In a small town, a mother receives a call at work. She needs to come to the high school right away. They have her 15 year-old son, Brett in the office. He was caught with a bag of pills. As she's driving to the school, numerous thoughts run through her head. Is he doing prescription drugs? Where did he get them? How could I not notice a change in him? I pay attention. I know the risks and the signs. What am I going to do? When she gets to the school, she's led into the assistant principal's office and learns the details of what has happened. A vehicle in the area had been broken into and a bottle of OxyContin had been stolen. One of the girl's at the school had the painkilling opioids and thought she was going to get caught. So, she asked Brett to hold them for her. He said yes and shoved them into his pocket. Another student witnessed it and alerted the office staff. When Brett was called into the office, at first he denied having them. When asked to show his pockets, he admitted to them. He wouldn't say who they came from. Nobody, including his mother or school staff believed he had taken any or was planning on using them. He also wasn't involved in the burglary. The school gave him the mandatory three day suspension. It could have been a lot worse.
When Brett and his mom left the school, his mom asked him why he would make a choice like that. Didn't he realize the seriousness of prescription drugs? They sat in silence for a while in the car. Then she asked, "If she would have handed you a baggie of cocaine, what would you have done?" His response was quick and definite, "I would have said no way!"
The Problem
Prescription drugs have become the second most abused drug in the United States according to the Office of National Drug Control Policy. In addition, they present "a unique challenge because of the need to balance prevention, education, and enforcement, with the need for legitimate access to controlled substance prescription drugs." The 2008 SAMHSA National Survey on Drug Use and Health (NSDUH) found approximately 52 million Americans aged 12 and older reported non-medical use of any psychotherapeutic (prescription-type pain reliever, tranquilizer, stimulant or sedative) at some point in their lifetime. This represents 20.8% of the population. This survey also found 2.5 million persons aged 12 or older who used a psychotherapeutic non-medically for the first time within the last year. That's 7,000 initiates per day.
As prescription drug abuse increases, so does the need for treatment and unfortunately the fatality rate. According to SAMHSA, 29% of teens in treatment are there for dependence on prescription drugs. Across all age groups, between 1995 and 2005, treatment admissions for prescription drug dependence grew more than 300%. Between 1999 and 2006, hospital admissions for prescription drug overdoses increase 65%. Poisoning has become the second leading cause of unintentional injury death and has been on the rise for the last 15 years now surpassing automobile crashes as the leading cause of unintentional injury death for people 35-54 years of age.
Due to the complexity of abuse of a legal substance, law enforcement and health care professionals have to work together. Many prescription drugs are obtained legally. Once at home, numerous people, including teens and their friends, have access to these lethal drugs just sitting in the medicine cabinet or on the nightstand. More unscrupulous are those who procure prescriptions from a variety of unsuspecting doctors, known as doctor shopping. These people then sell the drugs to others. Another problem is when prescription dispensaries, known as pill mills enter the picture and allow anyone to purchase prescription drugs for a price. All of these factors combine requiring communities, healthcare professionals and criminal justice personal to work together to combat this issue. The creation of education components within law enforcement, such as Broward Sheriffs Office's (BSO) Operation Medicine Cabinet, the Drug Enforcement Agency's (DEA) Take Back programs, Prescription Drug Monitoring Programs (PDMP) and prescription drug task forces have combined to help communities battle this fatal problem.
Education
"New medications can do great things and also do great harm," states James McDonough, former Director of the Florida Office of Drug Control and Secretary of the Department of Corrections. "Easy access makes them much more popular and easy to use. It camouflages the stigma of going into a dark alley to shoot up. All you're doing is going into Grandma's medicine cabinet and taking some of her pills." Florida and Broward County in particular have the number one problem in the country for prescription drugs. BSO recognized the problem and took steps to combat it including implementing Operation Medicine Cabinet (OMC) a program designed to increase education and awareness, as well as, offer community events for collection of unused prescription medication. "Prescription drugs essentially are good for what they're intended for, but the abuse is very lethal," explains Sara Oren, BCO External Affairs and liaison for OMC. "In our county alone in 2009, we saw seven deaths caused by heroin, 26 by cocaine and 462 caused by prescription drugs. So, it's a big problem." Oxycodone deaths totaled 1,185 in 2009. This is a 249% increase from 2005. "Some use it for recreation," explains Oren. "Some become addicted because they had a legitimate injury." A major concern is the age range this problem affects. "Anyone from teens to 45," states Oren. "There is no specific population. That is a problem because it has a wide audience."
OMC provides educational opportunities for the community. "It's geared to the public, parents, school administrators and health care professionals," explains Oren. "We want them to know not to just prescribe things. Make sure they have problems. The educational programs we give can be to a home owners association or to schools. The idea is to educate people there is a problem. OMC focuses on cleaning out your medicine cabinets. Kids are getting these things from their parents, grandparents and friend's parents. This is where the problem started for teens." OMC focuses on a three prong approach: a law enforcement effort, Take Back programs, as well as, education.
Take back events
Last year, President Obama signed the Safe and Secure Drug Disposal Act of 2010 which allowed the DEA to develop a process for people to dispose of unwanted medication legally. These Take Back events now occur nationally in a variety of locations including Broward County. Initially, BSO planned on holding one event a month or maybe even one a quarter. Due to their success, the agency is now doing a couple per month. Since the programs start in the fall of 2009, OMC has collected almost 32,000 dosage units of controlled narcotics and more than 180,000 dosage units of non-controlled drugs. Nationally, on April 30th, Take Back events were held in 5,361 locations in 50 states and more than 188 tons of unwanted medications were collected.
Monitoring
Along with education, an important component of combating prescription drug abuse is through the use of Prescription Drug Monitoring Programs (PDMP). A PDMP is a state-wide electronic database which collects designated data on substances dispensed in the state. The data is distributed to authorized individuals. According to the DEA Office of Diversion Control, PDMPs assist healthcare and law enforcement agencies address prescription drug abuse, addiction and diversion. "Prescription drug monitoring systems are working," says McDonough. "It helps decrease doctor shopping. A doctor can check to see if the patient has other prescriptions. It's a way to check on the degree of prescription drugs coming out of a particular location. It takes a look at the clinics themselves. Are they legitimate or are they pill mills? It pretty much stops the problem at the source before it gets out and saves law enforcement the dilemma of backtracking."
The problem is not all states have them. About 40 states do and several others are enacting legislation to establish a PDMP. "Florida didn't have a system in place and it became a shopping stop for folks from Oklahoma, West Virginia and Ohio," explains McDonough. "In Florida alone, the death rate from prescription drug abuse had accelerated to seven per day. That's just the citizens from Florida. What we don't know is how many other people also died from the drugs they obtained from Florida." Florida continues to battle to implement a PDMP. Since PDMP technology is relatively new, they will continue to improve. "The technology is still early," says McDonough. It will get better and it will be more beneficial for doctors to avail themselves of the systems. You could recognize an addiction problem and you will have the treatment opportunity. If you don't get compliance, law enforcement can work quickly. I'd like to see the cooperation of medical boards increasing training and constraints of abuse."
Enforcement
A third component to tackling prescription drug abuse is law enforcement, specifically collaborations. Many states, including Ohio, Alaska and Connecticut have statewide prescription drug abuse task forces comprised of law enforcement, public health, mental health and substance abuse professionals. Other jurisdictions have county task forces, such as Hillsborough (FL), Hancock (OH) and San Diego (CA). Law enforcement is working together and doing it well Oren explains. BSO provides services to 17 districts and many areas, including cities like Fort Lauderdale, have their own police departments. "We work hand in hand with local police departments and the DEA. Since the problem is so big, we get tips all the time about high drug activity in certain areas specifically in regards to pain clinics. All the agencies work together regardless of jurisdiction. We have no boundaries when we're working on cleaning up the streets. Awareness is helping relationships form." BSO instituted a special unit in an area which had the most pain clinics in Broward County—the Oakland Park District Special Investigations Unit. "Since this team has been in place the number (of pain clinics) has decreased and I think there is only a handful now," says Oren.
"It's not a one jurisdiction problem," states Oren. "It's not just an urban problem. It's not just seen in the suburbs. You can't fix it without working together. We teach people this is a real problem and these are the dangers. We make sure people are on the same page with the same goals. People are dying."
McDonough agrees collaborations are essential. He recommends these tips for success. "Work together, observe patterns and (agencies should) avail themselves of the drug monitoring system," explains McDonough. "If there is an active case, gain access to prescription records and see if they are reasonable or out of line. Working in a coordinated way and maintaining respectful of privacy laws, law enforcement can do a lot to curtain what has become an epidemic."
Another important asset within law enforcement is School Resource Officers "SRO's are great because they could more quickly identify if there is a problem and they can deal with the kids directly," says Oren. "It's helpful. You want to recognize it before it becomes a big problem." Oren was quick to state it's important to make sure school staff is aware of the problem of prescription drug abuse. "Not every school and not every police department or jurisdiction has an SRO," she says. "It's equally important that administrators and teachers know what to look for and recognize identifying factors."
Law enforcement and other professionals have an invested interest in combating prescription drug abuse. People are becoming addicted and dying at an alarming rate. Children are more likely to pop a pill they got from their mom's medicine cabinet than to shoot up heroin regardless of the substance being the same. Doctors, unscrupulous pill mill clinics and a variety of individuals all contribute to the problem. In response, community members, health care professionals, legislators and law enforcement personnel combat this epidemic with education, Take Back events, PDMPs and task forces. What's a perfect collaboration? "A prescription drug monitoring system, one where law enforcement is respectful of it and it's not a fishing expedition, cooperation with federal, state and local law enforcement officials, healthcare professions, including Medicaid, good observation and integration of effort of all these people," suggests McDonough.
"It is a problem and law enforcement is aware of it," Oren concludes. "We're doing everything we can to combat the problem. One of the biggest things is you cannot arrest your way out of a problem like this. Addicts need to be identified and treated. Parents need to be aware of the problem. Take Back programs need to get the drugs out of the homes." As for Brett's mom, she hopes her son learned a lesson from the incident at school. She hopes he would now turn as quickly away from a pill as he would from other substances. His life might depend on it.
