If you can get through your day without some kind of "little helper," you are among the fortunate few. It's becoming increasingly commonplace to pop a little Provigil as a pick-me-up in the morning, an Adderall to get you through finals, a Xanax to deal with co-workers or Ambien for a good night's sleep. This doesn't even take into account those burdened with chronic pain or those simply needing an escape from reality.
People who came of age within the past decade are so at ease with taking prescription drugs, they've been dubbed Generation Rx. It seems nearly everyone is in search of the miracle pill to enhance their lives without seriously considering the health risks. As a growing epidemic, this affects nearly everyone, from celebrities and athletes to kids in the classroom. This has led to a market for prescription drug dealers and doctors forced into the role of investigator with their patients.
Adderall Advantage
Gone are the days of strong coffee getting you through an all-night cram session for an exam the next day. College students are now utilizing other stimulants.
Often called a "smart drug," Adderall is the most popular study drug on college campuses. Nicknamed "Addy," students say the drug boosts focus and cognitive function, enabling them to study for hours without getting fatigued. It is commonly prescribed for those with Attention-Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). The drug is amphetamine-based and therefore likely habit forming.
Common side effects of Adderall abuse include extreme weight loss, dry mouth, the development of sleeping disorders or generalized difficulty sleeping, chronic headaches or migraines, pain in the stomach, high blood pressure, mood swings or other emotional changes, nausea with vomiting, slowed growth among children, sudden dizziness or fainting, a sudden spike in heart rate, unexplained fevers, heartburn and chest pains.
The going rate for a 20mg pill is around $5, with the price roughly doubling during midterm and final exams. Students interviewed from TCU and UTA said it could be bought practically anywhere on campus: the library, cafeteria and dorms. Students admit seeing doctors and purposefully exaggerating symptoms of ADHD to get the medication. When you're in college these days, there's a chance that you will need help for someone addicted to adderall, and it’s most likely for your roommate.
While this is the case in many instances, there are those who have ADD or ADHD and legitimately need Adderall to function. TCU alumn Jonathan Nauck was diagnosed with ADD in the third grade. At the time, the disorder was fairly unheard of, but Nauck's mother was an educator and had learned about ADD while working on her master's degree. He struggled so much in school that his teacher would allow him to run laps on the playground in the middle of his exams. Nauck took Ritalin until the ninth grade, and then he switched to Adderall.
"While I was a student at TCU, I made it a point never to mention to anyone that I took Adderall," Nauck says. "Aside from the fact that I wanted to assimilate with my fellow academic contemporaries, I knew all too well what would happen if word got out. People would never leave me alone! I had to hide my medicine from people, and believe it or not, I still do to this day. Even the most morally upstanding college student will nick a pill or two if it might help them get a good grade/better G.P.A./better job/better life."
The reaction experienced by someone who does not need the drug is much different from that of someone who truly needs it. Nauck explains, "People who do not have ADD and therefore do not have a medical need to take this drug will experience a profoundly different experience when taking this medication. Whereas a person with my disorder will experience a pharmaceutical effect, the non-ADD person will receive a pharmacological effect. I have been told it's like taking speed or low-grade cocaine without having to worry about it being cut with foreign substances. Furthermore, they say that they're not hungry, their heart rate increases and they have the ability to hyper-focus for extended periods of time. As you might imagine, this is quite a beneficial asset to students needing to pull the obligatory all-night cram session."
The problem of prescription abuse goes beyond Adderall. The recent arrests at TCU opened the eyes of many in the community about a substantial quantity of drugs being sold on campus. According to the myriad of arrest warrants, in addition to marijuana, cocaine, ecstasy and LSD, undercover officers were also able to purchase Oxycontin, Hydrocodone, Hydromorphone, Promethazine/Codeine cough syrup and Xanax.
Among the 17 arrested in the initial raid, four of them were football players. Head Coach Gary Patterson had this to say in a statement released following the arrests: "Under my watch, drugs and drug use by TCU's student-athletes will not be tolerated by me or any member of my coaching staff. Period."
The FWPD was targeting dealers who allegedly participated in hand-to-hand delivery of the drugs. While this may seem shocking for a school with such a squeaky-clean reputation, this kind of activity can be found on most college campuses.
Despite the presence of other pharmaceuticals, Adderall is by far the most acceptable drug used. The misuse of Adderall has led to an alarming burst in demand for the drug. Due to this, there have been nationwide shortages of Adderall, and North Texas is not immune. The FDA added it to its drug shortage list in 2011. The reason listed for the shortage is "API (Active Pharmaceutical Ingredient) supply issues."
Those "supply issues" refer to the stimulant found in Adderall that is tightly regulated by the Drug Enforcement Agency (DEA). While many complain that the shortage is being caused by the DEA, a statement released by Gary Boggs, a supervisory special agent for the Office of Diversion for the federal Drug Enforcement Agency, clarifies: "We've given them quota sufficient to meet the needs and then it's up to them how they manufacture their product."
When contacted for information about pharmaceutical abuse on a local level, DEA media contact for the Dallas division, Terri Wyatt, chose not to comment and suggested other sources including the DEA Web site.
Dr. Jeff Beeson, medical director for MedStar EMS system in Fort Worth, speculates about why there are prescription drug shortages.
"We are dealing primarily with the EMS side of shortages with generic medications. What we are finding, and nobody knows for sure, is it appears with the Federal regulations to maintain consistency of medications, the cost to be in compliance with federal regulations is great," he said. "When you are dealing with the generic medication that costs $1 - $2 a dose, there really is no profit margin there. So, these pharmaceutical companies are no longer producing the generic line. The drugs that are short are all generic medications. The stuff that is new that is expensive with a high-profit margin, there are no shortages of those. Therefore we speculate it has to do with profit margin."
While those who really don't need the drug may be inconvenienced by not being able to fill prescriptions during this shortage, the ones who suffer are those that rely on Adderall to successfully function.
"The reason that I continue to take this medicine is the same reason people with vision problems wear eyeglasses," Nauck says. "If you can do something that will improve your overall quality of life and help you perform to your fullest potential, what in the world is wrong with that?"
Despite certain hurdles with drug shortages, prescription drug abusers and dealers still find ways of getting what they want.
The Candy Man
Trying to differentiate between those with legitimate prescriptions and those who abuse or deal medication can be difficult to do.
Sgt. Freddrick Long, a narcotics officer for the Fort Worth Police Department, says, "There are multiple tactics for obtaining prescription medications for sale. Some include forged prescriptions, drug shopping from different medical providers, organized medical and pharmaceutical corruption, and theft (among others). Some people deal their own prescription medication. … During the course of our investigation of other controlled substances (cocaine, crack, meth), we often run across illegal sales of prescription medication."
Doctor shopping is one of the primary ways that addicts obtain prescription drugs for non-medical use. Individuals will visit several different doctors or emergency rooms to obtain prescriptions for the same medications and then fill those prescriptions at different pharmacies. This allows someone to obtain more of the prescribed substance than any one physician or pharmacist would allow.
"The problem with our health care system today is that we don't talk to other hospitals," Beeson says. "If a patient doesn't tell us that they were at another hospital, we don't know. Electronic medical records help within your own facility, but if a patient goes to Baylor, Baylor doesn't talk to THR or JPS or Huguley. The DPS has a new database where a physician can log in and can put in a patient's name or identification number and pull up what prescriptions they have been given. The problem with this, especially in the ER department, is that the patient often gives false identification. There is no law that says they have to give you their real name, and there is no way to know. They lie to us all the time.
"As an ER physician, I see it quite a bit. Some will give us vague symptoms and end up getting a very expensive medical evaluation because we are trying to find out what is wrong with them. They will end up walking out of the ER with a prescription for pain medicine. It's a rampant problem," Beeson said.
Doctor shoppers often visit facilities where medical professionals don't know them. They also call during the weekend and request prescription refills using excuses like they dropped the pills in the toilet or left their pills somewhere on vacation.
"Someone will get a prescription for 90 Vicodin and then go out and sell them for $4 or $5 per pill. So they spend $10 on a prescription and then make nearly $500 very quickly," Beeson says.
Another illegal activity associated with doctor shopping includes the forgery of prescriptions. Prescription fraud is committed in numerous ways including using legitimate prescription pads that have been stolen from physicians' offices. Prescriptions are then written for fictitious patients. Some patients will alter the doctor's prescription amount in an effort to obtain additional amounts of legitimately prescribed medications.
Other forgeries involve drug abusers using prescription pads from a legitimate doctor with a different call-back number added so that an accomplice can answer and verify the prescription. Computers are also used to generate prescriptions from made-up doctors or make copies of legitimate prescriptions.
"Per requirement of the Drug Enforcement Agency and the Department of Public Safety, in Texas you have to put on all your prescriptions both your DEA number and your DPS number. Once you have given the patient a prescription, they have your numbers. There are groups that will manufacture prescriptions using the physician's name and numbers and then go to CVS or Walmart or wherever they can to get as much medication as possible," Beeson says.
Another source for acquiring an excess of pills is "pill mills." Texas and Florida share in the fact that they have more pill mills than any other state. These are clinics that dispense a great deal of medication without extensive scrutiny of the patient. Indicative factors of pill mills include:
- No physical exam is administered
- No medical records are required
- Medical equipment may be limited to non-existent
- Pain is treated by pills alone; no alternative treatments are available
- Pharmacy is on-site
- You can select your own medicines
- Large volumes of medications are dispensed
- Medications are dispensed that, when taken together, can cause serious problems or overdose
- Giant crowds, sometimes lines, outside the clinic
- Many patients are from out-of-state or have otherwise traveled great distances
- They deal only in cash
Prescription Drug Monitoring Programs (PDMP) were set in place to combat pill mills and are designed to allow physicians and pharmacists to cross-check prescriptions with each other and identify individuals who may be doctor shopping. The Texas PDMP was established in 1981. Before that, manpower was the primary resource available to combat abuse. It required many hours to interact with the large numbers of practitioners and pharmacies.
"Smurfing" is another scam where recruiters approach homeless people and encourage them to visit a pain clinic and acquire prescription medications. The dealers will typically offer the homeless a small amount of cash and then after filling their prescription, make a large profit from selling the pills.
The Internet is a candy store for anyone who wants to illegally purchase prescription drugs. Federal law prohibits buying controlled substances without a valid prescription from your doctor. This means there must be a real doctor-patient relationship, which by most state laws requires a physical examination. If you are caught buying controlled substances online without a valid prescription, you may be imprisoned. Not only is it illegal, but buying online is extremely dangerous. Drugs delivered by rogue Web sites may be the wrong drugs, wrong dosage strengths or expired.
Long explains the procedure when officers discover prescription drugs on any individual.
"When we come into contact with these individuals, we first have to affirmatively verify the non-existence of the prescription. We try to obtain a statement as to where the medications came from. Prescription medications fall within schedules set in the Health and Safety Code. Based upon the schedules, they also fall into Penalty Groups as set in the Health and Safety Code, which are roughly based upon medical benefit, the propensity for addiction, and potential for abuse. Offense level classifications are done according to penalty group and aggregate weight of the individual medication and vary as to amounts that constitute felony or misdemeanor possession. Those that do not fall into a penalty group, but are controlled substances, fall under Possession of Dangerous Drugs. Absent an exigent circumstance, arrests are made accordingly for possession, delivery, etc," Long says.
The No. 1 way that teens and young adults are getting prescription meds is not from dealers but from raiding the family medicine cabinet, a.k.a. "pharming." It is also popular for teens to collect meds from home and meet up for "pharm parties" or "pill-popping parties," where they combine what they have collected from home and partake in assorted prescriptions among friends. Bowls and baggies of random pills often are called "trail mix." A spokesperson from FWISD said that the district was aware of the term "pharm parties," but he did not elaborate.
Parents are advised to safeguard prescription drugs at home. Monitor quantities and control access by taking note of how many pills are in a bottle and keeping track of refills. Also it is very important to properly conceal and dispose of old or unneeded medicines. Unless the directions say otherwise, do NOT flush medications down the drain or toilet because the chemicals can pollute the water supply. Also, remove any personal information from prescription bottles or pill packages before you get rid of them.
The City of Fort Worth offers environmentally friendly options for disposal. The Take Back Meds Day is on April 28 from 10 a.m.-2 p.m. Residents can drop off unused and expired medications at multiple locations. For more information, visit fortworthtexas.gov/solidwaste.
Eliminating access to these drugs in the home can decrease chances of use especially among the younger population. According to the Center for Disease Control, drug overdose (both controlled and uncontrolled) is the No. 2 cause for accidental death in the United States, second to automobile accidents.
Beeson says, "Opiods are the most common overdose cases we see in the ER. Death from an opiod overdose is specifically linked to respiratory depression. It knocks out their respiratory drive, and ultimately they just stop breathing."
Doctor's Orders
Just as is true in any profession, in the medical community there are good doctors and there are bad doctors. Some are dispensing certain drugs like sugar-coated gum drops either voluntarily for monetary reasons or because they are easily manipulated by addicted patients.
Should doctors be held accountable when they overprescribe medication to someone who dies of an overdose? In national news, we have recently seen investigations into the deaths of Michael Jackson, Anna Nicole Smith, Whitney Houston, Amy Winehouse and Heath Ledger.
To address this problem, the medical community, including pharmacists, health insurance companies and law enforcement officials, is trying to deal with the steadily increasing prescription drug abuse problem.
"Unfortunately, today with our health care system, physicians are graded by patient satisfaction," Beeson says. "Every hospital uses Gallup polls, and one of the questions they always ask [patients] is "Did the physician take care of your pain?" I think a lot of physicians end up giving a few pain pills because there is no test to see if someone is truly in pain."
Health insurance companies need to be proactive in denying payment for same prescriptions from multiple doctors, and a drug database should be utilized so health care professionals could identify patients that are "shopping."
The Texas Department of Public Safety's database, Prescription Access Texas (PAT), is set to go online this summer. Physicians, pharmacists and law enforcement officials can register for access to the information. Currently there are around 200 registered users, 22 of those in the Dallas/Fort Worth area. In next year's legislative session, lawmakers will consider requiring doctors and pharmacists to check the database before writing or filling prescriptions of controlled substances, something that currently is voluntary.
Here in Fort Worth, Beeson is working closely with Dr. Sandra Parker with the Tarrant County Public Health Department. She is trying to come up with prescription return boxes, where if you have expired or unused prescriptions, you can return them.
"Pediatrics end up getting hold of Grandma's pain pills or high school kids raid their parent's pill cabinets," Beeson says. He sees it routinely at the children's hospital. So the No. 1 objective is to get old prescriptions off the street, and No. 2 is to enact a controlled substance procedure where primary care physicians can get on the same page. This is a multi-year plan to solve the problem.
It's important to realize that while many abuse prescription drugs, there are many with legitimate prescriptions that depend on them for quality of life.
Those who are often most desperate for prescription drugs are the ones dealing with chronic pain. Dr. Renaud Rodrigue with Southwest Pain Group says that one of the problems with pain medications is that after a period of time, you become tolerant. "It's kind of like treading water because you can never keep up with your own innate ability to overcome the drug and develop tolerance to the drug. For those people that really need them, they take them and get used to them, but all the while, their side effects are increasing. Pharmaceuticals are useful, just not a great long-term answer."
All medications contain chemicals that will cause side effects. Long-term consequences range from digestive problems and erratic weight change to psychotic episodes, seizures and damage to vital organs.
At Southwest Pain Group, Rodrigue has been successful with several other ways of dealing with perpetual pain, including but not limited to intrathecal pumps, cryotherapy, radiofrequency lesioning and spinal cord stimulation. Rodrigue also adds that there are additional alternatives to pain medications offered from other providers such as physical therapy, acupuncture and hypnosis.
Prescription drugs can help relieve many people from the symptoms of chronic pain, ADHD and other maladies. Medication helps these people live less painful and more productive lives. But that's only when the medication is prescribed for a specific person at a specific dosage to treat a specific condition. Taking prescription drugs other than the way prescribed by a doctor can be more than risky; it can be deadly. It can lead to drug abuse, and the legal repercussions can be the same as taking illicit drugs.
