, he refutes claims that the
programs were not effective; he said they just needed to be properly funded.
“I understand the process of when money gets tight you have get the more important
things,” Warner said. “But I think that drug education is one of the important things.”
But Betsy Jones said that budget cuts are only a fraction of the problem with drug
education. She that in addition to school drug awareness programs, parents and the
community need to continue the learning process outside of the classroom.
“We started a big campaign with our parents, like do you know what is in your medicine
cabinet, and do you realize that your teenagers are stealing their grandparents’
medicine?” Jones said. “The school is just one portion of the child’s life. We have to rely
on the parents to be mindful of the safety of the children.”
###
The Accountability Gap: Columbia’s strategy to combat prescription drug abuse.
By Austin Alonzo
“The lion’s share of physicians, they are truly out there to help people improve their
health. They are not out there to prescribe substances that they will abuse,” Bill Morrisey,
head pharmacist at Kilgore’s Medical Pharmacy on North Providence said. “They’re out
there trying to identify those patients that they think are seekers.”
Pharmacists are increasingly tasked with monitoring their patients for signs of abuse.
Across the industry concern is growing over preventing diversion, or prescriptions
winding up anywhere except in their prescribed patients hands.
Morrisey explained at his pharmacy every employee must follow strict procedures to
prevent diversion of controlled substances popular on the illegal market.
Patients are also monitored for warning signs. Morrisey said many of his customers are
regulars. Strangers, who come in seemingly nervous or on edge, put him more on guard.
“A pattern develops, it might take a few months to get to know a patient and kind of
know what their intentions are,” Morrisey said. “But a lot of times we’ll read between the
lines and figure out if they are up to no good.”
Statewide and national regulation of the prescription drug distribution system is not
uniform. The collection of controls set up by the US Drug Enforcement Agency, the
Missouri Board of Pharmacy and other institutions require strong monitoring of drugs
used to process methamphetamine, but not for controlled substances.
Doctors are tasked with monitoring each other and their patient’s medical history. Some
benefit from private systems that track what patients were taking, who was prescribing it
and how much was prescribed.
“In about 75 percent of the cases that come into our clinic we can obtain good records of
all the medications that have been provided that particular patient through pharmacies
over two years,” Joseph Meyer of Columbia Pain Management Center said. “But we’ve
learned even with that database, sometimes they miss things.”
Despite the best intentions of prescribing doctors and pharmacists, some patients do play
the system and some doctors are happy to help them. When they do, it falls on the
network of doctors and pharmacists to identify and report any problems to law
enforcement.
Both Morrisey and Meyer said they often calls other doctors and pharmacists around
Columbia and Boone County when dealing with a suspicious patient. They will trade
patient files and independently investigate unscrupulous doctors and patients.
Doctor shopping, as medical professional and law enforcement call the practice of
hopping from prescriber to prescriber, and “pill mills,” where doctors hand out pills
illegally, are concerns for Columbia.
Morrisey said the community became aware of the dangers of pill mills after a recent
incident involving a doctor from Fulton handing out OxyContin indiscriminately.
Doctors and pharmacists became suspicious, and eventually they informed the law about
the bogus prescriptions coming from her office. Eventually, the doctor was investigated
and prosecuted, but not before damage was done.
“That specific prescriber had a person who took OxyContin, and that OxyContin ended
up in a teenager in Centralia and she died from an overdose of it,” Morrisey said. “We
can’t turn a blind eye and pretend like that isn’t something we should do our best to
control and limit.”
Without independent monitoring of the pharmacists, and doctors the pill mill would not
have been shut down. However, self monitoring leads to a diffusion of responsibility,
leaving no specific entity in charge of watching out for unscrupulous doctors and
patients.
‘I think it’s easier if there’s not that recognition of that problem and people recognizing,
identifying and addressing,” Morrisey said. “If that doesn’t occur, there’s there more of a
tendency to just turn a blind eye.”
***
Sergeant Geoff Jones, the head of the Columbia Police Department’s Vice and Narcotics
and Organized Crimes Unit, points out at a plaque in the lobby of his department’s
downtown headquarters.
“Molly was shot by a drug dealer,” Jones said, looking at the memorial for officer Molly
Bowden, who was fatally shot during a traffic stop on Feb. 10, 2005. “That’s why I come
to work every day.”
Jones’ unit is in charge of investigating and prosecuting drug related crimes in Columbia.
For prescription drugs, the unit faces a unique challenge. Traditional law enforcement is
not equipped to prevent diversion and illegal sale of prescription drugs and is mostly
reactive in its enforcement.
Jones said his unit is focusing on educating doctors, pharmacists and other health
professionals about prescription drug abuse as well as using covert and overt operations
to arrest illegal pill seekers and distributors.
Columbia’s officers arrest impaired drivers and serve search warrants to find controlled
substances, and respond to calls from clinics or hospitals where they arrest those illegally
seeking prescription pills, according to Jones.
“They will tell they were alerted by a pharmacy or an office manager who said that us
someone called in a ‘scrip that didn’t seem right,” Jones said. “The pharmacist will tell
them the ‘scrip they filled and inevitably it will be different from the ‘scrip that their
doctor wrote or didn’t write at all.’
Police investigate the patient’s records, watch video and logs and speak with doctors
while pursuing charges against a suspected pill seeker, but Jones said the process takes
time.
“We’ve had people who’ve written dozens of prescriptions and we have people we
caught writing two,” Jones said. “Sometimes it will take us a couple days and sometimes
it will take us several weeks.”
Undercover agents find and arrest suspected drug dealers as well as doctors running pill
mills and conduct sting operations against pharmacies suspected of being involved with
illegal pill distribution. Jones noted the latter is more rare.
“Our pharmacies in town really do a good job of managing their prescription pills. We
have very few reports of internal theft from them.” Jones said. “They really have pretty
strong internal controls.”
In the past few years, Jones said, his division has focused on creating a “education-based,
community-based model.” He wants doctors, police, and pharmacists to talk about
prescription drug abuse and diversion and discuss strategies to prevent it.
The CPD works with other state and national law enforcement agencies as well as
hospitals and pharmacies to increase cooperation between doctors and law enforcement.
Jones talks with local hospitals about what they can and can’t report, facilitating
investigation.
“We have several hospitals here so the pill issue will continue to grow, I think, unless we
get a handle on it,” Jones said.
Officers on the beat hand out fliers, ask citizens to be aware and talk to people about
where they can get help. Jones explained the city of Columbia views prescription drug
abuse as both a criminal and public health issue.
“What we don’t want to happen is this revolving door of someone coming into the
emergency room, trying to get pills, us arresting them, them moving to another hospital,
doctor shopping, pill shopping, them getting arrested by another police agency and never
getting the treatment they need,” Jones said
“If we think we can get them treatment, then we hold off on charges,” Jones said. “We’re
very stern in our conversation, and very direct in our conversations with those people.
Because they need to know the next time they come in pill shopping that we’re going to
take them to jail.”
Jones is optimistic about his staff. He said his officers are dedicated and held to high
professional standards, but he added he has his doubt about the general law enforcement
strategy toward prescription medication.
“I think that we’ve made strides, but I don’t know that anything is going to be effective
until we can get some method in place to slow down the over-prescription and get more
effective treatment methods for opiate addiction,” Jones said.
“I don’t know that law enforcement can be successful without those things. I don’t think
they can.”
***
In Jefferson City, Missouri’s elected officials are debating the merits of a prescription
drug monitoring program.
The legislation, sponsored by Senator Kevin Engler, R- Farmington, would establish an
electronic system, run by the Missouri Department of Health and Senior Services, that
would monitor the prescription history of patients and doctors.
Engler’s staff said the bill would place the Missouri Board of Pharmacy in charge of
determining an instance of doctor shopping or illegal pill seeking and reporting it to law
enforcement.
The bill, now languishing in the state senate, is based on monitoring programs in other
states. Missouri is one of only two states in the U.S. that doesn’t have a prescription drug
monitoring program law or approved legislation, according to the National Alliance for
Model State Drug Laws.
Proponents of the legislation say the new law would improve medical professional’s
access to prescription records and facilitate investigations of clinics illegally handing out
prescription pills.
“We’re not trying to end the drug prescription, what we’re trying to do is have reasonable
regulations so we can monitor what is being prescribed,” Engler said. “90 percent of the
effect of this bill is that the doctor will be able to tell if this person has been abusing
prescription drug purchases.”
Engler cites Iowa as a test case for Missouri. According to data gathered by the Iowa
Office of Drug Control Policy, since the program was enacted instances of patients
receiving prescriptions for schedule II drugs from 5 or more prescribers or pharmacies
dropped from 437 in 2008 to 216 in 2011.
Instances of all controlled substances schedule II through IV distributed from 15 or more
prescribers dropped from 53 in 2008 to 9 in 2011.
“Consultation of Iowa’s [prescription monitoring program] by health care professionals is
voluntary, and while utilization rates remain relatively low, they have increased threefold
over the last two years,” Dale Woolery, the acting director of Iowa’s Office of Drug
Control Policy, said in a letter to Engler. “Most importantly, suspected cases of ‘doctor
shopping,’ as detected by the [prescription monitoring program], have been cut nearly in
half in the short time it’s been operational.”
Critics of the program like Robert Schaaf, R – St. Joseph, say the legislation is
overbearing and allows government to dig too deeply into private information. He has
filibustered the bill, and says he will continue to filibuster it on the grounds of protecting
civil liberties.
“I’ll stand till my legs fall off. It’s a severe infringement on the liberties of the citizens of
Missouri,” Schaaf said. “Since when does the government have the right to take your
private medical information and put it on a government database?”
Schaaf distributed an article from the Journal of American Medical Association
questioning the effectiveness of prescription drug monitoring programs in limiting opioid
distribution and abuse.
The authors cited a 2010 study of drug distribution in clinics using Ohio’s program and
concluded their program was ineffective.
“Results indicate that the targeted use of drug monitoring programs by prescribers does
not result in indiscriminately decreased administration of pain medicines,” Hallem
Gugelmann and Jeanmarie Perrone of the University of Pennsylvania Hospital wrote in
the November 23 issue of JAMA.
“My experience as a physician is that this won’t stop it, there are so many ways around it
and it isn’t worth the reduction in our liberty,” said Schaaf, a practicing podiatrist in St.
Joseph. “People will still die of overdoses.”
Schaaf also cited a study from the Journal of Pain Medicine in April of 2011 led by
Leonard Paulozzi of the Centers for Disease control. Paulozzi’s study agreed that drug
monitoring programs have not been effective.
“[Prescription drug monitoring programs] were not significantly associated with lower
rates of drug overdose or opioid overdose mortality or lower rates of consumption of
opioid drugs,” wrote Paulozzi and his co-authors. “[Prescription drug monitoring
programs] states consumed significantly greater amounts of hydrocodone (schedule III)
and non-significantly lower amounts of schedule II opioids.”
Engler doesn’t buy Schaaf’s response.
“I think it’s unacceptable, it’s preposterous for a doctor,” Engler said. “Every of the 48
other states that have done this have saw it go down because you control the level of the
narcotics going onto the street.”
“Our inaction in this body for the last five years is killing people.”
Both articles distributed by Schaaf’s office also conclude that prescription drug
monitoring programs are important in improving patient to doctor relations and
preventing abuse.
Gugelmann and Perrone as well as Paulozzi’s team concluded the failures of prescription
drug monitoring programs are policy failures. The programs, they said, would be more
effective if expanded to track and use more information.
“In theory, [prescription drug monitoring programs] have the potential to address the
problem of prescription drug overdoses,” wrote Paulozzi and his co authors. “But to do
so, their use of the information they collect will need to be enhanced.”
Joseph Meyer of Columbia Pain Management Center, who has access to a private
prescription drug monitoring system said he doesn’t think a prescription drug monitoring
program will instantly solve all of Missouri’s problems.
“From what I’ve read, they can be administratively difficult. While it’s a great idea, even
once we reach the point that we implement one in this state, I think it will be a good five
or ten years before its ... to the point where it’s seemlees,” Meyer said. “Imagine all that
data, all of the information that has to be constantly entered and then accessed.”
Bill Morrisey of Kilgore’s Medical Pharmacy agreed with Meyer’s standpoint.
“I think we always put it on the government to make things right,” Morrisey said. “I do
think that there are good laws and regulations out there but unfortunately whatever those
rules and regulations are they are only as good as the people who help enforce them and
try to abide by them.”
Is there a magic law that will fix some of the problems were having? No. I think as a
community if we make a group effort to try to address them that’s the only way I think
we can make a real, concerted effort to address them.”
###
Beating the Addiction
By Austin Alonzo
Addiction knows no race, class, creed or gender. It can tear lives apart and cause havoc
for law enforcement and policy makers, but it is not impossible to beat.
Medical professionals agree that addiction is a medical condition. The Diagnostic and
Statistical Manual - IV, the American Psychiatric Association’s guide to diagnosing
mental illness, lists “substance abuse” as “a maladaptive pattern of substance use leading
to clinically significant impairment or distress.”
The problem of prescription drug abuse and addiction is widespread and rapidly growing.
The National Institutes of Health’s National Institute on Drug Abuse, citing data from the
National Survey of Drug Use and Health concluded in 2010 approximately 7 million
people abused prescription pills, 5.1 million of them abused prescription pain killers.
Heather Harlan, a preventionist at Phoenix House, an in-patient rehabilitation center in
Columbia, Mo. said addiction beings simply. A an extra pill here or there to treat
lingering pain, a way to get high for a few hours, an escape from anxiety and the
pressures of the world.
Harlan explained that addiction resets with the brain’s reward system. The brain becomes
hardwired to find joy only in the use of illegal substances. She said addicts then use
anytime they are “glad, sad, mad or bored.”
Addiction affects young people especially because the neural pathways of the brain are
not fully mature until early adulthood
“They don’t have coping skills in place to know this feels really bad, and given some
time I can heal and get better, they don’t know that,” Harlan said. “An adolescent thinks
it’s all about the here and now.”
Because prescription pills are distributed by doctors, Harlan said, people are less likely to
worry about the risks of addiction.
“Young people have an attitude of ‘well it’s from a lab, it’s prescribed by a doctor’ …
instead of understanding that the abuse of prescription drugs is drug abuse.” Harlan said.
“We still don’t all know the effects of a lot of the pharmaceutical drugs that are being
prescribed, especially long term.”
The first way to stem the tide of use is to teach children at a young age the risks of
addiction. According to Harlan, it’s a unique challenge in Columbia, a college town,
awash in parties, alcohol and a galaxy of recreational drugs.
“Blaming young people for experimenting with alcohol and other drugs is like blaming a
fish for swimming in a polluted stream,” Harlan said. “We adults have created the
environment. We make it available.”
***
To begin the process of recovery, addiction counselors must find the cause, such as an
underlying mental illness or a traumatic event, according to Mike Trapp, an addiction
counselor at Phoenix House.
First, he said, prescription pill “dependent” patients are brought to the Phoenix House and
isolated for detox, which can be very intense for users of opioid and benzodiazepine
based drugs.
Once the drugs leave their system, Trapp said, patients move into group and
individualized therapy sessions, where they talk about their past, take place in
constructive activities and begin to contemplate abstinence from their drug of choice.
Trapp noted that the recovery process, above anything else, requires an individual,
internal mental change. Without an active desire to get and stay clean, the user will fall
back into addiction.
“We always want to look to the outside, because we don’t want to take responsibility for
our actions,” Trapp said. “If we’re a helpless victim, then that means that it was all
external and we didn’t do anything to cause it … so we don’t have to feel bad about the
consequences of our actions.”
“If I’m not a victim, but I’ve made some bad choices, that means I can make different
choices, and I can move my life forward in a positive direction,” Trapp said.
After their stay at the rehab center, recovering users face a mountain of challenges in
returning to their old life. Just being around old friends, and situations, especially if drugs
are around, can lead to relapse, according to Trapp.
“People make big changes in treatment, but people in their lives don’t realize the changes
that they’ve made, and people out in the community will tend to push people back to who
they were,” Trapp said. “So you have to be really careful to surround yourself with
positive people, to have a set schedule, to be able to identify what your potential triggers
are.”
Many recovering users turn to resources like Narcotics Anonymous which follow the “12
step program” and require their members to recognize a “higher power.”
“Some people always need to stay on it and they need the fellowship of fellow addicts,
other people just need to be in any kind of socially supportive environment and some
people, I think, can kind of turn a corner on it,” Trapp said. “For prescription drugs,
probably the safe thing is lifelong support.”
However, patients deal with a host of other problems once they are clean. Trapp said the
construction of drug-based neural pathways destroys the existing pathways for other
enjoyable activities.
“They can have a lifetime of negative psychological symptoms, probably the biggest one
is what we call anhedonia, which is a lack of joy in every day activities,” Trapp said.
“That has retrained my mind to only find enjoyment in those powerful narcotics.”
“The brain’s been superhumanly supercharged on what’s pleasurable, we’re not really
designed or created to be able to deal with that level of what we’ve been able to create in
the modern world.”
***
“Once an addict, always an addict.”
Heather Harlan keeps that idea fresh in the minds of her patients. She noted neural
pathways rewarding drug use are always just as strong as they were last time a user got
high.
Recovery from drug addiction is a never-ending process. One temptation, or lack of
structured time, can lead a user back to drugs.
Josh, an active prescription painkiller addict who wished to remain partially anonymous
for this story, said he fell into prescription painkillers during his freshman year at the
University of Missouri. He developed debilitating pain in his face, later diagnosed as an
endocrine problem.
“Basically what the doctor told me was, we’re going to write you these ‘scrips out for
these pain killers, be careful with them, you can have issues with them. That’s all I was
ever told,” Josh said. “And he said, if you ever need any more just come on by and we’ll
get them for you. So I felt kind of like I had an open-ended ticket for being in pain.”
Later Josh underwent surgeries, and got more pills. Even after his recovery, doctors kept
handing him powerful painkillers.
“I had so many refills from so many doctors of so many large counts, once I started
getting better, I didn’t know what to do with myself,” Josh said. “I’d already gone a few
months into this, I’d already gone too far down the path to really know how to come back
out.”
Josh’s addiction developed to the point where he said he was buying painkillers from
terminal cancer patients to keep up his habit. At that point, he realized he had a problem.
“I was an Eagle Scout, I used to be sponsored by Bass Pro, ... I run the FFA and won
multiple scholarships and I had teachers and parents and everybody tell me the sky’s the
limit for you, you could do anything you want,” Josh said. “Unfortunately at the time
that’s all I wanted.”
When Josh arrived in Columbia for college that year, he quit drugs cold turkey and said
he managed to stay mostly clean for almost two years.
Josh fell back into pills after a fall down stairs that injured his spine and broke several
ribs. He said he stayed clean, despite the temptation because his girlfriend helped him
stay strong.
However, last summer Josh was involved in a car accident that broke several of his ribs,
and while he was dealing with pain, he found some of his father’s Oxycodone and
relapsed. Josh’s father underwent several more surgeries that fall and winter and the pills
just kept coming.
“I mean I never planned it, I never wanted it to happen. My Dad knew it, had known in
the past, that I’d stolen some stuff from him and that’s one of the most shameful things
I’ve ever done. And I did it again,” Josh said.
“It’s just like something takes control of you another person in you. My mind was
screaming, what are you doing, stop, stop, you know this is horribly wrong, this is going
to lead to something horrible, but I saw my body doing it and I wasn’t going to stop.”
Josh, who said he’s been clean for a few months, said his addiction is something he will
always have and he knows he will relapse again, and he’s afraid of what it could do to
him.
“I never realized what I was getting myself into. I never realized how far it could go, how
deep the rabbit hole goes,” Josh said. “I can understand how people end up on the streets
homeless, I can understand because when you get to that point, you’re willing to sell your
best friend for a fix.”
Some could say that Josh’s cycle of addiction and relapse is a result of a lack of structure
in his life, bad luck, and a lack of professional help. When Josh has non-using friends and
family around, he found it easier to stay clean
Perhaps Josh’s biggest problem was him not telling his doctors he was an addict to
prescription pain pills. Mike Trapp said that type of behavior is typical among addicts
who are afraid the doctors won’t give them the good stuff if they tell them they have
problems.
Regardless, Josh has only relapsed twice over the past five years, and his relapses lasted
less than a week. Now he strives to stay clean.
***
However, long-term recovery is not impossible. By utilizing a strong support system,
once destitute addicts can lead clean, healthy lives.
Mike Pagel and Leanne Stohle of Columbia, Mo, both recovering addicts of prescription
painkillers and a host of other drugs, have been clean for four and a half years and five
years respectively. They say the support of each other has been key.
Pagel has dealt with addiction for most of his life. He said he had his first drink when he
was 8 and smoking marijuana by high school. After high school, Pagel injured his back
while working on a construction job in Rolla, Mo., Pagel had multiple surgeries and took
pills for pain for well over a year.
“Being on the prescription medicine for over the course of a year, I came to kind of
depend or rely on it pretty heavily to not only suppress the pain, but also to alter the way I
felt emotionally,” Pagel said.
After years of use, the drugs took a toll on Pagel, his marriage, and his body. One night of
drinking that turned into a nearly fatal case of alcohol poisoning in 2007 was the deciding
factor for him to get help.
In treatment, where he spent five-and-a-half months, he said he learned life skills.
“I learned for the first time that addiction is not based on your drug problem, but your
drug problem is a symptom of other things in your addiction,” Pagel said. “I had never
learned life skills in a sober manner. If things didn’t go my way, or if something didn’t
feel the way I wanted it to feel I dealt with that with drugs or alcohol. I never really
learned accountability or responsibility.”
Mike’s addiction hasn’t subsided, according to him, but with the help of methadone, an
opioid used to assist recovering heroin addicts, it has improved.
Leanne Stohle, Pagel’s girlfriend, a fibromyalgia patient, said she was addicted to Xanax
to both kill the pain of her condition and to treat her post-traumatic stress disorder she
sustained when she was raped in her childhood.
“I had addictive thinking or depression before I ever picked up. My whole life I’d been
that way,” Stohle said. “I had three suicide attempts in one year, and they said we’re
keeping you unless you go to long-term treatment so I went.”
Stohle said she attempted suicide in 2007 by taking dozens of pills.
“I had three suicide attempts in one year,” Stohle said. “I just couldn’t stand the pain, the
pain of living. It was just awful. My life was awful. The addiction had taken over and I
couldn’t see my way out of it.”
Pagel and Stohle met in rehab and have been living together since. They say each other is
the biggest part of their continued recovery.
“My first line of defense is my sponsor and Mike,” Stohle said. “We support each other,
we know each others talk to each others programs and we work together on things.”
“I don’t have to run from everything and hide from it behind my addiction to drugs
anymore. If problems come up or emotions come up that I’m not comfortable with, I talk
to someone, I talk to Leanne.”
Both are active members of Narcotics Anonymous and council recovering addicts in their
spare time.
Stohle said the kids coming into NA are getting younger and younger. While they only
used to see recovering addicts in their late 20’s, now they are seeing ones who aren’t
even 20 who are hitting the bottom of their addiction.
Teaching them that there is a way out of addiction, even if that first trip to NA doesn’t
lead to recovery, is important to both of them.
“You plant the seed,” Stohle said. “They know that’s where they can get help.”
“Even if they don’t stick with it,” Pagel said. “They’ve seen examples of people who
have long-term recovery and are successful in that who have good lives today.
###