1 Viewing prescription drug abuse in Florida: An Interdisciplinary approach from the perspectives of Psychology and Social Work By: Taylor Neighbors University of South Florida-Sarasota Manatee
2 Sunshine, palm trees, the ocean, flip flops, expensive cars and homes, designer clothes, and lavish lifestyles define how many Floridians live (Mormino 2005). However, there is a dark cloud looming over the Sunshine State, for those who are suffering from a prescription drug addiction, or for families and friends who have lost loved ones as a result of prescription drug abuse. As noted in Farlow and Martin, according to Bruce Grant, who heads the Florida Office of Drug Control, on average, seven people die, per day, as a result of prescription drug abuse in Florida (2010). Currently, Florida ranks number two in the nation for prescription drug abuse (Michalski 2010). Prescription drug abuse can happen to anyone, no matter how good or bad one s life is. Someone could have an operation and is given pain medication by doctors to take for a specific period of time, but this may turn into a deadly addiction that could ultimately result in one s demise. This could result if one does not seek help immediately upon becoming addicted. Many young adults, who seem to live the ideal lifestyle, get lured in by the euphoric effects of prescription drugs, which results in becoming a prescription drug abuser or addict. People are under the misconception that, because prescription drugs are legal, they are safer to use and to experiment with, or they are used to escape from reality, rather than using illegal drugs (Mayo Clinic 2010). They are also widely available and can be easily obtained. Using both psychological and social work perspectives, this paper seeks to determine if prescription drug abuse is a serious social epidemic plaguing the Sunshine state. There will be an emphasis on individual psychological characteristics of an abuser. The social work point of view will focus on what legislation and resources are available to help those struggling with an addiction to prescription drugs. It is vital to note a definition of prescription drug abuse and what kinds of drugs are most widely used. Since prescription drugs are legal substances, some people may not understand that,
3 even though these medications may be legal, they can have harmful, and even deadly, effects if used improperly. Prescription drug abuse occurs when a person takes a prescription medication when one has not been ordered to by a doctor, by a means of stealing medication from others or using a medication not in accordance with the specific dosage specified by a doctor, and using such drugs for recreational purposes (Mayo Clinic 2010). Often, people begin using prescription drugs legitimately to help cope with pain associated with an injury or after having a surgical procedure. Even though such patients initially use these drugs to help manage pain associated with an injury or from surgery, they may continue to use these drugs even after they have healed, and may self-medicate beyond the prescribed dosage by physicians, or seek more of these drugs. In a lot of cases, patients did not have intentions of becoming abusers of prescription drugs. Furthermore, there is an increase in the number of youngsters who are addicted to prescription drugs. Prescription drug abuse can happen to anyone, ranging in age from school age children to the elderly, and from any social background. Presently, prescription drug abuse predominately plagues those of primary school age to secondary school age students (Mayo Clinic 2010). Since prescription drug use is common among adolescents, it is understandable that teenagers may be influenced by friends to try such drugs and end up becoming abusers (Mayo Clinic 2010). Peer pressure is extremely powerful to teenagers, who struggle to find their niche in various cliques, which often can result in delinquent behaviors, such as a drug abuse. Moreover, there is not a specific profile that deems someone a prescription drug addict. Mannelli et. al. sampled individuals from all fifty states in the United States and found prescription drug abusers living in their own homes or with family or friends, dorms, group homes, on military bases, and homes for alcohol and drug abusers (2009). This study also found that there was a nineteen percent usage among users who were not in school (2009). College
4 students, in an effort to focus on their school work and juggle other aspects of their lives, often abuse prescription drugs used to treat Attention-Deficit-Hyperactive-Disorder (DuPont 2010). These medications are frequently combined with alcohol and other illicit drugs, which may result in fatalities (DuPont 2010). DuPont also found that these students obtained ADHD drugs by claiming they had ADHD, by imitating common ADHD symptoms, and from other students (2010). Students are under the impression that such drugs will help them focus and perform better in school, as well as balance other demands of life. However, Mannelli et. al. (2008) found a greater number of female prescription drug addicts. One study found a high percentage of prescription drug abuse among adolescent females (Mannelli et. al. 2008). Researchers speculated that females had higher instances of prescription drug abuse, because girls tended to self-medicate to deal with symptoms associated with menstruation (Mannelli et. al. 2008). Girls may have bloating, cramps, and feel fatigued and take a prescription pain pill to help alleviate their symptoms. The researchers also discovered that females were more likely than males to obtain prescription drugs, and they often shared such drugs with other females (Mannelli et. al. 2008). A common scenario among females in high school could be that one female is struggling with pain attributed to her menstrual cycle, and her female confidante may offer her a prescription pain reliever to help her, especially if the female providing the prescription pain reliever uses such drugs to deal with pain attributed to menstruation. Females may use prescription drugs to help deal with psychological issues and the anxiety that such issues cause (Mannelli et. al. 2008). Some users may use such drugs to suppress one s appetite (Mayo Clinic 2010). Since Mannelli et. al. noted that females had a high prevalence of prescription drug abuse, it is notable that many females may begin using for this reason, especially when girls face harsh societal standards to be skinny (2008).
5 Therefore, people may use prescription drugs for a multitude of reasons, besides to perform better in school, deal with menstruation, or to suppress one s appetite. Prescription drug abusers often report poor physical and mental issues as well (Mannelli et. al. 2008). There may a certain social stigma attached to seeking help from mental health professionals (Mannelli et. al. 2008). Some individuals and various cultures look unfavorably upon receiving help; rather, people should turn to their family and friends for help (Morales & Sheafor 2002). As a result, many turn to prescription drugs to help cope with various issues in their lives, instead of seeking the assistance of mental health professionals. Furthermore, the ethnicity and race of prescription drug abusers is also an essential factor in understanding who abuses such drugs. While there is not a specific ethnic or racial profile of prescription drug abusers, studies have concluded that some ethnic groups have a higher prevalence of abusing prescription drugs (Mannelli et. al. 2008). For example, African Americans and Native Americans have the highest percentage of prescription drug abusers, followed by Asians and Hispanics, in comparison to Caucasians (Mannelli et. al. 2008). Also, rural areas have a higher prevalence of prescription drug abuse than do urban areas (Ford 2008). Possible explanations for African Americans and Native Americans having the highest incidents of prescription drug abuse may be connected with the lack of counseling and treatment facilities where they reside, or they may lack resources to obtain assistance (Morales & Sheafor 2002). People may be less likely to seek help if they have to travel long distances to get there. In addition, Ford (2009) looked at one s immediate environment and connection with school to see how each plays a role in whether adolescents become prescription drug abusers. Ford s study looked at the influence of social control theory to determine whether or not adolescents became addicted to prescription drugs (2008). Social control theory is comprised of
6 four elements, which include: attachment to family, peers, and school; commitment to extracurricular activities, involvement in extra-curricular activities, as far as putting a great deal of time and effort into these activities; and belief, where a person personalizes societal norms and applies them to his life (Ford 2008). Ford discovered that a person who is attached to friends, peers, and family members is less likely to turn towards wrong behaviors (such as using prescription drugs) because it will upset and create turmoil in these relationships. He also found that students who make a commitment to extra-curricular activities are motivated to do so and thus, do not have time to think about any other behaviors that could be deemed as deviant, because they are so focused on their activity. Also, a person holds beliefs that prescription drug misuse is taboo and therefore, should not be done (Ford 2008). Ford also discovered that parents who are highly involved in their child s life tend to deter their children from misusing prescription drugs (2008). This study appears valid, because the more a parent is involved in a child s life, the more likely parents will have time to interject, if they feel their child is not doing the right thing (such as using prescription drugs). Also, when children have tight connections with their parents, it may be easier for children to turn to their parents for advice and ways of coping, as opposed to remaining silent, and using prescription drugs as a means of dealing with problems. Furthermore, Ford also looked at the relationship between a child s bond with school, in regard to whether children will use prescription drugs. A student s school environment plays a pivotal role in regard to whether or not a student will misuse prescription drugs. Ford discovered that students who elicit a powerful bond with school are less likely to use prescription drugs inappropriately (2008). Ford found that students who think favorably upon school tended to have closer attachments with teachers, athletic coaches, and school administrators (2008). He noted
7 that one of the key reasons why students turn to misusing prescription drugs is because students do poorly in school (Ford 2008). When students do well and receive positive feedback from their school environment, it helps boost a student s self-esteem, and therefore, could deter a student from prescription drug abuse. However, when a student does poorly in school, he may turn to prescription drugs as a way to cope with this disappointment he feels inside himself and for disappointing others in his immediate environment (i.e. teachers, parents, and peers). Ultimately, Ford s research shows that a significant attachment to parents and school environment act as a buffer against prescription drug misuse. However, there are a number of prescription drugs readily available. Today, it is easier to obtain prescription drugs than in the past, which has significantly contributed to the prescription drug epidemic plaguing Florida. In the past, society dealt with drugs such as marijuana, being used habitually, but since the nineteen sixties, prescription drug use has become widespread (DuPont 2010). There are three categories of drugs which people most commonly abuse, which include: opioid painkillers (i.e. oxycodone and hydrocodone), sedatives and tranquilizers (i.e. Valium and Ativan), and stimulants (i.e. Ritalin and other drugs used to treat sleep disorders and ADHD) (Mayo Clinic 2010). According to the St. Petersburg Times staff writers, In 2006, 180 million prescriptions were written for opioid painkillers; 11,000 people died from misusing them this occurs as a result of doctors writing numerous prescriptions for medications that people are becoming addicted to such medications (n.p. 2010). People can buy prescription drugs without ever having to leave their homes, by using their computers. Prescription drugs can be purchased online. The national pharmacy group, in an article by Martin and Stein, noted, Internet drug sales are projected to hit $75 billion this year (n.p.). Mark Trouville, an agent for the Drug Enforcement Administration from Miami, was quoted by
8 Martin and Stein s article, by saying: Tampa (is) the Ground Zero for Internet pharmacies (n.p. 2010). Often, most prescriptions can be written after just one phone call to a doctor, in which a person basically states what drugs they would like, and the doctor writes the prescription (Martin and Stein 2010). Buying prescription drugs online has become extremely popular, due to its convenience. One of the significant warnings for people buying prescription drugs from online pharmacies in other countries, was to be skeptical of the drugs that are being sold, because often people make artificial substances that are, in fact, not drugs (Martin and Stein 2010). People do not know what they are getting and what they received could be laced with deadly substances. Thus, on a local level, Florida is infamous for its prescription pain management clinics or pill mills. Often, people tend to be blinded by the fact that the Sunshine state is dotted by numerous pill mills. Currently in South Florida, one hundred seventy pill mills are operating (Collins 2010). Michalski mentioned that one pain management clinic in Largo, Florida, made over six thousand dollars in cash in one day writing prescriptions for medications (2010). Some doctors reap a huge benefit from writing prescriptions for drugs for some patients, because they are not taxed for such revenues, because cash transactions are not recorded. Some people travel out of state to obtain such drugs in Florida (Michalski 2010). Outside of pill mills in South Florida, it is not uncommon to see a number of out-of-state license plates of those patients who are in Florida pill shopping (Collins 2010).The reason for this is because Florida is known for dispensing prescription pain killers, due to lax standards by law enforcement. Thus, one must wonder who is at fault for augmenting the prescription drug epidemic. Doctors play an influential rule in the prescription drug epidemic that not only plagues Florida, but other states as well. Dr. Romain, a physician at Cosmopolitan Clinic, in Hernando County, is
9 banned from practicing medicine in Florida, but he is working alongside Dr. Reppy, who is known widely for prescribing copious amounts of oxycodone to Medicaid patients (Martin 2010). Dr. Romain is barred from practicing medicine after a California man took hydrocodone prescribed by Dr. Romain, via the internet, and died, as a result of overdosing in 2006 (Martin 2010). Unfortunately, there are many cases in Florida resulting in the deaths of many prescription drug abusers that are connected to unethical doctors, who, in most cases, have had their medical licenses revoked. Martin and Stein noted that it would not be out of the ordinary if one doctor prescribed over twenty thousand pills to eighty patients in one day (2010). Corrupt doctors, who write prescriptions for prescription drug abusers, often do this for a multitude of reasons. A doctor in Clearwater, Florida, wrote a prescription for Roxicodone for her patient, who paid her with cocaine (Martin and Stein 2010). Doctors are now exchanging drugs for other drugs, which further augments the illegal, and legal, drug epidemic in Florida and throughout the United States. Meanwhile, doctors accept cash from patients for drugs so that inaccurate records are taken, and some doctors may even succumb to exchanging prescription pain pills for sexual encounters (Martin and Stein 2010). It has become hard for doctors to differentiate between who has legitimate pain, or who is trying to just obtain prescription drugs (Martin and Stein 2010). Collins compares a doctor s ambivalence of whether or not to write certain prescriptions for some patients to walking a tight-rope (2010). Doctors are forced to make the decision to prescribe, or not to prescribe, and many end up prescribing these medications, even if they do not feel a patient necessarily needs such medications. This is because they fear they will be sued for malpractice, if they were aware of a person s ailment, and did not prescribe such drugs.
10 Furthermore, such doctors writing numerous prescriptions to fuel user s addictions do not fit the typical profile as drug dealers. Dr. Steven Rosenberg, a doctor from the Florida Board of Medicine (as noted in Martin & Stein 2010), spoke of doctors as (drug) dealers with an MD after their names (2010). In many cases, doctors do not fit the profile as drug dealers. This is because doctors, who have been found guilty for contributing to the prescription drug abuse epidemic, tend to be highly educated, from specialty fields in the United States, and have years of experience (Martin & Stein 2010). It is also difficult for law enforcement personnel to convict doctors, because they cannot do anything until a complaint has been filed, and patients receiving these drugs are not going to reveal who their drug dealers are (Martin & Stein 2010). For some patients, picking up prescription drugs from their doctors has become so frequent, that they do not even realize they have an addiction, and if they do realize they do, they just repress feelings of guilt associated with their behavior. Even if law enforcement officials charge doctors with writing such prescriptions unlawfully, it could take many months to bring such doctors to trial, and even if a doctor is convicted of felony charges, doctors may continue to practice. This is a prime example of one of the issues that expands, because the judicial system is overloaded with cases. Further, Florida has yet to enact a prescription drug monitoring system aimed at catching those who seek to doctor shop (patients who go from doctor to doctor obtaining various prescriptions to assist them with their ailments), in order to obtain prescription drugs, due to a lack of funding (Martin and Stein 2010). Without a system to monitor people s actions, they will continue their prescription drug abuse behaviors and fall further into addiction. Furthermore, research conducted by Bischof et. al. (2009) examined what kinds of treatments are available to individuals struggling with an addiction to prescription drugs. Bischof et. al. conducted research in a hospital setting to examine patients readiness to receive
11 counseling, and other such treatment, to help with prescription drug abuse (2009). Of those patients identified in the study, Bischof et. al., concluded that people would fall into three categories (precontemplators, contemplators, and preparators) based on the amount of selfcontrol and personal readiness to change and receive treatment for their addiction (2009). Most of the patients fell into the category of precontemplators, in which they did not feel very motivated to change their current drug use behaviors (2009). Of those sampled, the majority of patients were in favor of receiving counseling (2009). Thus, Bischof et. al. concluded that it would be advantageous to offer intake counseling sessions, in hospital settings, for those admitted for prescription drug addiction (2009). Some people may initially be afraid to seek counseling because of the stigma attached with receiving help from others, especially in certain cultures. Others may lack self-esteem and feel they do not have the capabilities to change their current addictive behavior (Morales & Sheafor 2002). Thus, other researchers (such as DuPont) have focused on educating society on the harmful ramifications of prescription drug abuse and have made a staunch effort to reform current policies, in hopes of reducing the number of prescription drug users and the number of overdose deaths. As stated in DuPont s research, the FBI noted that the number of overdoses related to prescription drugs is double the number of murders per year across the United States (2010). According to Sheriff Tom Knight, of Sarasota, Sarasota County was number one in the state of prescription drug overdoses, at 48 (mysuncoast.com 2010 n.p.). DuPont hopes that national public education efforts will be help reduce the number of prescription drug abusers and deaths (2010). One program seeks to educate youngsters on the ill effects of misusing prescription drugs and sharing medications with friends (DuPont 2010.). Other programs would focus on educating doctors on signs to recognize patients who are abusing prescription drugs and
12 to evaluate the validity of their patient s claims, before writing a prescription (DuPont 2010). These efforts will hopefully educate those who think that prescription drugs are safer than illegal drugs, by showing these people that prescription drugs are dangerous and can used illegally if misused or shared with others. Further, efforts to monitor patients will reduce the number of patients who are deemed as doctor shoppers. Florida has yet to adopt Prescription Drug Monitoring Programs (PDMP) but is expected to establish such systems in early December (mysuncoast.com 2010). Such systems would not only monitor patient information, but what doctors are prescribing as well. Moreover, DuPont s research indicates a need for drugged driving legislation (2010). Just as people get into accidents that are the result of drinking and driving, many accidents are often the result of a driver being under the influence of prescription drugs. As mentioned in DuPont s research, those drivers twenty-one and over with a Blood Alcohol Content (in regard to prescription drugs) over the legal limit should face the same consequences that drunk drivers do (2010). Those found to be under the influence of prescription drugs, under the age of twenty-one, should be prosecuted in the same way someone under twenty-one would be, if they were found to have alcohol in their system (DuPont 2010). It is necessary to have such legislation because driving while under the influence of prescription drugs is just as dangerous as driving under the influence of alcohol, even though both kinds of drugs are legal. Furthermore, legislators in Florida are working to enact two bills, in hopes of reducing the number of prescription drug abusers and deaths. It is essential that legislators develop policies that seek to combat the prescription drug epidemic infecting Florida. House Bill 225 would allow doctors only to prescribe a three day supply of various drugs to patients paying by cash (Michalski 2010). Often, users believe that paying in cash will make it difficult for law
13 enforcement and other officials to find out what they are doing, because there are usually no records indicating their purchases, since it was made in cash. Limiting cash paying users to a three day supply of prescription drugs will hopefully reduce the number of users. Senate Bill 2272 (Florida) is aimed at prohibiting doctors who have been convicted of prescription drug infractions from practicing or managing pain clinics. Further, this bill seeks to allow the Florida Department of Health to review doctors, pain clinic employees, and patient s records to catch any infractions that take place (Michalski 2010.). These bills seek to provide a watch dog effort to make sure doctors are practicing ethically and patients are not abusing or selling prescription drugs. Consequently, Sarasota County Sherriff s Department is seeking to crack down on prescription drug abuse in Sarasota County. Sheriff Knight of Sarasota County mentioned the number of home invasions, in which burglars were stealing prescription drugs from others medicine cabinets, is on the rise in Sarasota (mysuncoast.com 2010.). As a result, Sarasota has established the Pharmaceutical Diversion Investigative Unit, which seeks to eliminate the prescription drug abuse problem in Sarasota by educating high school students and the community about the dangerous effects of prescription drugs and setting up boxes where people can drop off unwanted prescriptions for the Sheriff s department to dispose of properly (Sarasota County Sheriff s Department 2010). Local law enforcement brings awareness of this issue to the community, provides resources for people who may be struggling with addiction to prescription drugs, and has specific locations where people can drop off prescription drugs so that they will not end up in the hands of the wrong person. Legislators in Florida, Sarasota County Sheriff s Department, and local organizations such as Families Against Addictive Drug Abuse (FAADA) work collaboratively with one
14 another to help eradicate the prescription drug abuse issue in Florida. Since this issue is so widespread throughout Florida, it is necessary to have local groups involved in this effort to assist those on a local level. According to the FAADA website, three elements comprise their efforts, which are: to educate the public, network, and act as advocates (2010). This organization hopes to educate the community, using websites, billboards, school programs, and to distribute information on prescription drug abuse (FAADA 2010). By networking with other local and state organizations, they hope to make a difference, not only in Florida, but nationally as well (FAADA 2010.). Also, as advocates they hope to play an influential role in proposing legislation to implement harsh policies to curb the prescription drug problem and closer examining of doctors and patients. Though FAADA may be a local organization, they play an influential role in providing help to those who struggle with prescription drug addictions and their families, as well as slowing the progression of the prescription drug issue in Florida and the United States. As a result, one can see that prescription drug abuse is prevalent in the Sunshine state. This requires that law enforcement officials, medical professionals, legislators, and citizens play an essential role in bringing awareness to this problem, in hopes of reducing the number of fatalities and people addicted to these dangerous drugs. From a psychological perspective, many may begin using as a means of self-medication, using as a means of escape and choosing not to receive counseling, due to social stigma attributed with receiving help, suppressing appetite and other emotions, availability, the fact that such drugs are legal and prescribed by doctors, and lack of connection with family, friends, and school environment. Users, much like doctors, who are fueling the prescription drug epidemic, can come from a variety of backgrounds and do not fit the commonly held stereotypes as prescription drug addicts or dealers. Floridians are coming to the realization that this epidemic should not continue. Legislators are working to bring about
15 bills that would only allow a three day supply of prescription drugs to those paying in cash and close monitoring of doctors supplying pills, and patients engaging in doctor shopping. This type of monitoring system is scheduled to begin in December of this year. In addition to legislation, local law enforcement officials and Families Against Addiction Drug Abuse (FAADA) are working closely with each other to bring awareness and provide valuable resources to Sarasota and surrounding communities. Meanwhile, research has led legislators to enact laws, such as drugged driving laws, which seek to eliminate the number of users who abuse prescription drugs and drive. Research has discovered that some ways of preventing prescription drug abuse is by forming tight associations with one s immediate social environment, and having preliminary counseling intake sessions for those admitted in the hospital for prescription drug abuse. Hopefully, Florida will get a handle on this epidemic and seek to steer people away from abusing prescription drugs, towards enjoying what Florida has to offer its residents, in terms of beaches and other outdoor activities.
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