Prescription pills: Deceptively dangerous

By Darby Moore | gargoyle@flagler.edu
Most people believe illegal drugs are most likely to lead to addiction. This common-held belief is no longer true when considering modern-day substance abuse. Yet many addicts get their drugs from a place you might not expect: Their own medicine cabinet.
The National Institute on Drug Abuse (NIDA) found in a 2014 study that an estimated 52 million people have used prescription drugs for nonmedical reasons at least once in their life. St. Augustine, Florida and St. Johns County are no exception to this sobering reality of prescription drug abuse. The St. Johns Sheriff’s Office, alongside healthcare service providers, are working to keep illegal prescription drugs off the streets and out of the hands of our county’s youth.
One program in place for the prevention of the distribution, sale and abuse of prescription drugs is Operation Medicine Cabinet, which Corporal Diana Bryant started in St. Johns County in 2010.
“We started Operation Medicine Cabinet when the department saw that there was a need for the program when prescription drugs became one of the most highly abused substances in St. Johns County, if not the most commonly abused. We knew the drugs were either being stolen from family members or from individuals that were leaving them in their cars and then those cars were being broken into for those drugs,” Bryant said.

The St. Johns County Sheriff’s Office is working to stop prescription drug abuse.

Not only does Operation Medicine Cabinet help to maintain a safe and healthy community for St. Johns County residents, it also raises awareness of the potential abuse of prescription drugs.
“If anyone has prescription drugs that they no longer use or have a need for or have let expire, you can go to one of the locations to drop off what you have. Once the medications are dropped in the box, we seal them up like any other evidence and it’s stored in the evidence vault. We would sign them out and take them to a separate location to be destroyed,” Bryant said.
Operation Medicine Cabinet allows for the safe disposal of unneeded prescription drugs, resulting in a decrease in the negative social and environmental impacts that result from improper disposal of these substances. Secure drop boxes are located at the St. Augustine Beach Police Department, the St. Augustine City Police Department and the Sheriff’s Main Complex on Lewis Speedway.
“Unfortunately, people tend to store, hoard, or stock up prescription drugs that they don’t need and they don’t know what to do with them. When they have family members or friends over, it’s not uncommon for those individuals to steal and abuse those drugs,” Bryant said.
According to the NIDA, the most commonly abused prescription drugs include opioids, depressants and stimulants. The most common among these substances include Vicodin, OxyContin and Adderall. A 2010 NIDA study found that one in 12 high school seniors used Vicodin, an opioid used to relieve pain, for nonmedical purposes.
The study also found that one in 20 high school seniors had used OxyContin, another opioid used to relieve pain, for nonmedical use. This makes OxyContin and Vicodin the most common prescription drugs adolescents abuse.
It is a commonly-held misconception that prescription drugs are not as dangerous as illegal drugs. This is only true when those prescriptions are taken responsibly, as directed by a physician. Opioids such as Vicodin and OxyContin produce severe drowsiness in users, depressing one’s breathing, especially when these substances are combined with the use of other drugs or alcohol. NIDA researchers state that opioids depress can the amount of oxygen reaching the brain with long-term use.
NIDA has also found that more people die from overdoses from misused prescription opioids than any other drugs combined, including cocaine and heroine.
Health care service providers and health care workers have also begun to work to stop the abuse of prescription drugs in St. Johns County, in response to these negative health effects the abuse of these substances have on abusers. Crescent Beach Care, an independently owned clinic located in St. Augustine Beach, Florida, has taken an active role in working to stop the abuse and distribution of prescription drugs.
Amanda Hodge has worked in the medical field for over 12 years, and is the physician office manager of Crescent Beach Care. As part of Hodge’s responsibilities, she must train her staff to look for the warning signs of patients that are looking to obtain prescription drugs to either personally abuse or sell to others. To achieve this, Hodge works closely with staff members to screen patients before sending them to meet with Crescent Beach Care’s primary physicians, Margret Thorhallsdottir and Adrian S. Long.
“The doctors at Crescent Beach Care always put their patient’s health first. They encourage and direct patients to use alternative options for treatment, instead of controlled substances. Any patients that are on a controlled substance must have an appointment with the doctors every month, prior to receiving their prescription refill. This allows the doctors to fully evaluate the patient, and to be certain that the patient is taking their prescription correctly. If a patient misuses their prescription, the doctor’s work with the patient’s to get them the help that they need,” Hodge said.

Pills in four colors. Credit: Wikipedia

Hodge states that she has found that the most commonly abused prescription drugs in St. Johns County are opioid pain relievers and stimulants, such as medications used for the treatment of attention-deficit/hyperactivity disorder, or ADHD. Hodge and her staff are especially vigilant when prescribing patients drugs that are classified as controlled substances by the federal Controlled Substances Act, due to their potentially addictive qualities.
“Mostly what we look for is when patients have inconsistent or confusing stories because patients who misuse drugs often try to confuse the medical staff with their medical history. We also look for ready excuses for inappropriate behavior and excessive mood swings or hostility. Finally, some of the more serious signs include continually ‘losing’ prescriptions, not making eye contact, asking for prescriptions early, and patients who make excuses such as ‘my spouse had a migraine, so he took some of my prescription,’” Hodge said.
It is this type of irresponsible sharing of prescription drugs that contributed to the initial motivation for the establishment of Operation Medicine Cabinet in St. Johns County.
The NIDA describes prescription drug abuse occurring in three most common ways: by an individual taking a medication that has been prescribed to somebody else, by taking a drug in a higher quantity or in another manner than described, and by taking a drug for another purpose than prescribed. When patients exhibit these behavioral warning signs, the health care providers of Crescent Beach Care will investigate the patient’s past with prescription drugs.
“Our first step is to check E-Forcse, which is a Florida prescription drug monitoring program. E-Forcse is a database that documents each time a controlled substance is prescribed to a patient in Florida. It includes the prescribing provider’s name, name of the prescription, and quantity of the script,” Hodge said. “If a patient’s E-Forcse is inconsistent, the doctor is notified immediately. This will be reviewed with the patient and then options for help are offered to the patient.”
While the use of prescription drug monitoring programs are not mandatory for use in doctor’s offices, programs such as these are growing in popularity with health care providers that wish to combat the growing abuse of prescription drugs.
Though programs such as E-Forse and Operation Medicine Cabinet are key preventative measures against the spread of prescription drug addiction in St. Johns County, there are also programs in place for those already struggling with substance abuse. The EPIC Behavioral Healthcare recovery center is but one rehabilitation center located in St. Augustine to aid those in need.
Full-time nurse Shareka Session has worked with EPIC since the opening of the center on Jan. 31, 2014. Session has worked as a nurse for 11 years and is currently working to aid EPIC in its mission to “strengthen our community by assisting individuals and families impacted by drugs and alcohol, mental health disorders, and related problem behaviors through a comprehensive system of Education, Prevention, Intervention, and Counseling.”
Session recognizes this troubling trend of prescription drug abuse in St. Johns County.
“The most commonly abused substances are alcohol and prescription opioids such as OxyContin and Lortab,” Session said. “We receive patients for prescription drug abuse daily, making this is more than half of our population. Most commonly they start out as using a prescription from an injury or something, but from that point patients will often begin to misuse these prescriptions.”
EPIC will not take patients under the age of 18, but Session states that the most common ages for patients seeking treatment for prescription drug abuse are ages 18 to 45. One of the greatest obstacles that these patients must overcome is recognizing that the abuse of these substances is harmful, despite the fact that they are provided by a doctor.
“When they first come in, a lot of patients think, ‘It’s my prescription in my name so it’s OK.’ but then they realize they have a problem. At the same time, they think they have a back entry to getting high because it’s from a doctor and it’s a prescription with their name on the bottle. When that supply is out it goes to something different. Most commonly, it starts with pills that are taken orally, and then when that doesn’t hit the addict as quickly or as hard as they would like, they will move onto intravenous methods,” Session said.
According to the NIDA, over 2 million people in the U.S. suffer from substance use disorders related to prescription opioid pain relievers. Depressants such as opioids have effects on users similar to that of heroin when taken in ways other than prescribed.
In Session’s experience, prescription drug abusers using intravenous methods often begin buying prescription pills off of the street, and commonly begin abusing heroin for its similar effects and similar availability.
The road to recovery is long and hard, and it is not for everyone, as Session has seen in just under two years of work with EPIC.
“When patients come in for prescription drug addiction, the first two days are the hardest days that they will ever have, depending on what they’re on and the last time they used. If you make it through the first two days, it’s a much higher success rate, but if they used the day that they came in and have to ‘come down’ when they’re here, then the patient is most likely going to check out before detoxing fully,” Session said. “We have at least 50 percent of our prescription drug patients come in as re-admits.”
While the abuse of prescription drugs is bound to remain an issue on a national scale, St. Johns County will continue its efforts to prevent the illegal distribution and sale of these substances.
In a 2009 study conducted by the Substance Abuse and Mental Health Services Administration, almost 70 percent of prescription drug abusers obtained those drugs from the family medicine cabinet or from friends. This is why members of St. Johns County such as Bryant with Operation Medicine Cabinet are so successful when working in conjunction with physicians, such as Dr. Thorhallsdottir and Dr. Long of Crescent Beach Care, who have decided to take an active role in this fight against prescription drug abuse in St. Johns County.
Conversely, Session represents but one active participant in the fight against the continuation and perpetuation of drug culture. While Session is charged with the responsibility of aiding those with pre-existing substance abuse problems, EPIC also works to start the conversation about prescription drug abuse in St. Johns County, aiming to put an end to the commonly held misconception that these substances are not as dangerous as illicit or illegal drugs simply because they were prescribed by a doctor at some point.
Together, Operation Medicine Cabinet and responsible health care providers can reduce the availability of commonly abused prescription drugs in St. Johns County while educating the local community of the dangers of these substances.