Drugs of Abuse, the next part

Recently our local county sheriff was interviewed and communicated this idea: That while heroin is a growing problem for our area, prescription drug abuse was a greater and more harmful problem. http://www.upnorthlive.com/news/story.aspx?id=905806#.VE9zv_nF9yw

More harmful than heroin. 

Most prescription drugs that are abused are opioids. That is, they come from the same family as heroin. Prescription drugs are easier to find without the seedy drug dealer, right in your own home or a friend's home or someone's purse or...well, the possibilities are endless.

Washington, D.C. October 7, 2013 - Michigan has the 18th highest drug overdose mortality rate in the United States, with 13.9 per 100,000 people suffering drug overdose fatalities, according to a new report, Prescription Drug Abuse: Strategies to Stop the Epidemic.

The number of drug overdose deaths - a majority of which are from prescription drugs - in Michigan tripled since 1999 when the rate was 4.6 per 100,000. Nationally, rates have doubled in 29 states since 1999, quadrupled in four of these states and tripled in 10 more. (http://www.healthyamericans.org/, 2014)

At a seminar for continuing education that I attended last year, a state police officer described how people, not just kids, were grabbing prescription drugs from their grandparents or sick relatives and taking them to parties where they would put all of the pills into a container. Then they would reach in and take pot luck whatever pill they happened to grab. It could be a mix of blood pressure medication, thyroid meds, pain killers, water pills; it didn’t matter. This is a new and scary kind of Russian roulette.

Someone described to me how a family member was so addicted to pain killers that they would take topical pain patches and open them up and lick the medication from them. People crush painkillers and inhale or inject them. There are new forms of certain prescription drugs that are crush proof to try to stop this practice and make the drug less desirable.

And then there is the money question. In the light of the economy and the uncertainty involved with being able to receive medical care, people are taking advantage of selling their prescription drugs, whose cost in the first place is hard for these same patients to manage.

NEW YORK (CNNMoney) -- Prescription drug abuse, now the fastest-growing drug problem in the country, has created a ballooning street market for highly-addictive pain relief, anxiety and depression drugs. Given the money involved, it's no wonder.

Here's a sampling of the street prices for a single tablet of some commonly trafficked drugs, compared to their retail prices:

-Oxycontin: $50 to $80 on the street, vs. $6 when sold legally

--Oxycodone: $12 to $40 on the street, vs. $6 retail

--Hydrocodone: $5 to $20 vs. $1.50

--Percocet: $10 to $15 vs. $6

--Vicodin: $5 to $25 vs. $1.50 (CNN, 2011)

These are per pill prices, not per quantity. Most people I know are strapped for money. This is pretty temping. Big bucks for hardly any effort. 

So, what can we do about it?

Do not share, sell, or give away prescription drugs. There are so many reasons not to, but let’s see if saving a person’s life is a value you can work with.

Turn in out-dated and unused prescription drugs to your police department. I know Benzie Police Department has a locked container to drop drugs in for safe disposal. Some pharmacies have yellow jugs for disposal of old drugs.

(http://www.munsonhealthcare.org/News/Default.aspx?sid=1&nid=340, 

http://www.michigan.gov/msp/0,4643,7-123-1579---,00.html)

Do not flush your old prescriptions down the toilet, particularly if you have city water. What goes around comes around, and traces of prescription drugs are showing up in city water supplies as well as non-prescription drugs.

Don’t assume someone will not steal your drugs. 

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For your information: There are a lot of people contesting which drugs are controlled substances. As of October 2014, this is the current standing:

Definition of Controlled Substance Schedules

Drugs and other substances that are considered controlled substances under the Controlled Substances Act (CSA) are divided into five schedules.  An updated and complete list of the schedules is published annually in Title 21 Code of Federal Regulations (C.F.R.) §§ 1308.11 through 1308.15.  Substances are placed in their respective schedules based on whether they have a currently accepted medical use in treatment in the United States, their relative abuse potential, and likelihood of causing dependence when abused.  Some examples of the drugs in each schedule are listed below.

Schedule I Controlled Substances

Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine ("Ecstasy").

Schedule II Controlled Substances

Substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence.

Examples of Schedule II narcotics include: hydromorphone (Dilaudid®), methadone eperidine (Demerol®), oxycodone (OxyContin®, Percocet®), and fentanyl (Sublimaze®, Duragesic®).  Other Schedule II narcotics include: morphine, opium, and codeine.

Examples of Schedule II stimulants include: amphetamine (Dexedrine®, Adderall®), methamphetamine (Desoxyn®), and methylphenidate (Ritalin®).

Other Schedule II substances include: amobarbital, glutethimide, and pentobarbital.

Schedule III Controlled Substances

Substances in this schedule have a potential for abuse less than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence.

Examples of Schedule III narcotics include: combination products containing less than 15 milligrams of hydrocodone per dosage unit (Vicodin®), products containing not more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine®), and buprenorphine (Suboxone®).

Examples of Schedule III non-narcotics include: benzphetamine (Didrex®), phendimetrazine, ketamine, and anabolic steroids such as Depo®-Testosterone.

Schedule IV Controlled Substances

Substances in this schedule have a low potential for abuse relative to substances in Schedule III.

Examples of Schedule IV substances include: alprazolam (Xanax®), carisoprodol (Soma®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®), temazepam (Restoril®), and triazolam (Halcion®).

Schedule V Controlled Substances

Substances in this schedule have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics.

Examples of Schedule V substances include: cough preparations containing not more than 200 milligrams of codeine per 100 milliliters or per 100 grams (Robitussin AC®, Phenergan with Codeine®), and ezogabine. (US Department of Justice Drug Enforcement Administration, 2014)

Inappropriate Songs to Sing at Your Workplace, again

I made the mistake of telling my friend at work that I despise, detest, and totally hate "McArthur Park" and now she keeps singing it to me. I get her back by singing Beatles songs, particularly "I am the walrus". So there!

Today, songs from childhood days were playing in my mind. Songs about duckies. You know, quack quack? Remember the one little duck with the feathers on his back? And this lead to the song about the little black bug swimming in the water.

Thinking back to childhood, a whole cornucopia of music comes to mind. I was real lucky and blessed to have a variety of music growing up, everything from Hank Williams Sr to Peter and the Wolf. Burl Ives and the Kingston Trio filled my repertoire up with songs like Ann Boleyn and The Fox, and my favorite Mangwane Mpulele.

So much music, so little time.

But music seasons the day. I use music like a frightened person whistles in the dark. It brings back good times and reminds me of better days. Hope it does the same for you.

Going to the Doctor

The world sure has changed.

When I was a child, there was one doctor you saw for everything that ailed you. Dr Kamp delivered me, treated me for everything from chicken pox to taking a BB pellet out of my ear to cleaning up a cut on my knee that I got from kneeling on a piece of broken whiskey bottle in an old village dump behind my grandparents.

Well, ok, Mom had a bone doctor. Dr Clark was as much a part of our lives as Dr Kamp was. We saw Dr Sarya for our orthodontist, Dr Ross for our dentist. My grandmothers both went to Dr Willoughby. But, we didn't have an ear, nose, and throat specialist, or a dermatologist. Dad did go to an open heart surgery pioneer when he had his bypass surgery, and that was over in Milwuakee. That guy gave us thirteen extra years with Dad, and I am very grateful for that. That in mind, there is certainly a need for specialists.

I used to think that a doctor's work day was more similar to a workday you or I am familiar with, with the earnings based on production or care given. I had no idea what being a doctor really meant. To this day, I don't have a clear understanding, but I am getting a pretty good picture. It really made me angry at what I perceived to be the doctor's wage for visit. So much money for ten to fifiteen minutes of his or her time!

What I didn't realize is how much work a doctor is actually doing.

1. Today's doctors need to do a lot more paperwork than ever before. Due to insurance changes, HIPAA, legal requirements, new medications and changes in how medications can be prescribed, there is a whopping lot a doctor has to do on paper or on computer. If he or she doesn't create the paperwork, they need to find if paperwork has been completed historically, such as medication agreements. Doctor's also have to do prior authorizations, or at least have their nurses do them. Some insurance requirements make providing care a nightmare with the burden of proof of the patient's needs resting on his primary care physician.

2. Due to the internet, patients come in with information that may or may not be correct and healthy for them. The doctor is constantly challenged by a patient's "education". Add in pharmaceutical advertisements on TV and in magazines, and popular opinion, and this can be a pretty good mine field for a doctor to maneuver through in order to provide correct and healthy treatment for the patient.

3. A doctor is constantly interrupted. He spends time listening to the patient during the appointment and has to chart this visit. But there are prescription refills to address, appointment requests, calls from other doctors or health care providers to discuss other patient cases, and more. And always it seems that just after a patient finishes his appointment, he remembers that he forgot two or three important things he needed to ask the doctor about.

4. Patients do not follow orders.  There are people who actually get huge kicks out of not following doctors orders and  how daring that is. Then they come back, complaining about the same symptoms and blame the physician for not taking care of them. I am just as guilty of non-compliance: I am overweight, and have been told by years by my physician that I need to address this. I am still overweight and getting more health issues as time goes by. It is within my power to gain health, but it is so much easier to ask the doctor for a simple remedy. Self discipline is just too hard..

5. Some patients are just lonely or needy. Seeing the doctor may be their only social event. They spend a lot of time talking with the doctor, asking to talk to their doctor, demanding to get appointments for this or that, and being traumatized when the doctor can't see them.  These folks take a lot of the doctor's time as well as the office staff's time. This is just a fact.

6. Doctors have feelings too. A doctor can't stop taking his or her appointment's for the day when they hear a friend or family member has passed away or other bad news. Sometimes, patients will take out their bad day on the office staff and the doctor. A doctor can't take this personally: Sick people are not at their best. Frightened people may lash out too, when lab reports or diagnostic imaging gives bad news.

7. Doctors have had a lot of schooling, and are continually learning. They have a lot to remember. I went to school for four years to become a medical assistant. I took some classes twice because I didn't get it the first time around, and I didn't want to risk other's health because I didn't understand what I was learning. This wasn't all that long ago, and I have already forgotten terminology and techniques. I am in an administrative position, and glad of it. I  had a two-year program that took me four years. How long does it take to become a doctor? And how long does it take to pay off those student loans?

How can a patient help his PCP have a more productive visit?

Seek care when you need it. Understand what is an emergency and what is not an emergency. If your situation is not clear, call and talk with a nurse about your symptoms. Listen to your doctor. Take medications as directed. Don't save antibiotics for later. Understand that your PCP sees many people. Be involved with your care and aware of your symptoms. Have an annual wellness exam. Don't take your bad day out on your doctor and his staff. Do make sure your insurance and address and phone number are up to date in your chart. Specify where you want prescriptions to be sent.  When you call your doctor's office, please identify yourself and please state what you are calling about clearly. Don't expect your doctor to address fifty issues in a ten minute time span. Don't bring family members in to your appointment to be seen for a problem they are having. They need their own appointment.

My mom used to bring all of us kids in to see Dr Kamp when one was sick. It made sense as a mom, but was really hard of Dr Kamp. He finally told her she couldn't do that anymore. Sometimes we just don't think. It is hard to remember that you are just one of many patients, particularly when you are really sick. You are important! So are the other patients.

Drug Abuse, step one:

When you think of drug abusers, what comes to mind?

Now, think again about drug abusers, and substitute the image you visualized with a grandmother, a teacher, a minister, college student, or even yourself.

I used to think that marijuana was THE gateway drug. Now I think it is pain relievers, starting with harmless little old aspirin. We have been taught for years to take a pill and the pain will go away. So convenient! Now that I am in my fifties, I am noticing that there is a lot more pain and a lot less time so it’s a Tylenol here and an Aleve there. If I don’t take too many and have a variety, that is better, right?

This is me normally as a teen. Honest!

So, plain old over the counter pain killers are commonly abused.

These are the gateway drugs, if you ask me. It was in high school that I first heard of a way to get high with aspirin. Just take it with a Coke, on an empty stomach is best. This was when aspirin was still ok for kids to take. Reyes Syndrome was not a new notion in those days, and in truth a school mate had died from Reye's Syndrome. But it was not a firm theology to avoid aspirin yet then.

The other issue with aspirin, Tylenol, ibuprofen and similar drugs is that we do not think of them as being drugs, not really. A drug is something like Tylenol three or Percocet. But anything that is medication consists of drugs, a fact to keep in mind. Also, too much of any of these meds is bad for your body. Do you really want to have issues with bleeding ulcers or liver damage?

Do not exceed the prescribed dosage on any medication. This is not a good idea.

It is also a very good idea to check your other medications for interactions. I was prescribed a medication for restless legs. I got a headache, and thought nothing of taking an aspirin for it. Big mistake! On that particular medication just about any and all other medications interacts badly! I stopped that medication pronto. It was too scary. Read those drug inserts, folks, they can save you a lot of grief!

The thing is, our brains are tricky manipulative little buggers who figure out that if one pill helps the pain, another would help more.  Like Pavlov’s dog, an ache or pain is the bell that calls for a reward of pain relieving bliss. Instead of physical activity such as stretching or walking we baby the pain with pills. Instead of quiet rest with a cold compress on the eyes, we keep reading or working on the computer or driving. We of this current culture, with all its gizmos and doo-dads and time-consuming things, do not know how to rest.

Read the label and the package insert for safe use of medications

This is all basic stuff. What do I mean by drug abuse?

Taking more than the prescription reads, or more than is suggested on the package of over the counter medications, is drug abuse. You have a doctor written prescription for pain medication. You only use it when you need it, it is to help you. But if you take more than the doctor has prescribed, that counts as drug abuse. That means your prescription will run out sooner than it is written for and you will be shocked by the fact that the doctor will not do an early refill for you.

Say your sister has a migraine medication. You get a migraine. She gives you one of her pills. This is illegal. It is also unsafe. Say your sister is a heavy person and you are thin. The dosage is designed for her, and you may actually receive an overdose. Never take a drug that has not been prescribed for you.  You wouldn’t borrow someone’s prescription glasses would you? Prescriptions are not one size fits all.

Taking or using medications in a way other than they were prescribed is drug abuse. For instance, crushing an extended release pill is not how it is prescribed. It is designed for the medication to be released over time. When a pill like this is crushed, the medication is felt all at once. Don’t cut pills that are not designed to be cut. Don’t open capsules. If swallowing pills is difficult for you, tell your doctor or pharmacist. There may be an alternative method for that medication.

I am working hard on developing good habits with medications. This includes reading the insert that comes with prescribed medications and sticking to the suggested dose on the packages. Before I became a medical assistant, I was pretty ignorant about these things. If you cannot read or understand the inserts, ask your pharmacist. They can also tell you about possible interactions with other medications you may be taking.  There are also drug books that are easier to read for people without medical degrees, and websites that help.

Inappropriate Songs to Sing at the Workplace, Second Verse

“Great big gobs of greasy grimy gopher guts…”(lyrics)

I almost sang that out loud at work. My brain radio throws up some crazy music without warning and fully prepared for me to be singing out loud with. The other day had Gilbert and Sullivan ( The Nightmare Song) running rampant in my brain. On yet another day, I had Salt and Peppa’s “Let’s Talk About Sex” in my mind. (Salt N Peppa)

 

Which cues this next thought: I remember the first time I saw a little kid of about three or four singing George Michaels “I Want Your Sex” and dancing to it, just like she knew what she was singing. I was kind of shocked by this!The problem is, the song is fun and has a good beat. It gets wedged in your head. (I will bet you are singing it right now!) Mind you, there are worse songs, lyrically, on those Kids Bop collections.( 8 Worst Kidz Bop Songs)

(Good gravy. Just because I said the song had a good beat, I now have the theme to American Bandstand playing in my head. Thanks, Barry Manilow.) (American Bandstand Theme)

Beyonce’s “Put a Ring on It” is another one that kids seem to really jam to. There are babies in videos online just jamming down to this song, which is kind of fun. Even the spoofs are worth watching for a good belly laugh.(single ladies baby dancing)

But to hear the song is to watch the video for me, and I just can’t get my head around all that dancing in high heels with bathing suits on. Not just cause I am jealous of those women who both can wear high heels and look awesome in one piece suits, either.

Work doesn’t help either. Sometimes hold music is pretty drowsy stuff. Today I heard a song about chickens. Yep, chickens. Done to a swinging 40’s beat. I was amazed to be able to complete the call coherently, it took me so by surprise.(The Chicken Song)

My husband, bless his heart (and I mean that in a truly southern way), can burst out with C.W. McCall songs and be able to sing every single word; intonation, innuendo, and all. I am not just talking about “Convoy” and “Wolf Creek Pass” either. And he does sing every word.(CJ 5)

The other day at work when the radio was quiet, he broke out loudly and proudly with “Jeremiah Was a Bullfrog.” The people all around him fell over in awe.  Or was that ow? One thing we both learned in choir is how to project, and that boy can out project a Broadway singer. (Joy to the World)

The problem is, music gets in to the brain and it stays there. It is hard to not hear music, especially if it is an annoying song that you never want to hear again, ever. Like, oh, “McArthur Park.” I so very much hate that song. Why is the cake so traumatically important? Who cares about the cake? Non-the-less, in my brain radio, that despicable song lives on. (Very Dreadful Song)

Great. Now I have the theme to Dispicable Me in my mind. Wait, I like that song! (Dispicable Me)

Antisocial

This post is written by my husband, Tom Martin.

 My wife is very social.

  She enjoys interacting with people. It doesn't matter if she is at a party or a funeral. She loves to go to yard sales and talk to the people who are having it. She will even have a ten minute conversation with someone she knows if she happens to bump into them at the store.

 

I, on the other hand, am antisocial.

 A lot of people misunderstand that. Some think that that means that I am grumpy. But I am not,

at least not always. I am frequently happy, and even silly.

 Some people think that I mean that I don't like people, and I have been known to say it that way myself.

But that is not accurate either. I do like people. Just this weekend, I was at a garage sale and saw a Star Wars comic book for sale. I knew that a co-worker, someone I have almost never talked to, would love it. So I bought it and gave it to her the next day at work just to make her happy. Not something that someone who didn't like people would do.

 So what do I mean when I say that I am antisocial?

  I mean that I don't like socializing with people. I don't like the noise. I don't like the confusion. I don't like having to pretend that I am interested in what someone is blathering on about and wasting my time when I could be accomplishing something.

  I also don't like the demands on my time that people think they can make just because they know me.

 They had a company picnic at the company that I work for this past weekend. I didn't go. So this morning, the company H.R. person from the downstate branch came out to ask me why. I dodged the question, since it was none of her business. But it bothers me that they think that I should have to explain why I didn't give up part of my free time for their silly party.

 The only person I cheerfully sacrifice my free time for is my wife. And that is because I love her more than I love me.

 I don't feel bad about being antisocial. It can actually be rather convenient. Where I work people come and go all the time. But since I don't spend a lot of time learning about their lives, and forming emotional bonds with them, It can be weeks after they're gone before I notice, and I seldom miss them.

 This carries over to people who have died.

 My dear wife grieves over the death of people she hasn't seen since college, thirty-three years ago. If I haven't seen someone in two or three years I may feel a few seconds sadness, and then I am done.

 So if I don't socialize with you it's not because I don't like you, or because I am a grump. It is simply because it does not come naturally to me.

Depression

I am one of millions of people who struggle with depression. I am taking medication for it. Some days, even with the medication, it is really hard to get out of bed and get on with living. Sometimes I feel very much separated from people; Friends, family, coworkers feel like they are outside of an invisible wall and I am on the inside, alone. Some days I wish I could cry, other days I am weepy for no reason.

Sometimes I feel like an abandoned house, broken down and empty

Depression comes if your life is good or if your life totally sucks. Depression is not just a feeling. It can be a symptom as well as the disease. It is hard to act normal when you have depression.

We do a lot of things to ourselves that tend to make us open to depression. Alcohol is a depressant. Constant stimuli, such as being on the computer for hours on end, sleeping with the TV on, never taking any mental rests, can fatigue a person until they have no energy left and are depressed.

Robin Williams was such a hero? Advocate? Model? For people who suffered from depression. He was aware of his demons. He experienced, vicariously, the lives of others who were depressed in his acting career, whose stories both turned out with happy endings and tragic endings. As a result, some people are judging him harshly for his death, calling him a coward. As a result, some people may think that if he didn’t find any reason to keep going, then why should I try? 

As a result, depression is in the spot light and mental health is being evaluated. The price was too high, but this could be a good thing. Maybe the powers that be will recognize that something must be done, help is needed. This is not a fake or imagined problem.

Robin Williams is not the first, nor the only person to be overwhelmed by depression. He is not the only famous person, not the only man, not the only person who seems to have it all. Sadly, he will not be the last person overwhelmed by depression, 

So we survivors grieve.

Grief is not the same as depression. Grief is a healing process; even anger can be a part of the healing.  But depression is like a black hole, an opposite of feelings. It is beyond numbness. It isn’t death, but it isn’t living either.

In my life, there have been situations that have caused me to have a bleak outlook for myself. Situations that convinced me that I was a ruined individual, that I deserved bad treatment, that I was fat, useless, ugly, an abomination. I was convinced that I could not do even simple things like drive a nail into a board, drive to work, or do anything right. I tolerated humiliating experiences because I truly believed I deserved it. Toleration does not mean that I walked through these things without it affecting me.

It has taken years to see what had really happened and to change my opinion of myself. The depression continues, though, because life keeps happening and keeps not being easy. I am continually healing.

There was a time when I didn’t want to heal. I wanted to die. I hated who I was. I was full of shame and humiliation. I drank. I did acid. I was stupid. I drove around for hours, trying to work up courage to drive into a tree or into a lake and just die. Why I didn’t just leave the situation on my own strength, I do not know. I felt like a prisoner. I felt worthless.

But I didn’t have enough courage or weakness to actually kill myself. And I survived.

Before that time of my life, other things happened to me that made me think I was ruined or stupid. After that time, things happened to make me think I was incapable or crazy. Living sometimes just beats on a person.

And then, hormones stepped in and screwed things up even more.

In spite of everything, I am still alive. I have gone back to college and earned a bachelor’s of applied science degree. I took the exam and am a certified medical assistant. I can use a computer and learn new things. I am remarried, to a childhood friend, and we lend each other strength and courage. Sometimes, we just allow ourselves to be weak, but only in front of each other because we trust each other and we can.

I have a faith in God, which gives me reason to have hope. Without hope, people perish.

The battle is not over, not until I die. Life is in constant flux. Hormones are regularly throwing me for a loop. I have a long way to go to improve my self-image and my health.

They are now saying that Robin was recently diagnosed with a terminal disease. We have amazing breakthrough in health care, but we also keep people alive beyond quality of life.

I believe that live is precious and not a thing to be carelessly disposed of.

But I also believe, for myself, that I would want to die before being unable to live keeps me in bed, with strangers wiping my butt and bathing my helpless body, with no more mind left to think with. I am terrified of Alzheimer’s or similar dementias. I fear having a stroke.

I used to harshly judge those who committed suicide. Then I started learning that I don’t know everything, including what that person’s last thoughts or prayers were. I am not God to judge people. I am a human being. I have wanted to die, too. 

It does seem selfish that they have died that way and left the rest of us to face life afterwards. More depression comes into the world because of this. Survivors live in shadows, asking was it something I did? Why didn’t they love me enough to stay?

I, and many others who suffer with depression, currently choose to stay. But I will not curse at the ones who choose not to. I will pray for those they left behind.

Faith is the evidence of things hoped for.. and it is what keeps me going forward.