Download Artiaga Nicole Artiaga Professor David Wirthlin Writing 39C 12

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Nicole Artiaga
Professor David Wirthlin
Writing 39C
12 March 2014
The morning of August 16, 1977 the death of legend, Elvis Presley, saddened the hearts
of many. At the humble age of 42, many were shocked to hear the reason of his death was a heart
attack. Not surprisingly, sometime after his death the cause was labeled as drug overdose.
Presley’s personal physician, Dr. George Nichopolous, “began treating Presley in 1967 and was
his personal physician from 1970 to his death”(Brown, Andrew, 1). Naturally, Presley’s fans put
Dr. Nichopolous partly up for
blame for his death; one even
tried to shoot him. Medical
history indicated that the
number of prescriptions
Presley was taking kept rising
instead of staying roughly the
same. It wasn’t until 1979,
“when he first had to defend
himself [against the Tennessee Medical Board] against charges of excessive prescribing 12,000
pills and injectable to Elvis in the last 20 months of the singer’s life”(Brown, Andrew,1). Of
these 12,000 drugs, Presley was prescribed amphetamines, sedatives, as well as narcotics. “Still,
for his generous prescribing, no medical board of examiners has ever found Dr. Nick to be a bad
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man or a bad doctor, only a naïve one perhaps, and too compassionate”(Brown, Andrew,1). The
image you see are the prescription drugs that were prescribed by Dr. Nichopolous to Elvis
Presley in which were refilled numerous of times. To Dr. Nicopolous’ defense, he said he was
simply being to compassionate, however many didn’t buy into this excuse. An excuse of being
an overly passionate man should not be viable for ultimately killing a man. It’s understood that
doctors are under tremendous pressure and are ultimately in their profession to help create
healthier lives, but the United States as a community needs to take a step back and look what
over prescribing drugs, popularly codeine has led to.
The problem with over prescribing any drug is this: whether or not the patient is actually
having the alleged symptoms for said drug, they will eventually hold the prescribed drug in their
hand and doctors will not know for sure whether or not that patient will take that prescription,
finish that prescription, or give or sell that medicine to someone without the alleged symptoms.
Once the patient walks out of that pharmacy, the prescribed medicine could get in anyone’s
hand. A scenario of this is if a patient that just received their prescription has a rebellious child,
that child can sell it at school or the patient themselves could sell it but my point it that along the
line, the reason that medicine was prescribed isn’t validated anymore because there is no patients
that genuinely needs it. My point is, without the
doctors watching their patients take the drugs they
prescribe; they won’t know the patient actually took
them therefore it’s crucial for doctors not to
prescribe more than one patient needs. Additionally,
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it’s interesting to note who is doing the over prescribing. The prescription of codeine is on close
watch because it’s has a high susceptibility for patients to become psychologically and/or
physiologically addicted.
To be clear, the definition of a drug is “any chemical compound used for the diagnosis or
treatment of disease or injury, for the relief of pain, or the feeling it causes. A drug is either a
pharmaceutical (including both prescription and over-the-counter products) or illicit”(Center for
Disease Control and Prevention). Additionally an overdose is defined as “when a drug is eaten,
inhaled, injected, or absorbed through the skin in excessive amounts and injuries the body.
Overdoses are either intentional or unintentional. If the person taking or giving a substance did
not mean to cause harm, then it is unintentional”. Lastly, misuse or abuse is defined as “the use
of illicit or prescription or over-the-counter drugs in the manner other than as directed”.
Fatal drug overdoses have been steadily rising and becoming the leading cause of injury
death in the United States over a span of the last two decades. Overdoses would be less common
if doctors prescribed less amounts of medicine at once. As stated by The Center for Disease
Control and Prevention National Center for Injury Prevention and Control, “drug overdose was
the leading cause of injury death in the 2010. Among people 25 to 64 years old, drug overdose
cause more deaths than motor vehicle traffic crashes”. Additionally, interestingly “of the 22,134
deaths relating to prescription drug overdose in 2010, 16,651 (75%) involved opioid analgesics”.
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Codeine as by
definition, “is a mild
opioid widely used as an
analgesic in various age
groups, including various
pediatric settings”,
(Benini, 2). Furthermore,
said in Nursing 2013 by Lisa D. Watt, “to work as a pain reliever, codeine must be metabolized
to its active metabolite, morphine. Because of genetic differences in this metabolic pathway,
codeine’s effects can be unpredictable.”(page 62). Therefore, codeine has different effects on
different individuals. An enzyme, cytochrome P450 2D6, is the specific enzyme that makes the
conversion from codeine to morphine, however this enzyme is “more active in some individuals
(termed ultra-rapid metabolizers), [in which] convert codeine into morphine more quickly and
completely” (Benini, 2). With this in mind, if people metabolize codeine differently, why do
doctors prescribe them without checking if their patient can even metabolize this drug?
Additionally, following not asking if the patients can metabolize the drug, over prescribe? The
sequence of these two events could be upsetting because those that misuse the drug can take full
advantage of receiving an abundance of medicine at once. When the doctor routinely ask their
patients if they’re allergic to any medicine the patient’s not going to say whether they are allergic
or not, they just want the pain killers for other reasons.
I personally came across this issue about a year ago. I had gums removed by my dentist,
in which I wasn’t under anesthics, however after the procedure I was prescribed 10 codeine pills
for the pain. Because the codeine had a bad reaction to my body, I didn’t take more than one. At
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the time, I did some research about the effects of drugs and I was shocked to that most of the
articles I found were about how the prescription of codeine could go wrong. It’s understood that
“variations in a specific gene makes some people poor metabolizers [me being one of them] and
others ultra-rapid metabolizers. Poor metabolizers can experience typical adverse reactions of
codeine (such as nausea or voting) with little or no pain relief” (Watt, 62). The scariest part was
to know that in other people’s situations, those nine other codeine pills could have been sold to
someone who really doesn’t use them. Who knows what could have happened to those nine other
codeine if I hadn’t thrown them away.
To completely understand the risks of codeine, one must know that this drug could affect
a person at any point in their life; from as young as a fetus to as old as the last day of one’s life.
As for fetuses and young children, an addiction can’t occur because at their age their body can’t
process or break down the drug as well as adults can and can be fatal depending on the dosage.
Once more, there are risks for taking codeine at any age.
Not only in the womb can a fetus encounter opioid toxicity by the exposure to morphine
in their bloodstream, breastfed infants can also encounter opioid toxicity from exposure to
morphine. “The active metabolite of codeine, which [has been] prescribed to mothers who are
cytochrome P450 2D6 ultra rapid metabolizer”(P, 1), results to fetus’ and infants suffering from
central nervous system depression. Central nervous system depression leads to infants with
“unexplained episodes of drowsiness, apnea bradycardia, and cyanosis in suckling infants”(P,1).
Mothers addicted to codeine have left an insufficient reason to depress a life of an innocent child.
How do pregnant women even get a hold of codeine, one may ask; the answer to this due to the
over prescription of codeine. The more codeine that’s being over prescribed, the more codeine
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there is out on the street. The street codeine on the street, the bigger the black market for
prescription drugs grows and therefore the more available codeine is.
Codeine is prescribed at all ages and therefore can be very accessible to any age. For
example, in a study by Children’s ENT of San Diego, James W. Ochi wrote how severe throats
from tonsillectomy in children can last up to ten day, in which codeine is prescribed for relief,
“but has recently been banned by the Food and Drug Administration due to a recently recognized
risk of death”(page 2058). As a result, acupuncture has been another source of relief for children
ranging from two to seventeen years of age, instead of codeine which is a much safer and ideal
solution especially children.
This study brings to mind many questions about other children’s medicines in which
include codeine as well. Codeine cough syrup is prescribed daily to anyone with a severe cough
and is used to help numb the back of one’s throat to
help with pain. The only way to get hold of this
codeine cough syrup is by left over by over
prescription and in the hands of an irresponsible
person, the possibilities of bad endings goes on and
on.
A popular, “misuse of codeine cough syrup
began to draw attention of the national
media…codeine is abused unaltered in both pill and
syrup forms” (Agnich, 2445). “Purple drank”, “syrup”, “sizzurp”, “barre”, and “lean” are all
nicknames for the codeine cough syrup containing medicines such as promethazine,
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hydrochloride and antihistamine. These other medicines are prescribed for patients with upper
respiratory issues and to help with allergenic issues. The mix of these drugs and often soft drinks
or candy or even alcohol creates a sedative feeling as a result. This method of misuse caught the
media’s attention when former Oakland Raiders Quarterback JaMarcus Russell was arrested in
2010 for possession as well as allegations of routinely misuse. Additionally, the mention of this
concoction is in numerous popular rap songs today such as Mac Miller’s “Loud”, “I got codeine
in my cup, you can bet your ass I’m sippin’” and Lil Wayne’s “Just Lean” talks about staying
under the influence of codeine cough syrup in the song.
https://www.youtube.com/watch?v=_BYIEXzdnlY (listen up to 42 seconds)
Since the media has publicized “purple drank” the misuse of cough codeine syrup has
gone up tremendously and also apparently more popular in certain groups of individuals. In a
study by “Drug and alcohol dependence (2013)” concluded the “prevelance and risk factors
related to nonmedical use of opiods are similar between urban and rural residents; however rural
residents report codeine use more than their urban counterparts” (page, 156).
As of today, codeine is categorized as a controlled substance in Schedule II which is one
of the most regulated in the United States. The criteria for schedule II drugs include “having a
high potential for abuse, a currently accepted medical use with restrictions, and the potential to
cause severe psychological and physical dependence.” (Kuehn 862). Codeine of more than
ninety milligrams per dosage unit is considered schedule two, while under ninety milligrams per
dosage is considered to be schedule III drug which has even less prescription regulations than
schedule II. It’s important to keep in mind, who the one prescribing is, which is primary care
physicians. Because the role of primary care physicians is so general, it’s hard to tell what pain
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codeine is being prescribed for. Yes, codeine is a painkiller and has been very beneficial to many
in pain, without a doubt but this
drug is only for temporary use and
so therefore there becomes a point
of abuse and misuse. Doctors have
power to prescribe all kinds of
medicine to help sick
patients,however by abusing that
power and over prescribing United
States’ communities are being harmed instead of helped.
Because restrictions on codeine are already really tight, although might not seem, other
steps can be taken to limit the prescription and use of codeine. By simply reminding doctors of
misuse, abuse, and overdose statistics, they would feel inclined to keep a closer eye on how
much they are prescribing. By reducing all the prescriptions by a quarter, this would limit
patients being over prescribed by seventy percent and as for refills, the amount of refills if even
needed should be limited to a quarter of the original, instead of a whole new full prescription. If
at that point, the patient is still ill, another visit to the doctor’s office should be verified before
prescribing another dose. With a reminder of how much is being prescribed, the less codeine in
hands of patients that may not even need it the better. With less codeine on the streets and
eligible for the black market, alternatives to relieve pain could be beneficial to many.
Once the over prescription of codeine has gone down, those that are still in need of a
painkiller could look to other outlets to alleviate their pain is a safer manner. Although not as
popular in the United States but should make its way from Europe and China are acupuncture,
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behavioral management and other complementary medicines. These alternatives can effectively
and efficiently contribute to relieve pain without using unstable codeine, or if really needed, to
supplement with smaller doses of codeine. Acupuncture is the process of multiple procedures in
which needles penetrate certain points on the body. “The general theory of acupuncture is based
on the premise that there are patterns of energy flow through the body that are essential for
health” (Crawford). Unfortunately, acupuncture is a mildly invasive procedure and is short-lived.
On top of this, acupuncture works best for only a few common pains that codeine is prescribed
fore. Additionally, behavioral management includes “cognitive behavioral therapy, fitness
training, activity scheduling and pain management methods” (Knott) and all help improve the
reaction to medication reduction and depression. This is not always the most helpful to the ones
that have heavy doses of codeine prescriptions because they have high tolerances for the codeine
and therefore cannot go through this treatment without a decreasing amount of codeine to
supplement. Lastly, “homeopathy is a system of medicine which involves treating the individual
with highly diluted substances, given mainly in tablet form, with the aim of triggering the body’s
natural system of healing” (Endler). The downside of homeopathy is that there is no scientific
proof that it works and this leads to people thinking it’s a placebo and therefore makes
homeopathy less valid.
To conclude, the over prescription of codeine is clearly a problem within our society and
can ultimately be addressed by addressing the physicians prescribing to limit themselves and
refer to other alternatives such as acupuncture, behavioral therapy or complementary medicine.
Whether it be the doctors who are “naïve and too compassionate” or fetus’ central nervous
system being depressed due to the mother’s irresponsibility, codeine is a problem in our society.
The death of famous Elvis Presley could have easily been avoided if Dr. Nichopolous was more
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careful with prescribing his medicine. Even though one wouldn’t have access to codeine, doesn’t
mean one couldn’t be healed. Prescription codeine is clearly being taken advantage of and needs
to be stopped. Personally coming in contact with this drug was scary at the time, however now
knowing the serious consequences of the drugs horrifies me. I know how the prescription drug
should be used, but it’s sad that many others don’t understand the seriousness of this growing
problem. With simple restrictions on prescription drugs such as codeine, humanity within United
States would have a safer and healthier living environment.
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