We’re all aware of the issue–there are a lot of drugs out there, and they are killing people. But they’re also helping people.
It is felt the responsibility of a physician is to alleviate pain, and these troublesome substances can be powerful tools. Used correctly, they can dramatically improve quality of life and functionality. Used incorrectly, or by the wrong person, they are a major source of societal problems and personal tragedy.
The government agencies overseeing drug regulations have begun to institute stricter policies regarding their dispensation, but we have a long way to go before this problem is solved.
Medications are deemed “controlled substances” when they carry such a high risk of adverse effects, such as abuse and addiction, mandating special regulations is needed.
The main categories of controlled substances are: (1) narcotic pain killers, including morphine and codeine; (2) stimulants, such as the ADD drugs Ritalin and Adderall; (3) sedatives, such as Valium and Xanax; and (4) sleeping pills like Ambien. While these medications may be highly effective, they share dangerous characteristics. They are addictive, meaning that one of their side effects causes the brain to compulsively seek more, whether needed or not. And unfortunately, these chemical compounds can be used solely for “partying” and end up the hands of folks who have had no education about potential adverse effects.
Most experts feel the essential strategy to reduce illicit use of prescription medication is to reduce the amount being prescribed. This way, there is less unused medication available to be misused, sold, or stolen.
The Drug Enforcement Agency (DEA) is the federal organization in charge of supervising these high risk substances; a doctor needs special authorization from them to prescribe these medications. However, until recently, that was really the only control the DEA exerted. It was assumed credentialed doctors would know how to provide the appropriate amount of medication and monitor its use carefully.
This assumption has proven to be terribly wrong. Many well-meaning doctors give patients large amounts of these substances as a “courtesy,” to save them from needing to come back for more. They may forgo regular visits with the patient to monitor the use of these medications, again trying to be kind and save the patient the cost of a visit. Prescription pads can be stolen from a careless physician and used to forge controlled substance prescriptions. And unfortunately, there are simply bad doctors who sell prescriptions to “patients” – they are a particularly malevolent type of drug dealer.
Several states–including New York– recently enacted their own measures to reduce the amount of controlled substances on the street. Prescribers now need to log on to a computer registry every time they give a patient a prescription for one of these medicines. They can see if their patient is getting controlled substances from different doctors. They can easily track how much the individual uses on a regular basis. It also provides an opportunity to thwart “doctor shoppers” as well as identify and counsel regular heavy users about the risks of addiction, the laws regarding driving under the influence of these substances, and the benefit of tapering down their usage.
Patients, also, can play an important role in limiting the amount of unused controlled substances available for misuse. Feel free to correct a physician if they offer you more pills than you need! Keep controlled substance prescriptions in a secure location, and when the need has passed, resist the notion to keep them around for a rainy day–discard unused pills properly as soon as possible!
Additionally, it is essential NOT to share pills with family, friends, and neighbors. Besides being illegal, it is profoundly unwise, as once the medication leaves your possession, you cannot assure it is used correctly.
“Primum non nocere” — above all, do no harm. That is at the heart of medical ethics.
But should you need one of these medications at some point in your life, be aware this is an aspect of medical care where that goal frequently is not attained. For the good of the community, take only the medication that you need, do not let others use it, and discard any leftovers as soon as you are able. You may end up saving a life.