Although Xanax abuse occurs by individuals of all ages, there is a growing problem with young people who are using this powerful depressant for recreational purposes. Combined with the ease of getting the drug without a prescription, this has led to Xanax being one of the most abused prescription drugs on the market today.

Xanax’s Appeal

Xanax is a member of a class of controlled medications known as benzodiazepines. Drugs in this category affect the brain and nerves in order to create a sense of calmness. They can also produce a feeling of euphoria. This euphoric feeling is what makes Xanax so appealing to those who abuse it. They seek the high Xanax can produce and use the drug for recreational purposes rather than a medical treatment.

The euphoric feeling from Xanax is further enhanced when the pills are crushed into powder and inhaled. The more they use the drug, the greater their tolerance to its effects become. As a result, they need increasing amounts of the drug in order to get the same high. The increased use typically creates a physiological dependency on the medication. In many cases, a full blown addiction develops that can be difficult to overcome.

Accidental Xanax Abuse

Xanax abuse also occurs in individuals who have been prescribed the medication, often by accident. Xanax may be prescribed for use in patients who are experiencing acute anxiety in order to give them short-term relief. Because of its intense addictive properties, it is not meant to be used for more than just a few weeks at the most. However, more and more people are becoming reliant on Xanax to keep them calm on a regular basis. This has led to an increasing number of people who abuse it by getting additional prescriptions from other physicians – “doctor shopping” – until addiction prevents them from discontinuing the medication.

Xanax is generally considered safe, and produces only mild side effects such as drowsiness or light-headedness when used in the intended and prescribed manner. However, the potential for abuse increases with extended use. Because the amount needed to get the euphoric results increases, so do the risks from side effects.

Two Types of Addiction

There are two different types of addiction including physical and psychological. Xanax abuse can lead to both. It is physically addictive because of the direct effect that it has on the brain. Physical addiction results in potentially dangerous withdrawal symptoms that occur when the individual abruptly stops taking the drug. The psychological addiction comes from the instant relief from anxiety that the individual comes to rely on. It can also come from the gratifying feeling of euphoria that it produces for those who use it recreationally.

Problems with Discontinuing Xanax

When regular Xanax abuse leads to dependency or addiction, stopping the medication suddenly is very dangerous. It can cause the brain to become overactive, resulting in serious withdrawal symptoms. These include:

• Heart palpitations
• Nausea, vomiting, and diarrhea
• Depression
• Sensitivity to light or sound
• Memory loss
• Rapid heartbeat
• Hallucinations
• Changes in personality
• Anxiety, tension, or panic attacks
• Seizures
• Death

Seizures are the one of the most dangerous withdrawal effects from abruptly stopping Xanax after using it for an extended period of time. This is why it is so important to gradually decrease the dose under a doctor’s supervision. However, since many people who are abusing the drug have obtained it illegally or are ashamed that they’ve become addicted, they are hesitant to seek help to discontinue it. As often occurs with drug abuse, they continue using it. Without professional help to wean them off the drug, the potential for stopping Xanax abuse is unlikely.

Easy Access

While some individuals abuse Xanax by seeking additional prescriptions once their current one expires, others have no difficulty getting the drug in the quantity they desire in order to self-medicate. There are thousands of websites where you can purchase Xanax online without a prescription. The combination of its use as a party drug and the ease with which it can be obtained has made it a very widely abused prescription drug. Even though the largest group of Xanax abusers is comprised of young people seeking recreational drugs, people of all ages – including seniors – abuse it as well.

There are additional dangers when purchasing Xanax over the internet or from vendors in foreign countries. Just as distribution laws differ from one country to the next, regulation of ingredients may also vary. Drugs obtained online may contain unsafe ingredients, including other types of drugs that may be even more dangerous and/or addictive than Xanax.

Effective for Short-Term Use

Although the potential for addiction is always present when taking Xanax, it does provide a good treatment option under some circumstances. Anxiety disorders can be potentially devastating and greatly reduce a person’s quality of life. If used properly, Xanax can restore quality of life without causing any detrimental effects. While it is not intended for extended use, the need for the drug helps keep it available and accessible to those who may abuse it.

High Risk for Addiction

Xanax should never be used as a recreational drug, particularly in conjunction with other drugs and alcohol. Repeated users who become tolerant to the drug and continue to increase their dose have a high risk for overdose. Even if they are using the drug for its intended purpose, they may not realize how potentially addictive it is.

No one should hesitate to get help if an addiction or dependency develops, regardless of whether it’s from prescription or recreational Xanax abuse. The longer it persists, the more difficult it becomes to treat. Like many other addictive substances, Xanax addiction should be treated with a combination of detox and counseling for best results. The proper treatment will help people overcome their addiction and prevent relapses in the future.

Specifically, mothers in a rat-based study who provided high levels of touch and response to their babies helped raise the levels of Inerleukin-10 in the rats’ brains, which later studies showed contributed to the rats’ ability to avoid morphine doses as they grew older.

While researchers have known for some time that the brain’s responses were involved in addiction, this study helps pinpoint a change in activity in the glial cells that exist in the areas of the brain responsible for rewards. Scientists believe they are better able to understand what addiction looks like at the brain level.

During the study, highlighted in Medical News Today, the rat babies were taken from their mothers while at very young ages and then brought back after 15-minute intervals. The babies whose mothers began to touch and nurture them showed less of a desire to activate an element of a special cage that would provide a dose of morphine. The rats who were not removed from their mothers or whose mothers were naturally less attentive seemed to show a higher incidence of going after the morphine as the study progressed.

Researchers described this response as serving to squelch the desire to seek out drugs, and noted that the more in-tune moms created a different reaction to the drugs than less nurturing mothers. The actual craving the rats experienced for the drugs seemed to be changed when the mothers touched and nurtured them more.

Further studies will explore other connections between how stress affects mothers and how it may be connected to immunological reactions at the brain level.

It was a perfect storm – a combination of astute marketing by Purdue Pharma and changes to healthcare protocol– that produced this phenomenon. Most experts in substance abuse believe the storm is not over yet.

In 2000 the Joint Commission on the Accreditation of Health Care Organizations (JCAHCO) changed their rules for medical professionals. Instead of checking four vital signs of patients on a regular basis, they now would monitor five: blood pressure, temperature, respiration, pulse rate and pain. Caretakers would ask patients if they were in pain, and then would be required to discover the location, intensity and cause of this pain. Unlike the other four vital signs which are monitored with instruments, monitoring pain is based on the patient’s subjective descriptions of it. Monitoring pain required caretakers to spend more time with each patient and to keep extensive records. It also opened the door for drug companies to sell more painkillers.

OxyContin, an opiate painkiller, came on the market just as the Commission’s rules were being debated and changed. It was not a new drug, but rather a new version of oxycodone, a drug most often used to control the pain of terminally ill patients, who are not in danger of addiction because of the shortness of their life spans. OxyContin, however, was not just marketed to doctors who treat cancer, but to primary care physicians. The idea was to make it available to people in chronic pain, such as those suffering from arthritis, and even those in acute pain, such as those with sports injuries. By 2003 half of the physicians prescribing OxyContin were primary care doctors.

Purdue Pharma used sophisticated strategies to market their new product. The company set up pain management conferences in Florida, Arizona, and California, and then paid for the travel expenses of 5,000 doctors, nurses and druggists to attend them. Purdue Pharma increased their sales force from 318 to 671 representatives between 1996 and 2000, and paid out over $40 million in bonuses to top salespeople.

Salespeople told doctors that the new drug was not addictive, and they often cited several studies of over 11,000 people who had taken OxyContin. The studies found that less than 1% became addicted. All of this was highly effective: the number of prescriptions for the new drug went from 670,000 in 1997 to 6.2 million in 2002.

Since the mid-1990s, new studies have found that oxycodone-based drugs are indeed highly addictive. The research used to market OxyContin had focused on people in acute pain, and not those in chronic pain who are more likely to use the drug for months and more likely to become addicted. Another problem is that some people have genetic susceptibilities to drug abuse, and if they have mental problems such as depression, anxiety or eating disorders, their risk for abuse is even higher. This group of people can become addicted to opiate painkillers within a week.

In 1997, Purdue Pharma and three company’s current executives pleaded guilty to misleading the public about the safety of OxyContin and agreed to pay $634.5 million in fines. The U.S. Department of Health and Human Services barred these men from doing business with Medicare or other taxpayer-financed healthcare programs for 20 years, and in December 2010, a federal judge upheld the disbarment.

By then the National Institute of Drug Abuse was estimating that over five million people were addicted to opiate painkillers. This agency, the United States Substance Abuse and Mental Health Services, and Partnership for a Drug-Free America are finding that prescription drug abuse is now more prevalent that abuse of cocaine, heroin, and other street drugs. They are reporting a 400% increase in the number of being treated for prescription drug overdoses in emergency rooms and admissions for prescription drug abuse into treatment centers.

These once highly-regulated drugs are now readily available in many people’s medicine cabinets. "Pain clinics" have sprung up all over the country, making it easier for people to obtain them by prescription if they cannot get them in emergency rooms or from their own doctors.

Opiate painkiller abuse has become such a crisis that local police departments are holding seminars to educate the public about its dangers. A recent one in Portland, Vermont, was sponsored by Purdue Pharma.

REFERENCES

Berry PH, Dahl JL. "The new JCAHO pain standards: implications for pain management nurses." Pain Management Nursing, 2000 Mar;1(1):3-12.

Bouthillette, Emily. "Seminar aims to educate on painkiller abuse," Portland Press Herald, January 6, 2011.

Byrne, Marilyn; Lander, Laura; Ferris, Martha. "The Changing Face of Opioid Addiction: Prescription Pain Pill Dependence and Treatment." Health & Social Work; Feb2009, Vol. 34 Issue p53-56.

Cho, Min; Min-Soo Kim, Sang-Woo Kim, Seong-Ho Kim. "Opioids in non-cancer chronic pain."
European Journal of Pain Supplements, Volume 1, Issue 1, September 2007, Pages 53-56; and

Comer, S.D.; Sullivan, M.A.; Vosburg, S.K.; Kowalczyk, W.J.; Houser, J. "Abuse liability of oxycodone as a function of pain and drug use history." Drug & Alcohol Dependence; Jun2010, Vol. 109 Issue 1- p130-138.

Kluger, Jeffrey. "The New Drug Crisis: Addiction By Prescription." Time; 9/13/2010, Vol. 176 Issue 1 p46-49.

Meier, Barry, "Ruling Is Upheld Against Executives Tied to OxyContin," The New York Times, December 15, 2010.

“OxyContin,” in the Physicians’ Desk Reference, 62nd Edition, (New York: Thomson HealthCare) 2009.

"Purdue Pharma, Executives Plead Guilty To Misbranding OxyContin, Fined $634.5M," Medical News Today, May 15, 2007.

Stoops, William W.; Hatton, Kevin W. Lofwall, Michelle; Nuzzo, Paul; Walsh, Sharon L."Intravenous oxycodone, hydrocodone, and morphine in recreational opioid users: abuse potential and relative potencies." Psychopharmacology; Oct 2010, Vol. 212 Issue p193-203.

Van Zee, Art. "Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy."American Journal of Public Health; Feb2009, Vol. 99 Issue p221-227.

Walsh, Sharon, Paul A. Nuzzo, Michelle R. Lofwall, Joseph R. Holtman Jr."The relative abuse liability of oral oxycodone, hydrocodone and hydromorphone assessed in prescription opioid abusers."Drug and Alcohol Dependence, Volume 98, Issue 3, 1 December 2008, Pages 191-202
 

Actually, heroin use never left. It just faded from prominence for a bit with the rapid rise in the use of opioids or painkillers such as OxyContin, Vicodin, Percodan and Percocet. And, make no mistake about it — painkillers are still a huge problem in this country. But the supply is getting harder to come by, and prices are going up. Sixty to $80 dollars per pill is not unheard of. That’s a lot of green for someone with a nasty pill habit.

What may have started as simple lifting of a few pills from the family medicine cabinet or snagging some from a friend quickly turns into a nearly insatiable demand for more pills and more often consumption. Most painkiller abusers don’t get their supply from a prescription given to them by a doctor. That leaves buying them on the street or conning someone with a legitimate prescription (but who doesn’t use them) to sell them.

How much easier is it to just go straight for the heroin? After all, heroin is always available, if you have the right hook-up. And, trust us, when you’re hooked on heroin, you always know where to get your fix.

It’s hard to believe that anyone would willingly subject themselves to the risks involved with heroin. Yet that’s exactly what’s happening across America, in big cities, small towns and rural environments. Over the past four years, as a matter of fact, heroin use has been steadily climbing.

Law enforcement officials point to the increase in number of arrests, mostly for possession and using the drug. There’s also the alarming number of overdoses coming into hospital emergency rooms that point up the escalation in heroin use.

What’s the lure of heroin that causes seemingly intelligent or otherwise normal people to smoke or inject the drug?

In a word: euphoria. Drug users are always in search of that extraordinary high, the nirvana or bliss that follows consumption or use. Law enforcement officials and emergency room workers alike say that men and women between 18 and 25 who use prescription opiates or methamphetamines are the most vulnerable to switching over to heroin.

Drug Use Starts Out Small

Typically, here’s what happens. Heroin users don’t just gravitate toward the hard stuff all at once. They arrive at that drug of choice after moving up the ladder, so to speak, from less potentially lethal substances.

Most begin experimenting with alcohol, followed quickly by marijuana. Pills of various sorts – stimulants, sedatives, and painkillers – may be next on the list, or they may be consumed in conjunction with alcohol and smoking dope.

By far the most widespread experimentation with drugs begins in high school and even junior high. Peer pressure leads to the first sip of alcohol, popping various party pills such as Ecstasy, lacing a joint with PCP or other chemicals, and moving onto other, harder forms of drug use. It’s not always a straight line progression, nor is it necessarily a foregone conclusion, but once young people start using drugs on a regular basis, there’s bound to be problems – in the near term and long-term.

Smoking Heroin Leads to Injection and Huge Risks

Some heroin users start off by smoking the drug. The high, while soothing, doesn’t seem to have quite the kick after a fairly short period of smoking it. Many users say they ditch smoking heroin and move on to injecting it within a few months of initial use.

Not only is injecting heroin a much more concentrated introduction of the drug into the body, it’s also a potentially lethal practice – in more ways than one.

For one thing, overdose is always a distinct possibility. It’s often hard to gauge how much is too much. Users never know the purity or strength of what they’re buying on the street. What was okay yesterday may be lethal today. Injecting the drug, a user may just fall unconscious with the syringe still in the arm, foaming at the mount and blood running out of the nose. If no one finds the unconscious individual in time, death from overdose is very likely inevitable.

Even if the person is rescued in time to prevent death, there may be serious and long-lasting consequences. Some overdose victims suffer cardiac arrest and/or stroke. Some have permanent vision loss or impairment in mobility – unable to move or difficulty moving a hand, arm, or leg. In addition, cognitive skills may be severely impaired. What used to come naturally now becomes a near impossibility: thinking logically, remembering simple things, making informed choices, being able to speak coherently. Headaches are a constant presence, and overall quality of life suffers immeasurably.

Do these things happen to all heroin users who overdose, or who use the drug for long periods of time? That’s just it. There’s no certainty that any one person will fall victim to such risks, although the likelihood increased with length of time and frequency of use. In other words, you can only dance with the devil so many times before you’re bound to get burned.

Heroin Supply Triples

According to the U.S. Department of Justice, the supply of heroin coming to the States from Mexico has nearly tripled in the past five years. This not only has caused the availability of heroin here to skyrocket, it has also raised serious concerns over the risks of intravenous use due to the potency of Mexican-produced heroin.

According to the 2009 National Survey on Drug Use and Health (NSDUH), in 2009 there were 180,000 persons age 12 and older who had used heroin for the first time in the past 12 months. This is significantly higher than the 100,000 first-time heroin initiates during the 2002-2008 periods. The average age of first use among those aged 12 to 49 was 25.5 years in 2009.

NSDUH statistics on those dependent upon or abusing heroin in 2009 are even more troubling, increasing from 213,000 in 2007 to 399,000 in 2009.

But talk with law enforcement officials and emergency room workers and you’ll see that the NSDUH data is only part of the story. Many people don’t self-report their drug usage, or downplay it significantly. And surveys are just that, extrapolations from a limited audience. The truth is that heroin usage in the U.S. is much higher than reported – and, seemingly gaining in popularity.

Watch for the Signs

Parents, friends, school officials, neighbors and concerned others should be on the lookout for signs of heroin use. They’re not always easy to spot, as users are often quite adept at hiding their habit.

·         Euphoria – When high on the drug, literally, the heroin user is in a state of pure nirvana. Nothing seems to faze him or her – until the high wears off.

·         Drowsiness – Feeling warm and content from using heroin leads to drowsiness. It can also relieve stress by inducing a detachment from pain and any stress-producing activities.

·         Nausea and vomiting – These are common side effects, especially when first using the drug.

·         Constipation – This is another common side effect users generally experience when beginning heroin use.

·         Pinpoint pupils – In reduced lighting situations, when the pupils normally become larger, someone who is using heroin will have pinpoint pupils – pupils that are very small.

·         Scabs on arm veins – When someone begins mainlining, or injecting heroin directly into the vein, you may start to see track marks on the arms, later followed by scabs as a result of repeated injections. After a while, users may wear long-sleeve shirts or jackets in an attempt to hide the injection marks.

·         Line of track marks – Over a period of months, heroin users who inject the drug will graduate to shooting up at least once per day – as compared with once or twice a week when first beginning heroin use. All that shooting up leaves an inevitable trail of needle marks, track marks, up and down the arm. In fact, you may see a one to three inch trail of scabs over these track marks up and down the arm or leg from the vein.

·         Right vs. left-handed injector – Unless the person is ambidextrous (able to use either hand with the same dexterity), the tell-tale line of injection marks will appear opposite the hand used to inject the drug. For example, a right-handed person will generally inject into the left side, while a left-handed person injects on the right side.

·         Collapsed veins – After a long period of injecting into the same veins, a condition occurs called collapsed veins. This is also called blow-out veins. The heroin user will switch then to injecting in veins behind the knee or in the back of the hand.

·         Physical signs of snorting heroin – Look for signs of a bloody nose, sniffling, and constant sneezing – when not otherwise sick.

At higher doses, heroin produces a sedative effect, with risk of overdose resulting in unconsciousness, coma, and sometimes death due to respiratory failure. If heroin is taken in combination with alcohol and/or other drugs – especially tranquilizers, the risks of overdose increase significantly.

Where to Get Help

What should you do if you suspect a friend or loved one has a problem with heroin abuse? In no uncertain terms, you should encourage the individual to get help. And help is readily available from a number of sources.

Talk with the family doctor about getting a referral to treatment for heroin abuse. Or get in touch with federal, state or local agencies that can provide direction. There’s an online Treatment Facility Locator (http://dasis3.samhsa.gov/) maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA) or you can call the toll-free treatment referral helpline at 1-800-662-HELP.

Check out the listing of State Substance Abuse Agencies (http://findtreatment.samhsa.gov/ufds/abusedirectors) and find resources and assistance in your state or locale.

County behavioral health organizations may also be able to provide help.

Also go online to check out Narcotics Anonymous (NA) (http://na.org/) and Narconon http://www.narconon.org/ (or call the national Narconon hotline at 1-800-468-6933).

Remember that it’s almost impossible to kick addiction or dependence on heroin alone. And detoxing (coming off the drug) without 24-hour medical supervision is not only difficult, it’s also dangerous. Just coming clean doesn’t solve the problem of dependence. Psychological counseling and learning healthier coping strategies are required in order for the individual to be able to achieve and sustain a drug-free lifestyle. Family support is also crucial, since understanding and encouragement of the loved one who is recovering from heroin abuse or dependence means developing and maintaining a strong support network.

What you can do, right now, is to begin to have the dialog that’s necessary to get the ball rolling to be ready for treatment for your loved one. Expect some resistance. The longer he or she has been using heroin, the tougher the job of convincing your loved one that the time is right for coming clean will be.

You may need to stage an intervention. If that’s the case, go for a professional interventionist – and make sure you’re willing to do what it takes to ensure that the home your loved one returns to following treatment is fully supportive of a clean and sober lifestyle. That may mean that family members need to get some form of counseling or family therapy at the same time as the loved one who’s in treatment. At the very least, go to 12-step family groups for the loved ones of addicts. You’ll not only learn a lot, but begin to understand how you can better help your loved one who’s striving to get on the road to recovery.

With street heroin making a comeback in America, it’s time to get more than just peripherally involved. Chances are that you know someone who’s moved from painkiller abuse to heroin use – and without some sort of professional involvement, the future for that person is not a pretty one. While you can’t make someone want to come clean and stay clean, you can become knowledgeable about what it takes and be ready to support the decision to go into treatment.

A recent Healthland report noted that most people recognize the association between addiction and withdrawal. Studies, reports and articles have all stated that a person who has become so dependent on a drug that stopping it causes physical symptoms of withdrawal means he or she is addicted.

Is this the appropriate time to discuss the difference between dependence and addiction? These two elements are not completely interchangeable, although both can create withdrawal symptoms when a medication is stopped. Individuals can experience withdrawal for a number of different medications, even when they are taken as prescribed, does that automatically mean they are addicted?

A number of individuals rely on antidepressants, antispasmodics and blood pressure medications to maintain a healthy lifestyle. When any of these medications are stopped, they will produce withdrawal, which can be fatal if the medication is not tapered off appropriately.

Substance dependence implies psychological dependence, which results in the compulsive use of a drug despite negative consequences. This is easily considered to be addiction, although it does not involve physical need or withdrawal. Crack, for instance, does not produce physical withdrawal symptoms when stopped, yet few would argue that it is not addictive.

Nora Volkow, head of the National Institute on Drug Abuse, describes addiction as a loss of control over the intense urges to take the drug, even when adverse consequences are certain. Withdrawal can certainly be a byproduct of addiction, but addiction can exist without withdrawal and withdrawal can exist without addiction.
 

Some may argue – and there’s ample evidence to back up the claims – that drug problems in doctors are related the medical specialties where they’re regularly in contact with addictive drugs. Ease of access, lack of early detection, stress, and the link with physician- suicide are other problems associated with physician drug use. Studies have found that up to 15 percent of healthcare professionals will battle substance abuse at some point during their careers.

But, just as with anyone who’s experiencing a problem with substance abuse, treatment can help. Thanks to treatment programs specifically geared toward professionals (including physicians), addicted doctors can successfully overcome substance abuse.

Impaired Physician Program

What happens when a physician is so impaired that he or she starts making costly – even fatal – errors in patient care? Intervention on a professional level is usually mandated formally by a licensing board, hospital, malpractice or other agency, or informally by employers, colleagues, and family members.

The emergence of a professional program to treat doctors with substance use, the so-called impaired physician program or physician health programs has resulted in thousands of doctors being able to reclaim their lives. Physician health programs are an effective alternative to punishing drug-addicted doctors. In essence, they are special programs that combine referral to treatment, monitoring, and rapid responses to doctor noncompliance.

The Impaired Physician Program (http://impairedphysican.com/) at the University of Florida College of Medicine uses state-of-the-art evidenced-based methods that have been widely reported in the medical literature. As reported in the Journal of Substance Abuse Treatment (JSAT), participation in a treatment program such as the Impaired Physician Program, when coupled with long-term monitoring, results in five-year return to work and recovery rates of more than 80 percent for physician addicts.

Scott Teitelbaum, M.D., is the Medical Director of the University of Florida’s Florida Recovery Center (FRC). The FRC is one of the country’s largest academic facilities and includes M.D.s, Ph.D.s, and counselors and others who are dedicated to the recovery of the physician addicts and their families.

As Dr. Teitelbaum said in a 2009 interview in Gainesville Today (http://www.gainesvilletoday.com/2009/06/2072/Discovery_to_Recovery/), “Research provides the new treatments and approaches. Additional research tests the treatments and makes them evidence-based.”

At FRC, new treatments were discovered to make detoxification easier. As Dr. Teitelbaum explains, “By itself detoxification is not treatment. Clean air, avoiding smoking, smoked drugs or alcohol, vigorous exercise, healthy eating and diet, and rigorous, long-term treatment, including peer recovery groups, follow from our work… and provide much of the evidence for the FRC’s successful programs and outcomes.”

What happens at the FRC when a physician-addict enters the program? The FRC offers comprehensive screening and evaluation of patients with substance abuse disorders and treats patients of all ages. As one of the only academic, university or college-of-medicine-based programs, the center is a leading choice for the treatment of business and medical professionals who are struggling with drug or alcohol problems, offering specialized recovery groups to focus on their unique needs. The FRC has successfully treated hundreds of these professionals, allowing them to get their careers and lives back on track.

Long-Term Monitoring Required

The key to effectively overcoming addiction to alcohol and/or drugs by physicians is long-term monitoring, say the experts. It’s more than the threat of what can happen with non-compliance that motivated doctors to stick with impaired physician or physican health programs. Eventually, the doctors gravitate toward wanting to change their behaviors.

So, in a simplified way of looking at it, what works is a little of the carrot and stick approach. If doctors relapse, they may face losing their medical licenses for good. If they stick with it, they may be able to beat their addiction and be in effective recovery for the long-term.

Such monitoring involves frequent and random urine testing (to detect the presence of alcohol or drugs). While programs for treating addicted doctors may differ, in general, program measures include group and individual therapy, residential and outpatient programs, surprise workplace visits from monitors, and links to 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous. In addition, doctor-patients receive treatment not just for drug problems, but also for accompanying medical or psychiatric disorders. In most cases, the doctors pay for their treatment, drug tests and follow-up care.

Dr. Gregory House – Fictional Example of an Addicted Doctor

For those familiar with the Fox television show, House, the title-character, Dr. Gregory House, battled an addiction to prescription painkillers during last season. The sight of Dr. House with his cane hobbling through the hospital was always followed by him popping Vicodin or another potent painkiller to alleviate pain from his leg surgery. It didn’t take long for him to become dependent upon and then addicted to the drugs. The situation got so bad that the doctor was hallucinating and incapable of doing his job effectively. Concerned for his safety – and that of his patients – his co-worker and best friend encouraged House (as he’s called on the show) to get professional help. After denying he had a problem for months (weeks, during two seasons), House asked his friend to drive him to a drug rehab center.

Thus began House’s journey to recovery. As with all prescription drug-addicted patients, the climb back from addiction wasn’t easy for House. But he did stick with the program, learned about his disease, and how to combat the cravings and urges that would plague him on and off following his discharge from treatment. He continued to go to counseling with his therapist and gradually became more confident in his ability to abstain from painkillers.

What this television show brought home to millions of viewers is how insidious addiction is and the fact that anyone can become addicted. It takes a great deal of courage and determination to overcome addiction, but with treatment anyone – doctors included – can do it.

A recent Science Daily release focused on a story that explored the pharmacological strategies for reducing the self-administration of cocaine. This study focused on animals to identify the potential in treatments for adults.

The primary excitatory neurotransmitter in the brain is the glutamate. This neurotransmitter has been identified more than once as the key to drug addiction. This element is also an important piece to learning and memory. Receptors involved in the glutamate have been identified as potential targets for drug addiction recovery methods.

In a study of rats by scientists at The Scripps Research Institute, it was determined that glutamate antagonists changed into opposite directions during the development of addiction. This pathway helped to better explain what happens during the transition from casual cocaine use to addiction.

If the right glutamate receptors can be targeted in treatment, recovery may hold more promise for cocaine addicts. Study authors do warn, however, that such treatments may only be effective in early stages of cocaine abuse.

It is also important to note that all types of cocaine use and abuse are not alike. When cocaine exposure is done to different extents by different users, different adaptations may occur in the brain systems. Further research must be conducted to identify one method in a number of potential addicts.
 

One such medication is modafinil, which is the generic drug for the brand name Provigil. This medication is prescribed for individuals wishing to improve wakefulness when excessive sleepiness is present. It is a common medication given for individuals suffering from narcolepsy or other sleep disorders. Modafinil works well in such situations as it is a wakefulness-promoting agent.

It is not totally clear as to why modafinil helps individuals to be more awake, although it is assumed that the drug alters the natural chemicals in the brain known as the neurotransmitters. It has been shown to effectively stimulate alertness and can improve functioning of the frontal lobe of the brain. The medication’s ability to stimulate and improve functioning was different than standard stimulants.

This medication has been known to cause dependency and even addiction in certain users and therefore individuals must assess dependence risks versus benefits of the medication before taking it long term. Likewise, even if the medication will only be used in the short term, gaining more information is a good idea.

In some situations, modafinil has been used to treat ADHD and early studies showed significant promise. In one clinical trial, however, one child – out of 933 – developed a life threatening skin rash, known as Stevens Johnsons Syndrome. While it is argued that the rash was not a result of the medication, the FDA refused to approve the use of the medication in the treatment of ADHD.

Doctors are not held to the standards of the FDA, however, in their prescribing practices. While the FDA forbids manufacturers to advertise their product in the treatment of any condition that has not been approved, doctors can prescribe the medication if they believe it is the right fit in the situation. This “off label” prescribing provides more leverage for the doctor and greater options for the patient.

Interestingly, modafinil has also been prescribed for the treatment of cocaine addiction, although it has not been approved for such uses and studies are still relatively small on the impact the medication can have for those addicted to cocaine.

Modafinil does affect the brain’s reward center, which highlights its potential for dependency and abuse. One NIAAA study stressed that additional research should be conducted as it is still unclear as to the potency and risk involved in taking modafinil long term.
 

Well, contrary to proponents of legalization of marijuana, the truth is that smoking marijuana can lead to an addiction to the substance in some individuals. But not everyone who tokes on a joint becomes addicted. Let’s look at the facts.

THC and Other Ingredients

The main component of marijuana is delta-9-tetrahydrocannabinol or THC. Marijuana is a mind-altering drug that also contains some 400 additional harmful chemicals, including known carcinogens. And much of the marijuana available on the street is laced with addictive drugs such as PCP. Unless you’ve got a prescription for medical marijuana, you never really know what you’re getting.

But the THC in marijuana today is much more potent than that available in the 1970s. Today’s pot delivers the desired effect in record time. Beyond elevating mood and relaxation, and depending on the level of THC in it, marijuana today may cause users to experience euphoria, hallucinations, and paranoia.

Marijuana is the Most Commonly Abused Drug

Marijuana is the most commonly abused illicit drug in the United States today. Despite calls for legalization, raw marijuana remains a Schedule I Controlled Substance. That makes it against the law to possess or use marijuana – although penalties and enforcement varies. Adolescents are generally introduced to marijuana by their friends in elementary or junior high school. Many graduate to smoking pot from using inhalants. Peer pressure plays a big part in adolescents’ use of marijuana.

But it feels good – and everyone’s doing it, say your teens. Don’t buy it.

Marijuana, Alcohol and Other Drugs

After being introduced to marijuana, many teens use it in combination with alcohol and other drugs. Any one of these can prove addicting, especially in individuals with a vulnerability to addiction (a genetic predisposition) but, taken together, the combination can increase the risk of addiction.

Marijuana’s Therapeutic Use

In a number of states, marijuana is available with a prescription for medical use only. There are stringent requirements for medical marijuana dispensaries, and much controversy surrounding the issue. Nevertheless, there are therapeutic benefits from smoking marijuana or taking prescription THC in pill or suppository form for people who have chronic diseases causing intense and unremitting pain such as cancer or for cessation of nausea in those undergoing chemotherapy. There are other conditions that are considered appropriate for marijuana prescription, and these are spelled out in state laws.

Long-Term Use Can Lead to Addiction

Drug craving and withdrawal symptoms can make it extremely difficult for a marijuana smoker to stop using the drug. Just saying you’ll stop smoking is one thing. Going through with it is another. Users report feeling irritable, anxious, unable to sleep, and increased feelings of aggression.

To avoid unpleasant withdrawal symptoms, users resume smoking marijuana. The longer a person uses marijuana, the more likely he or she is to use more of it and more often. This is classic addiction, according to many scientists and researchers.

Marijuana Abuse Can Be Treated

Most marijuana abusers or those who are addicted can benefit from professional counseling, including behavior modification therapy. This may occur in individual and/or group sessions. There is currently no medication approved for treating marijuana abuse. If you have tried to quit a number of times on our own, you might consider Marijuana Anonymous or a marijuana rehab.

It’s tough for employers to know where to turn and what to do about drug use in the workplace, but one thing is certain: if you don’t do anything, the situation will only worsen, and may result in tragedy, legal problems, fines, economic loss or other consequences. Clearly, then, it is in the best interest of employers to create and implement a comprehensive drug-free workplace policy and provide employee assistance for or referrals to appropriate substance abuse treatment facilities.

Who Abuses Drugs in the Workplace?

Surveys by the federal government have identified the following as drug users in the workplace. The drug user tends to be:

• Male
• Between the ages of 18 and 25
• White
• Less educated
• Divorced or never married
• Low paid

Which Industries are Most Affected?

While drug use in the workplace is not limited to any particular industry, some industries stand out as having the most numbers of drug-using employees. These include:

• Food preparation workers
• Bartenders, waiters, and waitresses
• Construction workers
• Other service occupation workers
• Material moving and transportation workers

Costs to Employers as a Result of Substance Abuse

Alcohol and drug-abusing employees cost billions of dollars in lost productivity, injuries, and medical costs each year. Just one employee that is chronically hung over or slipping out to do drugs on a break or at lunch can wreak havoc in the workplace. Multiply that by several employees, and you can really have a problem.

It is estimated that problems directly related to alcohol and drug abuse cost American businesses $81 billion in a single year. Research studies of drug-abusing employees show that they function at only 67 percent of their normal capacity.

Accidents and fatalities increase with substance-abusing employees. Up to 40 percent of all industrial fatalities and 47 percent of industrial injuries can be linked to problems with alcohol use and alcoholism. As for drugs, employees who use drugs are 3.6 times more likely to be involved in an accident in the workplace and 5 times more likely to file a workers’ compensation claim than non-drug using employees.

Absenteeism and employee turnover increases dramatically with substance abuse. One shocking statistic is that an estimated 500 million workdays are lost each year due to alcoholism. Drug-using employees are 2.2 times more likely to ask for time off or early dismissal, 2.5 times more likely to have absences of 8 days or more, and 3 times more likely to be late for work. In terms of employee turnover, illicit drug users are more than twice as likely as those who do not use drugs to have changed employers three or more times in the past 10 years.

Medical costs to employers for substance-abusing employees also increase. It costs employers about twice as much in medical claims for drug-using employees as non-drug using employees.

How to Decrease Substance Abuse Impact in the Workplace

Among the many things employers can do to decrease the impact of substance abuse in the workplace, perhaps the most important first step is to implement a drug-free workplace program.

You may know that, in 1988, the Drug-Free Workplace Act was passed requiring all federal grantees and some recipients of federal contracts to agree to provide a drug-free workplace as a condition of receiving any federal money. In such a drug-free workplace, all employees are required to adhere to a program of policies and activities that are specifically designed to provide for a safe workplace and a drug-free environment. Key to the policies and activities is that they discourage alcohol and drug abuse while encouraging substance abuse treatment, recovery, and return to work for employees who have problems with substance abuse.

It is important to note that, even if your company or organization is not required to have a drug-free workplace program, you can still benefit greatly from implementing one.

Drug-free workplace program components may include the following:

• Having a written policy
• Providing employee education
• Requiring and providing supervisor training
• Giving employees access to assistance
• Drug testing

The U.S. Department of Labor advises that while a drug-free workplace program can be effective without all five of the aforementioned components, employers should at least explore all five when developing such a program.

Program planning and philosophy are important to the development of an effective drug-free workplace. Some companies and organizations focus on identification or detection, apprehension, and discharge of those who use drugs, wielding a law enforcement model that treats such employees as criminals. Other companies focus more on performance and emphasize deterrence and assistance because they view employees who use alcohol drugs as impaired but otherwise capable employees. Experts say that the best drug-free workplace programs strike a balance between the two different types of philosophies. On the one hand, employers want to send a clear message, and on the other hand, they want to encourage employees to seek assistance if they are experiencing problems with drugs or alcohol.

Sometimes this balance is difficult to achieve. It involves adroitly navigating elements that are often competing. These include the rights of employees and the rights of employers, the need to know and rights to privacy, detection and rehabilitation, and respect for employees and the safety of all.

Benefits of a good drug-free program include decreases in absenteeism, accidents, downtime, employee turnover, workers’ compensation costs, and employee disciplinary problems. Other benefits that may result from a good drug-free program include increases in productivity and profits, customer satisfaction, health status, and employee morale.

Steps to Implementing a Drug-Free Workplace Program

In order to implement an effective drug-free workplace program, employers have a few basic steps to follow. These include delving into the following:

• Assess the nature and extent of alcohol and drug use in your organization.
• Develop and implement an alcohol and other drug abuse prevention policy.
• Choose and employee assistance program (EAP) that suits your organization’s needs.
• Develop and implement employee education and supervisor training.
• Evaluate the effectiveness of an alcohol and other drug abuse programs in terms of cost and human factors.
• Understand the technical, legal, and employee relations aspects of alcohol and other drug testing.
• Identify signs and symptoms of alcohol and other drug abuse.

In addition, it may be helpful for employers to research what other similar organizations are doing and determine what resources are available, collaborate and cooperate with workers, assess your current situation as well as determine any special needs, and determine whether any state or federal laws apply.

Uninsured Workers and Substance Abuse

In its February 2010 issue, The NSDUH Report (http://www.oas.samhsa.gov/2k10/177/177EmpNoIns.htm), from the National Survey on Drug Use and Health (NSDUH), states that more than 18.4 million full-time employees in the U.S. aged 18 to 64 (15.5 percent of full-time adult workers in that age range) have no health insurance. Of this number, an estimated 3.0 million uninsured full-time employees (16.3 percent) needed substance use treatment in the past year. Specifically, 13.3 percent needed treatment for alcohol use, 5.6 percent for illicit drug use, and 2.7 percent for both alcohol and illicit drug use.

Of the uninsured full-time workers who needed substance use treatment in the past year, 12.6 percent (378,000 individuals) received treatment at a specialized facility. The remaining 87.4 percent needed treatment but did not receive it, including 6.6 percent who recognized they needed treatment and 80.8 percent who did not perceive a need for it.

Contrary to what many in the general public may believe, uninsured adults are not mostly unemployed or part-time workers. In reality, the more than 18 million adults working full time who had no health insurance represent more than half of all nonelderly uninsured adults.

With the Health Care Act signed into law by President Barack Obama in March 2010, employers will be required to provide health insurance for employees, or face penalties in the form of fines. How the specifics of the coverage work out have yet to be determined – even if the new health care law is allowed to stand after pending legal challenges, or whether it is ultimately repealed.

Who pays for substance abuse treatment is one part of the health care equation. Another, and perhaps even more compelling part, is the necessity for such treatment.

How Do Employers Measure Success?

In today’s tough economic times, it’s easy to want to dismiss anything that costs a significant amount of money and/or involves a great deal of time and effort. But substance abuse (drugs and alcohol) are critical barriers to any organization’s overall success – not only in terms of profits, but also in terms of public and private perception and image and employee morale, productivity, and stability. In essence, you get what you pay for.

Give adequate time for the drug-free workplace program you implement to begin showing results. You should be able to see whether or not it’s effective within a year or so. Be sure to get guidance from experts so that you’re looking at the right set of criteria to measure effectiveness. You can always add to the program, building upon the successes you achieve along the way.

Resources for Employers

There are many resources for employers available through the following links:

• Cost Benefit of Substance Abuse Prevention – Includes links to SAMHSA/CSAP Workplace Managed Care Financial/Cost Research Evaluation Guide, Peer Support Program Cost Analysis, What’s the Return on Investment: Workplace Managed Care, Resource Guide to Costing Workplace Managed Care Programs, Review of Return on Investment Studies, and Cost Interview Guide for Internal Employee Assistance Program Case Studies

• Making Your Workplace Drug-Free: A Kit for Employers – Provides credible, authoritative, evidence-based information, resources and tools for producing and maintaining drug-free workplace policies and programs. The kit was assembled by the Division of Workplace Programs, in the Center for Substance Abuse Prevention, SAMHSA, U.S. Department of Health and Human Services. The kit guides employers through the process of understanding legal requirements (federal, state, and local statutes), building a team, assessing the workplace, developing a policy, planning and executing a program, and evaluating a program.

• Workplace Resource Helpline – 1-800-WORKPLACE or 1-800-967-5752 – The Workplace Helpline is a toll-free, confidential consulting service which provides technical assistance and guidance in developing and evaluating programs and policies designed to address alcohol and drug problems at work. The Helpline is staffed by trained workplace specialists that can help design a program to meet employer’s specific workplace needs. Consultation is provided on policy development, drug testing, supervisor training, and employee education and employee assistance programs. The service is provided free by the Center for Substance Abuse Protection (CSAP).

• 10 Most Frequently Asked Questions – The 10 most frequently asked questions of the Workplace Resource Helpline cover: What is an ideal policy for employers to adopt to successfully deal with substance abuse in the workplace? Is there a sample or model policy my company can use to develop an effective drug-free workplace program? Can I legally require my employees to take a drug test? If I suspect one of my employees is using drugs, can I require him to take a drug test? How should I determine which employees to include in a random drug testing program? My company received a contract from the federal government. Do I have to drug test my employees? How should I deal with an employee whose drinking is affecting job performance if the employee is covered by the Americans with Disabilities Act? Do I have a responsibility to provide rehabilitation? Where can I find Drug-Free Workplace Program training for my supervisors in my community? Can my company use non-certified laboratories for drug testing? How much advance notice should I give my employees before implementing a Drug-Free Workplace Program? For the answers to the questions, go to the link.

• Laws and Regulations – Available through the U.S. Department of Labor, this website includes links to help employers become familiar with state and federal laws that impact when, where, and how they can implement a drug-free workplace program. Areas covered include state laws, ADA and Rehabilitation Act, Family and Medical Leave Act, and other federal laws.

• Drug-Free Workplace Advisor – Also available through the U.S. Department of Labor, the elaws Drug-Free Workplace Advisor assists users to build tailored, drug-free workplace policies and provides guidance on how to develop comprehensive drug-free workplace programs.

• Institute for a Drug-Free Workplace – Formed in 1989 by four companies, today the Institute for a Drug-Free Workplace consists of nearly 100 major businesses and organizations, including many of the largest U.S. companies. It educates employers, employees, legislators, public officials, the courts, media and the public at large about: the dangers of substance abuse; the impact of substance abuse on the workplace; the most appropriate, effective and legally acceptable means for employers to address substance abuse; rights and responsibilities of employers and employees; legislative, regulatory, and legal developments, and the role of the employer in a national effort to combat substance abuse and its debilitating effects.