Prescription drugs: The opiate of the masses
In Colorado, the opioid-related death rate is double the rate of deaths in motor vehicle crashes. Drug addiction is a pervasive problem around the world, and Durango is no exception. You might assume you’re personally immune to developing an addiction – but much like disease, addiction doesn’t discriminate. Even the medical world has been riddled with misconceptions about it, and some doctors are still uncomfortable addressing the topic. Dr. Dan Caplin, a former ER doc who opened the Southern Rockies Addiction Treatment Services center in Durango last October, admits he was once ill-equipped to contend with the issue himself. “I didn’t have the tools to deal with it and I was miseducated,” said Caplin. “I experienced that with HIV back in the ’80s and ’90s – we didn’t know what we were dealing with, people were dying. And we saw that again last year with Ebola.”
The late ’80s, according to Caplin, was an era when addiction was considered a failure of morals. Addicts were thought of as “weak.” Caplin recalls his years working in the emergency department, sending citizens into detox and seeing them again four or five hours later, already inebriated. “I did this over and over, and it got to the point that we had to do something different,” he said. “I started reading more about addiction, how it’s really a disease of the brain. Everything we’ve been doing in the ER is wrong, we haven’t really helped anybody. They can’t quit on their own. The cravings are too strong.” He decided to take matters into his own hands, opening a non-narcotic pain clinic in Durango.
So what are the most common addictions in these parts? “In Durango, heroin is huge,” said Caplin. “Prescription drugs. Methamphetamine.” Dr. William Plauth, chief medical officer at Mercy Regional Medical Center, agrees the most popular addictions here are prescription pain medications, opioids, methamphetamine, and benzodiazepines like Ativan and Valium. Both expressed additional concerns about the addictive psychological effects of marijuana, a drug that is popularly believed to be benign.
The ins and outs of opiate addiction The Southern Rockies center focuses on treating adults addicted to narcotics like heroin or prescription opiates (e.g. OxyContin, Lortab, Vicodin, Percocet, morphine). It’s surprising and frightening how easy it is to get hooked on a perfectly legal substance – and opiates are one of the most widely-prescribed medications in the country. They’re great at diminishing pain if you’ve had a surgery or injury; the drawback is their habit-forming nature. Opiates are a derivative of opium, which is also used to manufacture heroin. The withdrawal symptoms from opiate use can be maddening and agonizing. Most people don’t even realize how risky swallowing their pills could be until it’s too late. “Physicians have felt a lot of pressures nationally to potentially prescribe more pain medicines to limit how much pain patients have, for patient satisfaction scores,” said Plauth.
Caplin treats his patients using methadone, a medication that is both safe and effective for the treatment of narcotic withdrawal and dependence. Caplin didn’t originally believe in the treatment success of methadone. But after doing extensive research and touring other methadone clinics, he became a convert. Patients taking methadone still feel pain (the thing painkiller addicts so desperately wish to avoid), but learn to deal with it in other ways, such as taking over-the-counter painkillers.
Caitlin Countryman, 29, was a pain pill addict for 14 years before visiting Southern Rockies. After a car crash at age 17, she was prescribed pain meds by her doctors, but wasn’t warned about the risks. “I was handed a script of 90 Percodan,” Countryman said. “I got to the point when I had such a high tolerance for the pills, I was taking up to 25 or 30 a day. I could drive and everything – I never got a DUI or was driving crazy. I just couldn’t get out of bed without taking pills, and I needed them to feel normal.”
When Countryman took her first dose of methadone administrated by Caplin, she felt better just 45 minutes later. Every patient is different, but recovering addicts often take methadone for a year or two, then slowly taper off (while continuing counseling). According to SRATS, some patients can remain in methadone treatment for more than 10 years, and even for the rest of their lives, but they constitute a minority (5 to 20 percent). “[SRATS] is the only place I’ve gone that helped me,” said Countryman. “When you think ‘methadone clinic,’ you think of a dark, gloomy place with junkies. But when I talked to Dr. Caplin, I knew I was going to be OK. He wasn’t judgmental. You’ll have doctors who try not to seem judgmental, but you know they’re judging you. He was compassionate, and felt really sorry about what had happened to me.”
Another Southern Rockies patient, 41, who asked to remain anonymous, said she became addicted to painkillers after requiring numerous surgeries including gastric bypass, right knee and vein removal. The stay-at-home mom, born and raised in Durango, admits she was warned by doctors about the dangers of the pills. But after she injured her shoulder and wasn’t able to get the appropriate surgery because of insurance hold-ups, she was suffering and succumbed to pain pill overuse. “I tried tons and tons of different stuff, and it got to the point where I was just so tired of trying things and waiting to see if it would work ... when I was hurting, and I knew what was gonna work,” she said.
Joel Smith, 41-year-old Durango resident, was addicted to Oxycodone and Percosets, what he calls a “$100,000 a year habit.” He tried visiting various detox centers but they didn’t treat addicts with medicine, thus Smith would find himself right back on the street amid horrible cravings. Then he found SRATS, became their fourth patient, started methadone treatment, and is today clean from opioids. “Anyone going through an opioid withdrawal will kill or steal to go get medication to feel better,” Smith said. “SRATS has brought big-city treatment to a small town with big-city problems that nobody knows about.”
Who becomes an addict?In a word: anyone. “One misconception would be that anyone is immune to being at risk of developing an addiction – it could happen to any of us,” said Plauth. Caplin has watched the heroin and opiate addiction problem skyrocket throughout white rural America. “It’s not what we used to think of at Skid Row, seeing the bums passed out on the street,” he warns. “The demographics have changed. Addiction is blind to your color, size, sex, religion. It affects anybody if you have two things: exposure and the genetic predisposition.” According to Caplin, about 4.8 percent of people have this genetic bias, or one in 20; meaning if you have enough exposure, you could become addicted no matter how strong your will power. Two weeks is enough time to become an opiate addict from prescription medication. Something as innocuous as back surgery can lead to a sudden dependence, and unfortunately, abstinence tends not to work. “You take a completely normal person and get them on an opiate, when they start to crave, they will do whatever it takes, hurt whoever it takes, just to get their next fix,” said Caplin.
Caplin claims 40 or 50 percent of his heroin-addicted patients started off with a legitimate prescription. The overprescribing of opiates is a huge difficulty in the medical community, as many of these patients eventually move on to heroin when their doctors cut them off pills. Heroin isn’t as tricky as it used to be, either; you don’t have to inject it intravenously, as you can smoke or snort it.
For Countryman, getting access to pain pills was all too easy. She visited almost every doctor in Farmington, or found pills on the street. “I could walk out of my house on a normal day, and in any direction, in at least a two-mile radius, I had somebody I could go to to get pain pills,” she remembers. “It was very simple; the doctors don’t take the precautions. They want you in and out of there, since they have so many patients. Sometimes they don’t even look you in the eye.” She figured out how to work the system; in Countryman’s experience, appearance dictated whether doctors gave you scripts, so she made sure to get up early before an appointment to do her hair and makeup. “And they’d give them to me every single time,” she said. “But people who went in there looking scruffy because they didn’t feel good – they’d get turned down.”
Smith says he was also never warned by doctors of impending pain med dangers, and feels doctors might have mishandled his treatment by giving him too many pills and not monitoring his progress or burgeoning chemical dependence. “I don’t want to blame the medical field for where I’m at – but my addiction came from a skating accident. I dislocated my shoulder, that’s when I was prescribed the Percoset. When they cut me off from that, I went berserk and started buying scripts off the street.”
How can you avoid getting hooked? Caplin recommends that if you’re prescribed pills, take them for the shortest term possible, and at the lowest dose. Use them only as prescribed, and don’t go to another doctor to try and get more. Being pain-free is unnecessary, says Caplin. You just need to be functional. “Eighty-five percent of hydrocodone in the world is used by the United States,” he added. “We don’t have 85 percent of the world’s pain.” Caplin says doctors dole out meds for simple injuries in the ER, at urgent care centers, for dental procedures ... the list goes on. He hopes to assist in the re-education of dentists, doctors, prescribers and physician assistants to limit the amount of opiates, the quantity and the consistency to the shortest amount of appropriate time. “In general, the risk of addiction goes up after using it for more than seven days,” said Plauth. Seven days is a very short time.
Plauth additionally notes one of the more recent advances in pain management, multimodals. Multimodal pain management uses a variety of pain meds that work in concert with one another, to minimize the amount or how much of any one drug is needed. “That has been very successful in decreasing the amount of narcotic or opiate use,” said Plauth. “By using medicine such as Tylenol, and NSAIDs like Motrin, as well as other medications like Gabapentin or Neurontin, it can reduce the amount of opioid people need.”
Smith says that if he’s ever injured again, he’ll request 800-mg Ibuprofen, which can be prescribed by a doctor. “People want to feel good,” said Smith. “But everyone doesn’t feel good – that’s life! You’re supposed to be getting anxiety, feel pain, hurt, worry. That’s human nature. Nobody wants to do that anymore, so scientists and rich pharmaceutical companies have come up with all these things.”
Most people’s medicine cabinets have at least one bottle of leftover pills tucked away. But be warned: Adolescents can find and harbor those pills. Caplin suggests disposing prescriptions properly at turn-in sites, which happen throughout the year at certain pharmacies. “The police department and Walgreens should have turn-in days,” he said. “If you throw them in the toilet, they wind up in the water system.”
What should changeWhat can be done to make things better? Plauth, for one, is hopeful of improvements. “I’d say over the last couple of decades, there’s been a large push for better treatment of pain, and over the last one or two years, there’s been an increase in recognition of addiction or some of the unintended consequences of that initial push,” Plauth said. David Bruzzese, director of public relations and marketing at Mercy Regional Medical Center, agrees there’s more scrutiny now than ever. “Opioid addiction has been in the news a lot lately, and the conversations are becoming public, so the awareness is being raised about this being an issue challenging providers and patients,” Bruzzese said.
“To tell you the truth, I think the doctors are going about it the wrong way,” added the anonymous SRATS patient. “A lot of times they just cut people off cold turkey, and I think that’s when they have the tendency to run into the heavy stuff, just to try to get away from the pain. What they need to do is gradually cut them down, work with them on it, talk to them about it and give advice on counseling and places to go. People might not have that understanding of how to get help.”
Sometimes, unexpectedly good things come out of hard times: Smith has quit the marketing business and is going back to school to become an addiction counselor. “What I called my curse is now my calling,” said Smith. He has observed that many counselors you find in the addiction field are recovered addicts themselves, because they have the experience. “If I told you what a roast smells like, could I explain it?” asked Smith. “No. You have to experience it.”
Countryman also desires stricter regulations of opiate prescriptions. “They need to make it super hard for people to get pain pills!” she said. “Honestly, I wish they would outlaw pills and come up with a different way. Now when I’m in pain I take two Aleve, and that helps way more than heavy narcotics.” Countryman, like Smith, is planning on going to school to become a drug and alcohol counselor, eager to help other people who have survived the ordeal she did. “I urge anyone who’s having these issues to take that first step,” Countryman said. “It will be the most important and best step you’ve ever taken.”