Prescription For Trouble

by Diane Dimond

We are a pill-popping culture. We take pills to sleep, wake up, get happy, keep our children less hyper. And while people might not realize it, sharing prescription drugs, using false names to get prescription drugs or shopping around to get more than one doctor to prescribe extra prescription drugs are all against the law.

It used to be that law enforcement worried only about illegal drugs like marijuana, cocaine, heroin and methamphetamines. Now they’re dealing with the criminal aftermath of a record number of people getting high on prescription drugs: Deadly car accidents, domestic abuse, sex offenses -- all committed by people too impaired to control themselves. Addicts of prescription drugs have been known to commit crimes to pay for their pills once their insurance runs out.

Health-care providers and law enforcement will tell you prescription-drug abuse results in the same problems as street drugs: addiction, crime and broken families.

So how bad is the problem? Hold on to your hats for some brand new, jaw-dropping statistics from the Drug Enforcement Administration: seven million Americans are regularly abusing prescription drugs – not just taking them, abusing them. The drugs of choice are powerful pain killers like oxycodone (the generic name for an opiate-type drug sold under three different brand names), Percocet (known as Tylenol 3; brand name for acetaminophen with oxycodone) and Vicodin (acetaminophen with hydrocodone, another opiate-type drug).

The DEA has been studying this for years, so comparisons are easy. In the year 2000, 3.8 million Americans abused painkillers. The latest figure of seven million marks an 80 percent increase!

Prescription medications now cause more overdose deaths than cocaine and heroin combined.

If that stuns you – and I hope it does – get this: It’s not just painkillers Americans depend on to get through the day. There has also been a massive jump in anti-depressant prescriptions. It seems inconceivable, but 27 million people are currently taking anti-depressants like Paxil and Prozac, according to a new report in the Archives of General Psychiatry.

There seems to be the feeling that if a doctor prescribes it, it‘s okay to take, that prescription meds are somehow safer than street drugs. It isn’t true. Many prescription drugs have a high potential for abuse, and patients can get hooked before they realize what’s happening. Some people get so used to taking a drug their bodies begin to crave more and more of it, and they die of a self-induced overdose.

Look, lots of patients have pain and depression and truly need these drugs, there is no denying that. Probably a lot of the increase in the skyrocketing number of prescriptions can be traced to the stress of life in the United States post September 11th, 2001; to the miserable state of the economy we’ve all had to deal with; and a decline in psychotherapy sessions after many insurance companies restricted payments.

But there’s also real criminality involved here. There are doctors who act illegally when they continue to prescribe or over-prescribe to someone they believe is an addict. There are pharmacies dispensing far too many pills to one household and ignoring the red flag of possible addiction. And there are scads of rogue “pharmacy” Internet sites illegally selling controlled substances. If they run out of doctors to write scrips, addicts often turn to these cyber-drug dealers. The web sites rake in profits -- millions of dollars per month.

Lawmakers have been talking about the potential for a prescription-drug abuse epidemic in America for more than a decade. Now, with a total of 34 million patients currently taking painkillers or anti-depressants, I think we’ve hit the epidemic level. As fast as authorities shut down careless pharmacies and illegal Internet sites, or strip offending doctors of their prescription privileges, others step in to take their place. In the last three years, tens of millions of doses of prescription drugs, and tens of millions of dollars in assets have been seized. But the seizures have done nothing to stem the growth of the problem.

The most depressing part of this mess is that it’s destined to get worse. Our children are learning awful lessons from our pill-popping behavior. And it’s easy for them to simply slip a few of their parents' prescription drugs out of the medicine cabinet. Don’t imagine your kids wouldn’t think about it. The DEA reports nearly one in 10 high school seniors admit to abusing drugs that weren’t prescribed to them.

I’ve got no brilliant idea for solving this problem. It just seems that we spend so much time, effort and money fighting illegal drugs while overlooking the scourge of prescription drugs. If we’re going to crusade against one, shouldn’t we include the other?

Our kids aren’t stupid. They see the campaign against hard street drugs and then watch us down all sorts of prescription drugs as though nothing bad can happen.

Bad happens. And we should all spread the word.

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Forensics Reveal Truth

by Diane Dimond

Imagine the hushed, sterile atmosphere of an autopsy room. A body arrives and a team of forensic experts quietly gets to work to try to determine cause of death. Scientific evidence is gathered to determine whether a crime was committed to cause the death, whether it occurred from natural, unavoidable causes or if it was death by suicide.

In many cases, such as that of retired NFL quarterback Steve McNair, the cause of death is pretty obvious. McNair, was found sprawled on his condo’s couch, shot twice in the head and twice in the chest. Nearby was the dead body of his 20 year old mistress, a gun underneath her. It was quickly ruled a murder/suicide.

But other deaths are not so clear cut. Take the case of 50-year-old infomercial scream-seller Billy Mays. After he was found dead in his bed by his wife, we heard that he’d violently bumped his head in an airplane just hours earlier. It was thought the hit on the head had something to do with his sudden death. But forensic science proved it wasn’t so. Once the medical professionals opened Mays’ chest they immediately discovered a diseased heart was to blame, an affliction Mays apparently was unaware he had.

And then there are the full blown forensic death investigations like the one surrounding entertainer Michael Jackson, suspected of dying at home from an overdose of a hospital strength anesthesia called Diprivan and, perhaps, a cocktail of other drugs. Cases like Jackson’s demand a full toxicology and histology workup. In layman’s terms: a full examination of blood, tissue, hair and organ samples to determine if someone should be charged with a crime.

All this scientific sleuthing takes time to accomplish and in the meantime families of the dead anxiously await the final verdict.

Autopsy blood workups are routine. The sample is usually taken from deep inside the body’s heart chamber and tests determine what compounds are present in the bloodstream. Some drugs like cocaine break down in the body quickly and are hard to detect. But most drugs stop metabolizing when the person dies and so the traces found in the bloodstream are indicative of what was present at the time of death. The forensic investigators also examine urine, bile and tissue samples from the liver, heart, spleen and kidneys. The information gathered fits together like pieces in a cause-of-death puzzle.

Hair is especially revealing, holding on to what the body has ingested like rings on a tree. Since scalp hair usually grows about half an inch a month the longer the body’s hair the more information can be found. A six inch hair will reveal a full year’s worth of clues. Traces of each drug used will be stored in the hair shaft and the coroner’s office will be able to list every one, be they prescription or illegal drugs, and when they were used. In the case of a bald person shorter hair from armpits or the groin area can be used, they’ll just yield less historical information.

But there is nothing as telling as what the scientists can deduce from studying the brain. Unlike other organs from which samples can be taken immediately, the brain requires special handling. The entire brain mass must be submerged and hardened in formaldehyde for about three weeks before samples can be taken. Once gathered a neuron-forensic pathologist usually needs four to six weeks to unravel all the telltale evidence about what happened to the body during life.

If the decedent was beaten as a child contusions on the brain will be seen as dead tissue, called necrosis spots. If in life the person suffered a drug overdose (or multiple drug overdoses) the scientist will be able to see evidence of that and can determine when the overdose(s) occurred. If the decedent suffered strokes there will be visible scar tissue.

When a family receives a negative cause of death determination from the coroner they are often in denial. They don’t want to believe their family member could have committed suicide or died of a self-inflicted drug overdose.

Media leaks about the state of Jackson’s body at death have been excruciating. The almost six foot tall performer was reported to have weighed just 112 pounds. The skin on his arms, neck and legs were said to have been pockmarked with both old and new needle punctures. All indications are he died from a fatal overdose of several different drugs.

If that is the final judgment on what killed Michael Jackson something tells me the Jackson family will never accept it. It will be more comforting to believe some outside force killed their loved one. It’s much harder to accept the fact that someone you cherished slowly and deliberately shortened his own life.

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