# Drug abuse



## oldman (Jan 8, 2015)

Fellow Forum Members: As some or maybe none of you know, I am a certified substance abuse counselor here in PA. I took courses at Penn State and received my certification in 2002. I counsel at churches, schools, prisons, rehabs and any organization that invites me to speak on substance abuse, which includes drugs (illegal and Rx abuse) and also alcohol. I also do one on one when requested and if available to do so. I am not an Addictionologist. Big difference. 

Last night, I gave a 45 minute presentation to a youth group in Baltimore City (One hour south of my home), which has a huge illegal drug problem among youths. After the talk and answering many questions, (I couldn't believe how many questions were being asked by these kids, but I felt good about this.), I had a 13 year-old girl come up and stand near me while I was speaking with some others. After they had left, she approached me and asked if she could ask me for some advice. Of course, I told her Absolutely. She went on about how her brother, who is younger, lives with their mother. She was telling me that her mom is an addict, but tries to hide it from her and her brother by wearing long sleeves and pants all of the time, even in the summer. She said that she knows her mom is into the heavy stuff because she has found her unconscious a number of times with the needle by her side. (How traumatic would that be for a 13 year-old girl?) Then, of course, she asked me the question that I knew was coming. "What can I do to help her get off of the drugs and alcohol before she kills herself and we become orphans?) 

I told her that the first thing she has to ask her mom is does she want to get off of the drugs and alcohol. I then went on to explain to her that even though a person wants to quit, wanting to quit is not enough. Without going into all of the science of what drugs do to the brain, sometimes it is impossible to quit, depending on the drugs and how long a person has been abusing them. I then said to her, "Look, you shouldn't have to put yourself through this. You are 13 and should be out with your friends talking about school stuff and boys. If your mom wants to truly quit, I am going to give you my card and you can give it to her, if she really wants to quit this type of behavior, I will gladly come back down here and meet with her and get her into a very good rehab center here in Baltimore that will take her Medicaid. She will need to commit to the program for 28 days and there is NO guarantee that she will be recovered when she leaves. You tell her those things and if she is still willing to go through the program, then call me. I will help her. But, if I can get her into rehab, she can not leave. If she checks out, she will not be allowed to return for a year. If she completes the program and relapses, she can go back in. No one expects an addict to be successful the first time around and when, or if, she relapses it is not a failure. Recovery for an addict that has abused drugs and alcohol for a long period of time does not get fixed in 28 days." (One side note here; regardless of what you have heard, addiction is a disease and not a weakness or failure on a person's part to over-come it.)   

So, I am crossing my fingers that I get a phone call in the next few days. Statistics tell us that if an addict does not seek help after being offered it within 5-7 days, the phone call probably will not come. The biggest reason why addicts that want to quit don't seek help is because they fear withdrawals. Yes, they are that bad for long term Heroin, Meth and Cocaine users. Kids that become addicted to bath salts, pain killers, psychotic drugs (LSD, PCP, etc.) and Benzos (Benzodiazepines) have it rough, but they are not the worse of the worse. Heroin is still King! 

BTW, there is a new drug in Russia that actually eats the skin off its users. (Krokodil, pronounced like the reptile.) Users think they are buying Heroin and the dealer is actually selling them this stuff. It has already been reported being used in Phoenix and Chicago. One last fact; did you know that alcohol is the third largest killer in America and that Nicotine is the most addictive and difficult drug in the U.S. to quit? (OK, two facts.) 

No one needs to reply to this post, however, if anyone has any experiences they would like to share, I would be interested to read them. Please feel free to PM me. Always looking to learn from other's experiences. Experience is the best teacher. 

Thanks to those that have read this.


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## Vivjen (Jan 8, 2015)

Interesting post; I spent many years as a pharmacist 'dealing' with addicts who were in the legal drug supply system.
a few did come off completely; most were maintained in the system, therefore became employed, and led less chaotic lives; keeping their children etc; some did not succeed at all.
I also came across the codeine addicts; benzodiazepine addicts; cough mixture addicts; and the rest..


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## oldman (Jan 8, 2015)

Vibjen:  So, I am glad to know your background. Maybe you can answer this question.... Oh, I see you are from the UK, so my question that I was going to ask may or may not apply, so I will ask you this...Does the UK keep a database of patients that continually have scripts for opiates? For example; some states here in the U.S., specifically Florida and PA keep a database of those patients that get opiate medications. It is actually a national database, however, states may choose to participate or not, depending if they have a problem with opiates or suspect that the scripts are out of control. I have a client that takes Percocet, actually Oxycodone, and gets it off the street. He uses about 100 grams per day and has done so for about 2 years. If he were getting the scripts legally, he would have been shut off by now. I have another client that abuses Dilauded, (Hydromorphone) and can't quite. Both clients have a strong desire to quit and have relapsed several times. The client using Oxycodone threatened suicide over Christmas and the police called me to go help him and the officer Christmas Eve as I was leaving for church. They are in a small town and have no intervention or crisis center, so somehow, I got caught up in it, which was OK, just bad timing. 

Does the UK have or use databases to track opiate use? Thanks.


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## Vivjen (Jan 8, 2015)

Not quite yet......
since Shipman; no scripts for Oxycodone and the like can be for more than 28 days; and must be dispensed within 28 days.
a running register of all are kept in each pharmacy; under each drug; so obvious abuse can be spotted easily.
under NHS; all scripts are sent to a central office each month; and CD scripts; (controlled drugs) are sent separately; so doctors and drugs can easily be brought together.
Also; the pharmacist has to know and, if necessary; verify; the doctor's signature on each script.
we also have a specialised police branch; known as the 'drug squad' who check the registers whenever they wish; and do; if they need to!
so checks and balances are in place.

we had a private 'rehab' unit shut down a few years ago; and the doctors struck off; because of over-prescribing....it only needed a couple of pharmacies to voice concern...


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## avrp (Jan 8, 2015)

Old Man, hopefully this is relevant to this thread. My sister (I'll call her Jane) suffers from back pain. She has degenerative disc disease, bulged discs, arthritis of the spine and spinal bone spurs. Her doctor perscribed 240 Tramadol pills per month (50 MG) which she used for three years. Last summer the nurse in the doctor's office told her that Tramadol was soon going to become a monitered controlled substance, therefore the doc would become extremely cautious about perscribing them.
At Jane's next visit, her doc cut back the amount of the prescription to 120 per month...one pill (50MG) every 6 hours.

Now Jane has to be extremely careful about her movements, lifting, pulling, etc. Her quality of life has changed quite a bit.
What disturbs Jane (and makes me annoyed and angry) is that she is being effected physically because of other people's drug abuse.
Sorry, but this is so unfair. Drug abusers and crooked doctors make the "real people" suffer.

Another concern of mine, which may seem oxymoron in a sense....
If a person is perscribed pain medication for a dx that can't be surgically corrected, (she just has to live with it) does that person become addicted to the pain medication even though the amount is never increased and the dosage remains the same for years? 
if so, in that case, is the addiction a "bad" thing? 

Would like to know your thoughts....


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## Vivjen (Jan 8, 2015)

If I may butt in, Marty; the same regs have come into force here.
however, that does not mean that your sister would have her script reduced; but, IMO; she should have been tried with different strengths and types of Tramadol in 3 years; slow release; 100 mg etc, to see if that helped more; and reduced her total dosage.
the problem is that she will, at some stage, become tolerant to that dosage, and there is nowhere else for her to go.
that is what happens sooner or later, with all opiates; so the only choice then is morphine etc; again, not a problem, but tolerance again develops.
has she suggested trying anything else; in tandem; or slow release patches to increase her base-line pain removal, so less tablets are necessary?
there are still many options open to her, IMO


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## oldman (Jan 8, 2015)

marty...Your points are true and accurate. We do have some people that are on opiates or opioids for life. So, naturally, their body requires the opium on a daily basis or they will suffer withdrawals. It's a "catch 22" of sorts. I sympathize for people that have chronic pain and need the narcotics for relief and some kind of normalcy in their life. A sign to watch for is when people begin to self-medicate by taking more than what's been prescribed. Normally, cancer patients excluded, people with back issues will be prescribed about 10 mgs. of Vicodin every 4-6 hours, but not to exceed 8 pills in any one day. Or, perhaps one 5 mg. pill of Percocet every 4-6 hours, not to exceed 6 per day. I know doctors do prescribe higher doses, but the other part to this is patients have to be aware of how much Acetaminophen they are taking. Maximum dose per day should not exceed 4 Grams. More than that on a constant basis may cause liver damage. 

I have a girl in one of my classes that takes Dilaudid for a neck injury the she suffered while skiing. Problem is that she takes more than prescribed and is now addicted. She no longer requires the medicine, but won't tell her doctor. I am not allowed to intervene and contact him either. That's a whole other issue of getting help and getting off the stuff. People ask me all the time why they just don't stop taking the pills. It sounds so simple, but in reality some of them would actually die, if they just up and quit. I have people that I worry so much about, especially those that are in their 30's and 40's raising families. They tell me how they have to run and hide to take their pills, so their kids won't see them take the pills and ask questions. They live in fear that their kids will see them or find their pills and start taking the stuff. They worry about being picked up by a Narc when buying pills off of the street and being arrested and having their name in the newspaper and their kids find out and they are bullied in school about their Mom or Dad being an addict. 

As for your last question, it goes back to what I said earlier. As long as that person is not self-medicating and taking more than the doctor has prescribed, they should be OK. But, if they are out buying pills off of the street because they want or need more to get that euphoric feeling, then it's time to seek help. The longer it's let go, the worse the problem becomes and the more difficult recovery will be also.


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## oldman (Jan 8, 2015)

There have been many arguments as to whether Tramadol is a true opiate or not. Here in the U.S. it is treated as a narcotic because it is chemically structured as a narcotic, but does not have the same effect on the brain's neurotransmitters as a true narcotic. Without going into the science of this drug, it is or can be addictive. Addicts will also boil it to shoot it. Tramadol may also cause respiration problems. Like any other drug, it is not to be messed with. Most people that I have dealt with tell me that they use it as a last resort because it is a weak substitute for better stuff.


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## Mrs. Robinson (Jan 8, 2015)

You brought up a point that I was wondering about OM-that you are not allowed to contact one`s doctor if they are abusing a drug. But what about the young girl who confided in you? Are you allowed (or required maybe) to contact CPS about cases such as this?


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## jujube (Jan 8, 2015)

Doctors are indeed becoming more diligent about monitoring drug prescribing.  I occasionally have problems getting to sleep....I can't seem to "shut down" my mind and I lay there and toss/turn/worry about stupid things.  Last February, the doctor gave me a prescription for three months of the lowest dosage generic Valium (2 mg).  I will take one maybe two nights in a row and then not again for two-four weeks.  So in December, I realized I only had a few left and called for a refill.  My doctor's office said they wouldn't give me a refill until I came in to be evaluated for "drug dependence".  Drug dependence? WTF?  I've used less than 90 2 mg Valium in almost a year and I'm "drug dependent"?  I know, I know...they're just covering their asses.  I'm just going to wait until my yearly physical in February.


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## Vivjen (Jan 8, 2015)

Valium; here; has become a controlled drug because of dependency. 
Only 28 days at a time; and the script has to be dispensed within 28 days; or else you have to go back to the doctor.
how do they know you are not selling it on the streets; an awful lot of people do...


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## avrp (Jan 8, 2015)

It's ridiculous when looking at it from our perspective, but as I said the druggies and the crooked docs have created a nightmare for legitimate patients who sincerely need pain meds or anxiety meds. 
Jane didn't do well with Vicodin and didn't like it so the doc tried Tramadol and she does very well with it. Tramadol is not a weak substitute for the real stuff...not for her.
Also, she has to be seen by the doc every three months. Last appointment, the doc walked in....says what's up today? and she replied, "I just came in so you can make sure I'm not a druggy." The doc's response....oh, the whole world is and its getting worse. So unprofessional!

I read about a doctor who is now in prison because he prescribed pain meds and xanex etc...very freely. Other docs would tell their patients to see this doc. He had patients waiting out the door of his office and down the block. 
It's really no wonder the medical field is a mess.

Mrs. Robinson, I was wondering the same thing. Isn't that what CPS does?


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## Vivjen (Jan 8, 2015)

Is CPS Child Protection Services? 
Forgive my ignorance.

we had doctors like that; until Shipman killed about 90 of his patients....


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## Josiah (Jan 8, 2015)

Oldman,

I applaud your willingness to invest what I'm sure is an enormous amount of time, energy and emotional commitment to assist complete strangers in dealing with these dreadful problems. You have my most sincere admiration.


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## avrp (Jan 8, 2015)

Vivjen said:


> Is CPS Child Protection Services?
> Forgive my ignorance.
> 
> we had doctors like that; until Shipman killed about 90 of his patients....



Yes Child Protective Service or DCS is Dept. of Child Services. Vivjen, I hope Shipman is in prison?
Old Man, I too, applaud your commitment to help people.


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## Vivjen (Jan 8, 2015)

Shipman hanged himself in prison....no great loss....


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## Georgia Lady (Jan 8, 2015)

I take Tramadol for back pain.  Since they made it a scheduled drug I have to show my ID when I give them the script.  Just for Tramadol?  The Tramadol does not make me feel loopy or anything.  Most times it doesn't help back pain unless I go to bed.


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## jujube (Jan 8, 2015)

Vivjen said:


> Valium; here; has become a controlled drug because of dependency.
> Only 28 days at a time; and the script has to be dispensed within 28 days; or else you have to go back to the doctor.
> how do they know you are not selling it on the streets; an awful lot of people do...



Well, since my prescription for 90 2 mg generic Valium cost me less than $6 WITHOUT using my drug plan (it would have cost me $8 WITH my drug plan), I kind of doubt I'd made a killing on the street.   Heck, I'd probably have to bribe the local drug dealers at least $50 to let me have a corner for a while and then I'd have to sell the pills for at least $1 apiece to barely break even.  Considering a drug addict would only have to go to the emergency room (for free, because he/she'd be indigent), wheedle a prescription for 2 mg generic Valiums from the doctor and head for the nearest drug store to buy them for $5.   Percodans now....or Hydrocodone I can see, but I think I'll have to pass on selling the Valiums.


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## SifuPhil (Jan 8, 2015)

Just as an aside, my student is a pharmacist here in PA and he just related to me how, when a pharmacist is renewing their license, you now have to take a continuing education course on recognizing and dealing with signs of child abuse. It's my understanding that course was pushed into the pharmaceutical board by the state welfare associations.

What next? Domestic abuse classes? Firearm safety courses? Advanced marine engineering?


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## Vivjen (Jan 9, 2015)

We have had to do those; child protection; and CRB check for visiting the elderly...and Valium are also on some controlled drugs regs.


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## SifuPhil (Jan 9, 2015)

Vivjen said:


> We have had to do those; child protection; and CRB check for visiting the elderly...and Valium are also on some controlled drugs regs.



I just cannot make the connection between a retail pharmacist and the recognition of child abuse. The child won't be coming up to the counter to have a Rx filled - are they expected to watch the children in the aisles with Mum and Dad? 

CRB's ... you're expected to be police, as well?!? 

I know that pharmacists already act as free medical advice givers - isn't that enough?


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## oldman (Jan 9, 2015)

Mrs. Robinson said:


> You brought up a point that I was wondering about OM-that you are not allowed to contact one`s doctor if they are abusing a drug. But what about the young girl who confided in you? Are you allowed (or required maybe) to contact CPS about cases such as this?



Mrs. R.....If I have direct and certain knowledge that someone is obtaining drugs illegally, I have a form that I fill out and hand it off to my Area Resource. She then in turns handles it. The idea is to help the addict, but find the dealer. The dealers are the enemy that is distributing the poison. The addict has now become a helpless pawn that requires what they are selling. If this woman calls me and I go to her home and she shows me what she has been up to, I will work with her to get her into a rehab or whatever help she would like, but I also have a duty to report this incident, so that the dealer may be attempted to locate. The addict will be left alone. The user will not be arrested or go through a shakedown. That would destroy any trust that the user may have with the counselor. 

I was once told that for every dealer we can get off the streets, we will save five lives.


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## oldman (Jan 9, 2015)

Georgia Lady said:


> I take Tramadol for back pain.  Since they made it a scheduled drug I have to show my ID when I give them the script.  Just for Tramadol?  The Tramadol does not make me feel loopy or anything.  Most times it doesn't help back pain unless I go to bed.



You would be surprised what an addict can do with Tramadol. Because it has the characteristics of an opioid or opiate, it is treated as a controlled substance. Addicts have found it easier to get their hands on it than other opiates. So they will take the pill, crush it, boil it and inject it. Of course, they use more than one 50 mgs. pill. There is another morphine laced pill that PM (Pain Management) doctors are now handing out to get around some of the laws, called Opana, not to be confused with Ipana, the old toothpaste. There is a derivative of this pilled called, Opana ER. The ER is for "extended release." The addicts will do the same with this drug. It is supposed to be uncrushable. You think? Wrong! It will also soon be a Class I drug.


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## Vivjen (Jan 9, 2015)

Of course, Sifuphil; we are unpaid everythings!


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## oldman (Jan 9, 2015)

I did want to make a comment about Pharmacists as it applies to the dispensing of narcotics. Just before Christmas I was at the Walgreens counter to have an Rx filled for Amoxicillin for my wife. There was a man, maybe 35 or so, also there at the other window, so I had no problem over-hearing his conversation with the Pharmacist. It seems that he had a script on file for Hydrocodone and he was arguing with the lady that was waiting on him as to why he could not refill his Rx at this time. Evidently, he was about a week early. His script called for 120 pills for a 30-day supply and his 30 days were not yet up. I could tell that he was in a desperate situation, so I stuck my nose in and told him that what the lady was telling him was the truth. Of course, he then stormed out of the store. I felt bad for him, but I thought that he would probably head to the hospital and do a little "shopping" there.


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## Vivjen (Jan 9, 2015)

It can get difficult; I was threatened by an addict because his doctor wouldn't give him another script; i wouldn't break the law for anybody......


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## Don M. (Jan 9, 2015)

If anyone wants to know why we are becoming a nation of Prescription Drug Addicts....here are a couple of good sites to browse that shows just how Money, rather than Patient Care, is becoming The Priority.

http://projects.propublica.org/open-payments/

http://projects.propublica.org/docdollars/

Then, when the side effects kick in, and these Drugs start killing people, the lawyers take over and levy their multimillion dollar class action lawsuits.   It's no wonder that we pay twice as much for health care as most of the rest of the world.


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## Mrs. Robinson (Jan 9, 2015)

Interesting. I guess Pharmacists having to take a Child Abuse course probably makes them mandated reporters, but your position as a substance abuse counselor does not. I do understand the reasons for not wanting to report the addict,and I too commend you for the work you do. Having seen that whole cycle with my son-and,by virtue of being his mom,living through it as well, any help these people can get is much needed.


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