Friday, October 25, 2013

Turn in Your Drugs? Just Say No!

Tomorrow (October 26, 2013) is National Drug Take-Back Day.  The Drug Enforcement Administration (DEA) says this day "aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse of medications."
This has been a twice-a-year event since October 2010, and tomorrow will be the seventh such specially designated day.

On the last National Drug Take-Back Day this past April, the public turned in nearly three quarters of a million pounds (or 371 tons, if you are among my "tons of friends" who like the word tons better). Press releases from the DEA offer some insight into the rationale underlying the program:
According to the 2011 Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health (NSDUH), twice as many Americans regularly abused prescription drugs than the number of those who regularly used cocaine, hallucinogens, heroin, and inhalants combined.   That same study revealed more than 70 percent of people abusing prescription pain relievers got them through friends or relatives, a statistic that includes raiding the family medicine cabinet.  
Although I am neither a lawyer nor a statistician - nor do I play either of them on TV, nor did I stay at a Holiday Inn Express last night - I love to look at sentences like that and examine what they really mean.

More than 70% of people using prescription drugs got them through "friends or relatives."  I am walking the streets and happen to see my buddy Jim.  "Hey Jim! Ya got any Oxys?"  (For the uninitiated, this is short for oxycodone, a potent prescription analgesic derived from morphine, which in turn was derived from the opium poppy.  These drugs are all generically referred to as opioids.)  Jim says he does.  We settle on a price, and both walk away happy.  Is Jim a drug dealer? You could say that.  But he is also my friend, and he counts in the statistic cited above.

So what are we really worried about here?  Mama is going out to get the mail. She slips on wet grass and falls, resulting in a rather nasty fracture of her ankle. She goes to the hospital and gets operated on by an orthopedic surgeon.  When she is discharged, the orthopedist estimates how much pain medicine she'll need for how long and writes a prescription for that.  As it turns out, she doesn't use anywhere near all of it, and it sits in the medicine cabinet.  Her teenage son or daughter or friends of theirs visiting the house discover the pills, and you know what might happen from there.

So what should you do?  Well, first, before you open the medicine cabinet, look in the mirror on the outside of it.  Ask yourself if you are the sort of person who might get addicted to opioids.  This requires a bit of introspection.  When you were taking the pills prescribed for some painful condition, did you always take them solely because you were in pain?  Or did you ever take them partly because you liked the way they made you feel?  Because they seemed to make the day go better?  Because when you took them your mood was better, you were less likely to get into an argument with your spouse, less likely to yell at the kids when they didn't really deserve that?  All of those other reasons for taking the pain pills - reasons other than straightforward pain relief - suggest you may have a propensity for getting addicted.  And maybe once you no longer need the pills for the problem they were prescribed to help with, it would be better to get rid of them.

As you might guess, though, that propensity toward addiction is more - much more - of a problem for people with chronic pain, who can't just get rid of the pills any more than they can just get rid of the source of chronic pain.  So those unfortunate folks have to ask themselves those questions about why they're taking the pills frequently, if they want to make sure they aren't slipping from seeking pain relief into seeking escape from life's annoyances or seeking mood elevation.

If, however, you are confident that you are not inclined toward addiction - maybe the pills just don't really do anything for your mood (not everyone experiences euphoria from opioids), or maybe you just don't have those kinds of at-risk personality traits - you probably don't see any good reason to get rid of your pain pills.  After all, you never know when you might need them for something else, and as long as they're still "good," why throw them away?  That's just wasteful. (By the way, most prescription drugs have a shelf life that goes far beyond the expiration date on the bottle.)

If you're not worried about yourself, and you have no irresponsible people living in your household, then why would you turn in your drugs?

You wouldn't.  No, you would, instead, respond to this program by asking, "What? Have these people lost their minds?"  And you might make a list of the reasons why this is a dumb idea.  (1) It's wasteful to throw away perfectly good medicine. (2) If I need a strong pain reliever in the future, I can just go to the medicine cabinet instead of bothering my doctor.  (3) If I had turned in my drugs and had to go see my doctor for an evaluation resulting in the issuance of a new prescription, his records would reflect the old prescription and the new one, and he might get the wrong idea about how much pain medicine I'm using, unless I remembered to tell him I used only half of what he gave me the last time and turned in the rest. (4) My primary care doctor never likes to give anyone more than ten pills of a controlled substance, because he always feels like Big Brother at the DEA is watching him, and any time I ask him for pain medicine, I get the uneasy feeling that he thinks maybe I'm a whiner who should just "walk it off."  So if I hold on to the extra pills left over from the orthopedist who operated on my broken ankle, I can avoid all that.

I'm sure you could come up with some more reasons of your own to add to this list.

You probably know, if you're a regular reader - and especially if you read my essay on New York City Mayor Michael Bloomberg's anti-Big Gulp campaign - that I am an avowed skeptic regarding any government programs based on what folks in government think is good for us.

Just in case you thought I was going to overlook an opportunity to skewer Big Pharma, there is funding for a public education campaign about this program from a company than makes opioids.  Turn in your drugs, and we get to sell more of them when you need them later.  Yes, I know, I'm just a cynic.

So, do I think you should turn in your drugs?  If you're like most people, Just Say No (credit to Nancy Reagan, although she was looking at a different aspect of the drug problem when that tag line was developed).  But there is a certain value in this program.  I hope it will get people to think about whether their own use of prescription opioids might not be solely for pain relief, that maybe they like the mood elevating effect, and that could suggest they're at risk for getting addicted. And I hope it will get people to think about whether prescription opioids in the home might be found and abused by teenagers or other irresponsible persons, in which case taking steps to secure potentially dangerous drugs is the logical solution.  This might mean turning them in, or it might mean locking them up.  If you have a potentially irresponsible person in your household, you should no more leave a dangerous drug unsecured than you would leave a firearm unsecured.

So, tomorrow ... have a nice day.  And hold on to your drugs, unless you're taking them just to have a nice day, or you have another good reason to turn them in.

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