The Centers for Disease Control and Prevention’s 1999 Gallup Poll describing decades of drug use data from the ‘60s and ‘70s and written by Jennifer Robinson in 2002 reads as follows: “The war on drugs has been raging for decades. There is no sign of victory, or even detente. Although they’re swamped with anti-drug messages, kids keep taking illegal drugs, and the drugs are getting more dangerous.”
The CDC’s Youth Risk Behavior Surveillance System found that almost half of all high school students had used marijuana at least once. Ten percent had tried a form of cocaine.
To bring this story into the modern era, potent analgesics such as the Oxycodone family became a “go to drug” for so many different prescribers who treated all kinds of pain — some real, some not so real, and in quantities that were really not appropriate for the condition being treated. CII drugs such as Oxycodone were used indiscriminately for diagnoses that did not require a drug with the potency and possibility of addiction.
The opioid problem has been with us for as long as I can remember. It was not always called opioids. When I started pharmacy school back in 1953, amphetamines, or “bennies,” were a major problem as were sleeping pills such as phenobarbital, Seconal, and Nembutal.
Barbiturates were first used in medicine in the early 1900s and became popular in the 1960s and ’70s. They were a treatment for anxiety, insomnia, or seizure disorders. With the popularity of barbiturates in the medical population, barbiturates as drugs of abuse evolved as well.
Barbiturates were abused to reduce anxiety, decrease inhibitions and treat unwanted side effects of illicit drugs.
Working nights in a pharmacy, or drugstore as they were more often called, I saw the same people often getting refills for all of the above. There was no problem getting such drugs refilled on a” prn” of “pro re nata” basis. (If you want, to you can check if my Latin is correct.) You needed to fill out or if I remember even sign what was called a black book used to verify the sale of what were known as exempt narcotics over the counter. This meant buying a bottle of what was then affectionately called “GI Gin” but was actually Elixir Terpin Hydrate and Codeine. There was also “Brown’s Mixture” and “Stokes Expectorant” that the old-timers who are reading this will remember.
The common denominator of these three “cough medicines” was codeine. The pharmacies were inspected by other pharmacists who understood what they were looking for and did their job looking for “outdated” products that were still on the shelves, not being used but just there probably because they were never prescribed but were part of inventory. I do not recall any inspector ever looking into any of the above books. Everybody I worked for tried to follow the rules, but since they were neighborhood stores and the pharmacist knew the prescribing physicians, you could do things to accommodate a sick customer by using a phone call to override a written RX knowing Dr. Smith would be in with a hard copy as soon as he could and they almost always did. Taking care of a sick person was paramount.
Time passed and certain neighborhoods were known for being a source of drugs for those who were on their way or already there to being what we now call a drug addict. Alphabet City on the Lower East Side was such an area. There was a new kind of addict now who had money and a drug culture was really born. For music rock stars, being high was OK in too many places and homes. Heroin was still frowned upon in the 1960s, and remained the most feared and romanticized drug in America, with estimates of a half million addicted heroin users by the end of the decade, the American Addiction Resource Center wrote in one of its publications.
Heroin, marketed by the Bayer Corp. of Germany, was initially at the forefront of a project to create a non-addictive opioid, but it soon became abundantly clear that heroin was incredibly addictive, according to ”The History of Oxycodone” written by Get 24/7 Help Now.
After heroin’s ban in America, two German scientists created Oxycodone, which was touted as a non-addictive, semi-synthetic substitute for heroin, morphine and opium.
Oxycodone was first introduced in the U.S. market in 1939 and 11 years later in 1950, it was combined with aspirin and sold in America as Percodan. In 1970, Oxycodone was listed as a schedule II drug in the new Controlled Substances Act and, in 1974, Percocet, which was Oxycodone combined with acetaminophen instead of aspirin as there is less bleeding with this combination, became available.
A few years later, another synthetic opioid, Hydrocodone, began being marketed in the United States as an FDA-approved narcotic analgesic. Despite their availability, many doctors were leery of prescribing opiates because of the known risks of dependence. It wasn’t until after the Vietnam War that opiate use surged again as recreational drug abuse hit an all-time high and heroin use spiked among veterans.
The federal government passed the Controlled Substance Act in 1970 and the establishment of the Drug Enforcement Agency in 1973 to restrict access to opiates. Pharmacies that stocked all the drugs needed for pain became serious targets for hold-ups, killings, and terrible times. My own pharmacy suffered nine hold-ups but, fortunately, nobody was ever hurt.
Medicaid and third party prescriptions were born. Pill mills and physicians who prescribed an excessive number of pills opened up all over. Almost nobody paid for the drugs and the problem really got out of hand. Pharmacies were now being inspected by the Drug Enforcement Agency, which replaced the Bureau of Narcotics. The Board of Pharmacy had its own inspectors. The drug problem was no longer confined to certain neighborhoods. Although they were swamped with anti-drug messages, kids kept taking illegal drugs, and the drugs were getting more dangerous.
Throughout the 1970s, doctors continued to avoid writing prescriptions for opioid medications, but by the 1980s and ’90s, a push for adequate pain management started to form among medical researchers. In 1994, Purdue Pharma Began testing OxyContin, an extended-released form of Oxycodone, for long-term pain management. In 1998, PurduePharma released an advertisement that depicted people who found relief from chronic pain by way of OxyContin. A year after the ad come out opioid painkiller prescriptions grew by 11 million.
We are a drug-oriented society and want everything to be made better with a pill. Yes, there are still medical professionals who are using these drugs in an improper manner and patients who continue to ask for such drugs because they have a toothache or whatever and the condition does not need such drugs.
Physicians who are treating cancer patients are being made to feel afraid to prescribe Oxycontin even though that is probably the best drug available for that patient for fear of being accused of causing an addiction. Yes, even in a dying patient who is in terrible pain.
David Chase, author of “Is your health plan contributing to the opioid epidemic?” in TLNT, argues that because physicians are pressed for time during appointments, many will look to find quick fixes that make patients “happy” and get them out the door by writing excessive prescriptions. A recent study published in JAMA found that most surgical patients used only 27 percent of the pills they were given. But the more pills that were prescribed, the more they would use, contributing to the potential for them to become addicted.
Lower back pain is an especially common problem. The National Institute of Neurological Disorders and Stroke reports that 80 percent of adults will experience it at some point. These patients and many others are now the victims of federal guidelines instituted about three years ago for primary care doctors, and that means internal medicine specialists and general practitioners. That being said, a report in The New York Times March 6 found that the limits on opioid prescribing leaves patients with chronic pain vulnerable. JAMA, in April of this year, printed an article by Dr. Thomas Kline, who calls his patients “pain refugees.” These patients had abruptly had their dose for pain relief cut or altogether refused.
Kline looks for solutions to the opioid problem and says that consideration of new options is imperative. “As doctors, we need to be sure we are doing no harm, as Hippocrates taught us some 3,000 years ago.” “Job one, in the medical profession, is to relieve pain. Prescription controls always sound good, but don’t work and harm those who are seriously in pain.
Bertram Drachtman
Great Neck
