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Community and Health
Implications of Prescription
Drug Abuse in Kentucky
By: Holly E. Hopper, MRC
Health Associate, HEEL Program
How common is prescription drug abuse?
 Nationally,
2% of the population age 12 and
older have misused prescription drugs.
 Most
misused were:
 Pain
relievers (2.6 million)
 Sedatives (1.3 million)
 Stimulants (.9 million)
These trends most seen in older adults, women,
and teens.
How big is the problem?
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In 1999, approximately 9 million Americans used
prescription drugs for non-medical reasons.
These drugs are often taken in large doses or
are altered before they are taken.
Since January 2003, 345 Kentuckians have died
from methadone-related overdoses alone.
On average, Kentucky has 400 overdose deaths
per year. (Associated Press, May 10, 2004)
Prescription Drug Abuse in Kentucky
Prescription-related Deaths in Kentucky
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Oxycodone-related deaths have increased since
1998.
From January 2000-May 2001, the presence of
oxycodone was identified in 69 deaths (Kentucky
State Medical Examiner’s Office).
During 2000, there were 19 OxyContin-related
deaths in Pike County (Pike County Coroner).
7 OxyContin-related deaths occurred in
southeastern Kentucky during December 2000
alone (Area Law Enforcement).
Terms:
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Diverted substance - a legally
prescribed substance that is illegally sold
or misused.
Opiates - naturally occurring substance,
from the opium poppy that has pain
relieving properties
Opiods - synthetic drugs that act like
morphine and are very effective pain
relievers
Methadone Abuse: Diverted substance
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Methadone, common treatment for narcotic
addiction, is often abused or diverted.
Clinics in Bowling Green, Lexington, and Louisville
are known for diverted methadone transactions.
Pills not taken in compliance are often crushed,
filtered, and injected intravenously.
In the Fall of 2000, 6 individuals died from
methadone overdoses in Breathitt County alone.
Since January 2003, 40 people have died from a
combination of methadone and alcohol or another
pain killer. (County Coroner, Bobby Thorpe,
Associated Press, May 10, 2004)
General Implications of Prescription Drug Abuse
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Community crime rates have increased.
Families experience the stress of drugseeking family members.
Drug-related health conditions emerge, often
resulting in disabling or life-threatening
results or death.
Employability declines resulting in damage to
the local economy.
Effects of Drug Abuse on Community and
Health
 Increased crime rates
 Increased risk of harm
 Loss of medical professionals
 Chronic disease
 Over-utilization of emergency care
 Occupational stress/loss
 Family distress
 Child abuse/neglect
 Death
Methods used by Abusers of
Prescription Pain Medications
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Abusers do not take prescription medications
as directed.
Abusers may be dishonest to healthcare
providers to get prescription medications.
Abusers may crush pills in order to snort, eat,
or inject the powder.
Abusers often take medications in high doses
or when pain symptoms are not present.
Types of Commonly Abused Prescription
Drugs
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Stimulants (“Uppers”)
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CNS Depressants (“Downers”)
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Prescribed to treat narcolepsy and
attention deficit/hyperactivity disorder
Used to treat anxiety and sleep disorders
Opiates/Opiods (“All-Arounders”)
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Often prescribed to treat pain
Natural “Feel Good” Chemicals
 Endorphins-the
body’s natural
pain killer
 Dopamine-the brain’s “pleasure”
chemical
 Serotonin-the body’s “mood
control” hormone
Natural High vs. Chemical High:
Surprising Similarities
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Endorphins
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a naturally occurring chemical, is released in times of
stress, to decrease pain, or to produce pleasure.
3 times more potent than morphine.
Individuals with chronic pain have high levels of
naturally occurring endorphins.
Endorphins release during food consumption
and pleasurable physical activity.
Exercise-increased production releases
endorphins, resulting in a sense of euphoria that
has been popularly labeled “runner’s high.”
How Do Pain Killers Work?
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Many painkilling drugs, such as morphine
and codeine, act like endorphins by
activating the same receptor sites in the
brain.
Euphoria is only experienced with the use
of prescription pain medication when there
is no physiological pain present or when
taken in larger doses.
Health Risks Associated with
Prescription Drug Abuse
Addiction
 Severe respiratory depression
 Organ damage
 Heart damage
 Seizure
 Death
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Most commonly abused prescription drugs
in Kentucky
Alprazolam, Diazepam (Xanax)
 Oxycodone (OxyContin, Percocet,
Percodan, Tylox)
 Diazepam (Valium)
 Hydromorphone hydrochloride (Dilaudid)
 Methadone hydrochloride (Methadone)
 Codeine phosphate/sulfate (Codeine)
 Amphetamine sulfate (Amphetamine)
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Source: Kentucky Drug Threat Assessment, KSP, 2002
What are Opiates and Their Uses?
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Opiates have been used for thousands of years
for both recreational and medicinal purposes.
Morphine, derived from the opium poppy, is a very
powerful painkiller and the most active by-product,
but it is also very addictive.
Morphine was named after “Morpheus”, the Greek
god of dreams.
Codeine, a less powerful drug, is also found in
opium.
Opiates relieve pain, relax muscles, and cause
drowsiness.
Pain-relievers: Opiates and Opiods of Abuse
Morphine was discovered to be
addictive after the American Civil War.
 Heroin was created as a less-addictive
substitute.
 Most morphine and heroin use outside
of the military was in cough “mixtures”.
 Camp physicians gave miners
painkillers to help them work longer in
the mines without feeling fatigue.
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Use of Sedatives or CNS Depressants
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In 1975, Valium© was the world's bestselling
drug - 15% of Americans were taking it.
Most doctors have now stopped prescribing
benzodiazepines for long-term use because
of worries that they might cause addiction.
Used to treat anxiety attacks.
Used to help sleeping difficulty.
Used to calm people before dental treatment
or surgery.
Treatment Uses of
Commonly Abused Prescription Drugs
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Anxiety
Tension
Sleep disorders
Panic attacks
Chronic pain
Post surgery pain
Pre-anesthetic preparation
Severe diarrhea
Cough
Stimulants of Abuse: Amphetamine
Amphetamines were used to help soldiers stay alert for
many hours; to be better soldiers.
Medical warnings now read:
METHAMPHETAMINE HAS A HIGH POTENTIAL FOR ABUSE. IT
SHOULD THUS BE TRIED ONLY IN WEIGHT REDUCTION
PROGRAMS FOR PATIENTS IN WHOM ALTERNATIVE THERAPY
HAS BEEN INEFFECTIVE. ADMINISTRATION OF
METHAMPHETAMINE FOR PROLONGED PERIODS OF TIME IN
OBESITY MAY LEAD TO DRUG DEPENDENCE AND MUST BE
AVOIDED. PARTICULAR ATTENTION SHOULD BE PAID TO THE
POSSIBILITY OF SUBJECTS OBTAINING METHAMPHETAMINE
FOR NON-THERAPEUTIC USE OR DISTRIBUTION TO OTHERS,
AND THE DRUG SHOULD BE PRESCRIBED OR DISPENSED
SPARINGLY.
What are Amphetamines?
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All amphetamines are based on the naturally occurring
chemical, ephedrine, found in the herb Ephreda
vulgaris.
Chinese people have used this plant for over 5000
years to treat asthma.
In 1887, chemists made amphetamine, a synthetic
substitute for ephedrine.
Amphetamine affects the brain, increasing alertness
and decreasing appetite. It increases the levels of
dopamine, the “excitable, movement control,
emotional response, pleasure, and pain” chemical.
The natural form, ephedrine, causes heart damage
and risk of stroke or death.
Marketing Lies for
Amphetamine-containing products
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DIRECTIONS FOR MEN & WOMEN: As a dietary supplement,
take 3 capsules with a 12-ounce glass of water 3 times daily,
approximately 30 to 60 minutes before meals (preferably before
breakfast, lunch, and dinner). Do not exceed 3 capsules in a 4hour period and/or 9 capsules in a day. Do not take within 5
hours of sleep. To assess individual tolerance, follow the dosing
chart below.
Week 1
1 capsule, 3x daily
Week 2
2 capsules, 3x daily
Week 3 & beyond 3 capsules, 3x daily
For best results, combine (product) with a low-fat, caloriereduced diet and an exercise program. Do not snack after dinner.
Consume ten 12-ounce glasses of water per day. Read the entire
label before use and follow directions.
Why Do Drugs Feel Good?
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Scientists believe addictive drugs activate the
brain's 'reward system‘ by increasing the release
of dopamine in the brain.
Dopamine release occurs naturally after food or
sex, but can also be induced by some drugs.
Drugs that artificially increase dopamine-release
in this way may cause craving for more.
Some people may have a genetic tendency to
quickly develop drug addictions.
What is Addiction?
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Unpleasant withdrawal symptoms that occur
unless users regularly take the drug.
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Drug cravings that interrupt thought until drug is
taken or person becomes distracted.
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An overwhelming urge to continue taking the
drug, even after withdrawal symptoms have
disappeared or negative consequences are
experienced.
Signs of Prescription Drug Addiction
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Excessive tiredness
Physical complaints with no identifiable cause
Lying
Lack of control or impulsive behavior
Doctor shopping
Difficulty discussing prescription use without getting
upset
Arguing about or justifying personal use
Late to work
Inability to stay awake
Erratic behavior
Seeming to be in a “deep hole”
Signs and Symptoms of Medication Misuse
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Changes in sleeping and eating patterns
Confusion or disorientation
Malnutrition
Poor hygiene
Neglecting one’s appearance
Slurred speech
Incontinence or difficulty urinating
Constipation
Complaints of blurred vision or dry mouth
Tremors
Shakiness
Frequent falls and bruising
Depression and
the Prescription Drug Abuser
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Persons addicted to drugs become desperate
to just feel normal.
Substance abuse has so altered brain
chemistry that this process takes time.
Depression, physical pain, and anxiety are a
part of the withdrawal process.
Medical supervision is necessary as stopping
use of prescription drugs without medical
supervision can sometimes be fatal.
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Prescription Substance Use
Among Older Adults
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Older adults are prescribed medications 3
times more than the general population.
This group has poorer compliance with
directions than any other group.
Addiction rarely occurs among people who
use the drug as prescribed.
Inappropriate use increases the risk of
addiction.
Tolerance and dependence to medications are
normal results of the treatment process.
Refusal to discuss these symptoms can lead to addiction.
What Can Extension Do?
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Educate the public about proper medication use.
Target senior’s groups and those with chronic illnesses that
may be treated with prescription pain killers.
Inform others of the importance of proper medication storage.
Family members should monitor quantities of medication
accessible to in-home caregivers and guests.
Inform individuals of what to do if they feel they are dependent
on medications. Symptoms can be eased and doses tapered
to decrease the discomfort of withdrawal and craving.
Provide assurance to those older adults who suffer conditions
that require such treatment. Appropriate use under medical
supervision is not addiction.
Stress that prescription abuse is not about bad drugs or bad
people but rather lack of education and a fear of
communicating.
Resources:
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www.whitehousedrugpolicy.com
www.nida.nih.gov/Infofax/PainMed.html
www.health.org
www.kentuckyconnect.com
www.samsha.com
www.sciencemuseum.com
www.usdoj.gov/dea/pubs/states/kentuckyp.html
“OxyContin replaced as drug of choice: Methadone
abused more in E. Kentucky”, The Lexington Herald
Leader online, May 10, 2004. Associated Press
article.
For more information:
Contact your local County Extension Office or
visit the HEEL website at:
www.ca.uky.edu/HEEL
Educational programs of Kentucky Cooperative Extension serve all people
regardless of race, color, age, sex, religion, disability, or national origin.
The development of the HEEL program was made possible by Senator Mitch McConnell with funds earmarked for the University of Kentucky,
College of Agriculture, Lexington, KY and budgeted through the CSREES/USDA Federal Administration.
This information is provided by the H.E.E.L. Program. Health Education through Extension Leadership (H.E.E.L.) is a partnership among the University of Kentucky College of Agriculture
Cooperative Extension Service, Kentucky State University Cooperative Extension Program, the University of Kentucky College of Medicine, and the Kentucky School of Public Health.