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The Prescription Drug Epidemic: A Federal Judge’s Perspective

/By
Judge Amul Thapar, U.S. District Judge for the Eastern District of Kentucky

It will come as no surprise to anyone reading this that we have a prescription drug problem in the United States. As I see it, however, we are not devoting our attention to the real root of the problem. Yes, we have prosecuted the drug-dealing doctors, pain clinics and pharmacies. Yes, we have taken on the middle-men (or women) between the doctors and the users. And yes, we have offered help to the addicts. But the real victims are their children, and they have gone overlooked.

I sentence pill peddlers every month. They tell me the same story in nearly every case: Good person gets hurt, gets prescribed pain killers, gets addicted, loses job, and starts dealing to sustain his habit. “A doctor prescribed it so it can’t be bad for you,” they thought. And more often than not, they have kids. Kids who lost their parents to drugs and will now lose them again to jail. With broken homes and terrible role models, they, too, are likely to turn to drugs.

Pills are the new drug of choice for kids. A recent survey revealed that young people 12 and older are abusing prescription drugs at greater rates than cocaine, heroin, hallucinogens, and methamphetamine combined.1 Only marijuana abuse is more common.2 And, most troubling, every day approximately 7,000 young people abuse a prescription narcotic for the first time.3

In turn, young adults are joining the ranks of prison inmates, state and federal. Recently, I sent two young women to the federal penitentiary—ages 22 and 23.

This is the new crack-cocaine epidemic, but worse. Not because it is both rural and urban—crack and other drugs have reached past the cities. Not because it is lethal—many drugs are lethal. It is worse because (1) doctors are the enablers (sometimes knowingly), (2) the supply seems to be endless, and (3) some of our youth falsely believe that prescription narcotics are a safe alternative to other illicit drugs.

And unlike other drugs which kids had to seek out, prescription drugs find them. In a recent survey, 55 percent of 12 to 17 year olds said they obtained prescription drugs from a relative or friend for free; 9 percent paid a friend or relative; and 5 percent took drugs from a friend or relative without asking.4 Less than 5 percent obtained the illicit drugs from a dealer, and approximately 18 percent obtained the prescription from a doctor.5

This problem is insidiously rampant, and law enforcement cannot handle it alone. Indeed, they can arguably only attack a small percentage of those providing our youth with drugs (the dealers and doctors). And while I think stiff sentences for those peddling drugs to our children can help, more action is needed to solve the problem.

Luckily, this is not a problem without a solution. First, every state should have a system like we have here in Kentucky that monitors every prescription. Budgets may be tight, but this is worth the cost. Second, we must educate our children. Studies have shown that talking to our children early and often deters them from using drugs. Third, we must educate adults about the problem: (1) they must act as role models; (2) be involved in their children’s lives, including paying attention to whom their children are spending time with; and (3) make sure they themselves are not the supplier by properly discarding old or unused prescriptions. Children with involved parents have a 50 percent lesser chance of trying and using drugs.6 Finally, we must educate doctors about the problem. While most doctors would not illegally prescribe pills, they should still be cognizant of the widespread abuse and exercise special care when prescribing these drugs. And, the few that ultimately choose to become dealers must be prosecuted and sentenced to very lengthy jail times.

1Substance Abuse & Mental Health Services Administration, U.S. Department of Health & Human Servs., Pub. No. 10-4586, Results from the 2009 National Survey on Drug Use and Health: Volume I (2010).

2ibid at 14.

3ibid at 53.

4ibid at 28.

5ibid

6ibid at 72.

33 Responses to this article

  1. Avatar of colleen vickery
    colleen vickery / February 5, 2012 at 10:10 pm

    It’s time the companies that produce the addictive medication take responsiblity it was required by the tobacco companies. The american people have to burden the cost of this problem and there’s billions of dollars being pour in to these rehabilation services . It’s ashame that they can produce something so addictive and get away with it.

  2. Avatar of Alisa
    Alisa / October 17, 2011 at 3:37 pm

    There is no set reason why people do drugs, legal or illegal. Some do start out with prescription drugs because they were in pain.. When that pain goes away the pills dont and thats waht can cause a problem for people. Its not about the warm fuzzy feeling or wanting to fit in. People get high because THEY LIKE TO GET HIGH. Thats the bottom line. You can ask any drug abuser why they do it and that the UNDERLYING

  3. cheryl / July 20, 2011 at 8:08 pm

    This problem has multiple layers. I believe where we go wrong is wanting a “quick fix,” pun intended, for the problem. I believe there needs to be more research done regarding addiction and more sensitivity about the issue and the people with the problems. Throw them all in jail is NOT the way to do it. I have been reading medical journals off and on for the last couple years and I have seen precious little regarding a most obvious change in “class” of opiate drug users. There just has to a sea change here. We now have people who wouldn’t smoke joint, but become addicted to pain meds, get cut off cold from their doctor and end up going to street drugs. Most people wouldn’t survive jail. In addition if one is in recovery and is doing all the “right things,” try going to a doctor or dentist, even if one is being treated for an earache, one will often be treated poorly by the medical practitioner. That person has to feel ostracized for the rest of their lives (?) and that frankly erodes one’s self-esteem. This problem must be dealt with with sensitivity and on many levels. Ostracizing and jail don’t work and they make broken people, period!

  4. Perry Kaplan / July 15, 2011 at 5:01 pm

    Judge Thapar seems like a caring judge whose heart is nearly in the right place. The problem is that we have criminalized a public health problem. You can’t solve diabetes by imprisoning diabetics. You can’t solve substance abuse by putting addicts in prison. As long as this country continues to solve a public health problem through the criminal justice system it will fail.

  5. Avatar of Connie NC
    Connie NC / June 23, 2011 at 7:59 pm

    There are many factors. One I would like to address is the media and Hollywood. Remember when smoking was allowed in movies? Now it isn’t and the smoking rate has gone down. Has any one watched The Hangover, they show recreational drug use, hard core drinking and drugging and two of the main characters are upper class, I remember a dentist and teacher, etc. Teens think they can party and it wont hurt once in a while. Only it does, many will become addicts because they have the gene for addiction. Does it seem crazy we don’t see cigarette smoking in movies but we can watch pot smoking in Pineapple Express?

  6. Avatar of Rebebecca Doane
    Rebebecca Doane / June 23, 2011 at 9:06 am

    I live in Knoxville, Tn, and its a pill mill city. We have drs who are legal pill pushers, pain clinics, and drug stores who are making millions! We even have bill boards on the interstate advertising pain clinics with a phone # to call. No, doctors dont need to be trained, they need to be send to prison because people are overdosing everyday! Not just that, but drug stores are being robbed, people stealing from their owm family members, and the most sickening part is we have so many babies born that are addicted and have to be detoxed! Yes, drs are precribing to pregnant women. I know this for a fact! Every family I know is being affected by this epidemic! I want to put a stop to it! If anyone has any suggestions, please email@ beckydoane@yahoo.com.

  7. Avatar of Connie
    Connie / May 11, 2011 at 7:55 pm

    As a Recovering Addict, this is long overdue…
    Our system is broken. I became “hooked” on prescription meds (which made it ok) or so I thought. When my life spiraled out of control, I sought help. I was lucky.
    When I told my doctor I was getting help, he didn’t know what to say. I had to be very blunt with him and tell him to mark my chart as a recovering addict. No Narcotics.
    This epidemic is only a symptom of a broken society.

  8. Avatar of Eva McRae
    Eva McRae / May 9, 2011 at 2:59 pm

    I admit I haven’t taken time to read all the comments but wanted to bring up some things in case no one else has. The need for medication for chronic severe pain is very real and it is a quality of life issue. I became addicted to opiate pain meds when I herniated a disc. I was also rx’d valium for muscle spasms. I asked the doc to reduce the valium as I was concerned about dependence. I honestly didn’t know Vicodin and Codeine were addictive and he certainly didn’t say. Docs need to give information about risks. Docs also need more than a few lectures in med school about addiction because I don’t think they get enough to feel comfortable discussing it honestly. Docs shouldn’t stop prescribing for serious pain just educate about risks. Another thing I think plays into this is the way our health care system is set up. Doctors are under pressure to get patients through in 10 minutes or less in most HMOs. That and the fact that the reimbursement rates are low for the folks relying on Medicaid. Instead of spending a lot of time or ordering tests that might indicate another course of action, the most expedient cost effective thing is to give them something to numb themselves. Another thing to consider is that the drug companies are advertizing every 10 minutes in the US. “Ask your doctor about our product” Oh for the day when advertizing meds, docs and lawyers wasn’t allowed. My last point is that so many people in the world today are hopeless, maybe putting on a good front for the kids, but seriously stressed and depressed due to the financial inequalities. We see ads for this and that. The TV is the only entertainment most people can afford so we are bombarded with all the things we want and can’t afford to buy for ourselves and our families. Opiates dull an awful lot of emotional pain better and faster than any antidepressant I’ve ever taken. If you can’t afford therapy (who can?)the opiate pain meds left over from that last injury sure are seductive. Just a thought.

  9. Sandra Streifel / May 9, 2011 at 11:56 am

    Just throw more money at the problem. There is one thing known about drug use. Supply and demand. If there is demand for drugs, and there is in North America, when you restrict the supply/raise the cost of one drug, another will take its place. Prescription drugs diverted from therapeutic use are the latest “new threat” to attract the attention of addiction professionals, prevention advocates, and “War on Drugs” enforcement and politicians. If control of diversion for abuse, addiction from therapy, and import of fake pills should be successful, ie. this form of drug abuse becomes less popular, snorting some synthetic opiate from clandestine labs might, for example, take its place. The “War on Drugs” and its vigorous prohibition and expensive military interdiction philosophy here and internationally caused this problem, for the most part, and the end of police and military enforcement of user and small dealer prosecutions is the beginning of the solution, freeing funds for treatment and prevention.

  10. JG / May 9, 2011 at 8:45 am

    Thank you judge for your comments. We in New Jersey have one of the most progressive school initiatives in the country that has been look to as the Gold standard by the National Association of Student Assistance. Over the past two years the financial situation and the powers that be have been destroying what has taken 25 years to build. Please gto to http://WWW.ASAPNJ.org to see the program and how beneficial it really could be to our State and Country if we really wanted to get serious about prevention, identification,and treatment to change the path we are on. Our Governor and Department of Education don’t have a clue, and they live here. They just rule, or kids don’t.

  11. Brinna Nanda / May 7, 2011 at 11:36 pm

    Excuse me, but why are the pharmaceutical companies left out of the equation here? Does not the good judge find any culpability in the rampant, direct-to-the-public advertising of prescription medications, promising to relieve all of life’s problems with a simple, little pill? I say, it’s time to go after the true root of the problem. Rapacious capitalism, and an ideology which puts profits completely above any public health interests; not to mention the utter inability of congress to address this issue at its heart. Not surprising since pharmaceutical lobbies pay their salaries.

  12. Avatar of Todd Morris
    Todd Morris / May 7, 2011 at 5:42 pm

    Judge Thapar is right. Prescription Drug Abuse is an epidemic and a family problem. Addiction does not discriminate even with legally prescribed substances. Prescription drugs are easily accessible to teens who lurk in any medicine cabinet (family, friend, other). Many young people abuse prescription drugs because they do not see the harm. A doctor prescribed it therefore it must be okay. My parents take it therefore it must be okay. Physicians need to do a better job at screening for those who have substance abuse disorders before readily handing out prescriptions for drugs of abuse which can lead to addiction. Parents need to secure the meds and educate their children on the risk of harm associated with prescription drug abuse. Parents should lead by example-a positive example.

  13. Avatar of Lou Celia Frost
    Lou Celia Frost / May 7, 2011 at 9:56 am

    One very simple fix to the problem might be to limit the number of pills prescribed. I recently had oral surgery and was prescribed 30 pills. I took one. The next time I went in to have more work done they wanted to prescribe me another 30. I said “No thanks, I still have 29 left over from the last time.” I was in again to prepare for an implant to be done next month and they wanted to prescribe me yet another 30. “No, thanks, I still have 29 left.” If I had said yes every time they were offered, I would have 89 pain pills in my medicine cabinet. If doctor’s would only prescribe between 3 and 10 pills for these minor procedures there would be far fewer pills floating around to become addicted to.

  14. Avatar of Ron Gowins
    Ron Gowins / May 7, 2011 at 9:25 am

    Prison in not the answer. Locking up addicts in prison does not help anything. It’s a drain of resources and harms people to the very core of their psyche.

    Treatment is the answer. Use all of the money from sending addicts to prison and spend it on treatment. Duh….

  15. Avatar of Jerry Epstein
    Jerry Epstein / May 7, 2011 at 3:47 am

    Here we go again
    Lets start with NIDA:

    “cocaine, heroin, alcohol, marijuana, and other addictive drugs; … persons addicted to one drug are very vulnerable to addiction to other drugs; …. scientific research shows extensive biological across-drug commonalities in the causes, mechanisms, prevention, and treatment of drug addiction, regardless of which particular drug is considered;”

    alcohol 18 million abuse versus less than 2 million for pain pills (up in past decade from norm of 1.5 million)

    alcoholics have children too –

    NIH spends millions on designing prevention for ages 3 to 5 (see NIAAA)

    the judge thinks exposure to the pilll is the problem-== he better look to things between birth and age 21 === the choice of a specific drug is largely irrelevant

  16. Avatar of Yvonne
    Yvonne / May 6, 2011 at 3:49 pm

    I couldn’t agree with you more Judge Thapar. In fact, I believe physicians need to be re-trained in how they treat their patients and medical conditions. Generally speaking, I don’t believe prescription drugs should be given out to a patient just to treat symptoms. We need to focus more on ‘preventive therapies that doesn’t necessarily include prescription drugs, unless the prescription medication can be administered to HEAL the patient. Handing out prescriptions to treat mere symptoms could be perceived as negligence, substance abuse, and mal-practice.

  17. Avatar of Jay H. Byham
    Jay H. Byham / May 6, 2011 at 3:02 pm

    Finally! Someone is telling the story in the most effective, comprehensive way! Parents not only need to be aware, they need to be role models! Also, states must monitor prescribing of all narcotics, not just opioids, and make it enticing for pain specialities and other practicioners to participate in monitoring programs. Thanks, Judge. We need more spokepersons like this.

  18. Dave / May 6, 2011 at 2:51 pm

    With all due respect, the judge is not addressing the problem at its root: why do people (and especially young people) want to get high instead of living life on life’s terms. As an alcohol and drug counselor, I know that its partly biological and genetic, partly learned behavior modeled by parents and the rest of society (how many TV programs show people handling stress with alcohol!) and partly due to the hopelessness created by abuse and poverty and having poor expectations for your own future. Yes there is an epidemic of opioid abuse and that’s new. What’s not new is people using substances to make themselves feel better. Ultimately, if we want to stop opiate abuse, we have to curtail demand and the way to do that is to address why people start using in the first place.

  19. Avatar of kathryn page
    kathryn page / May 6, 2011 at 2:37 pm

    I think we can go even a step or two deeper, to the hole in the hearts of people who abuse prescription (or other) drugs.

    Recreational drugs give us a feeling that is very similar to the warm, happy sense of belonging–rooted in the neurochemistry of attachment.

    For millenia, oxytocin (attachment) and dopamine (pleasure) flowed freely whenever our village accomplished something together and celebrated, or any time a child learned well a craft or survival skill from elders.

    In our present culture of separation, competition and personal uselessness, these essential biochemicals are scarce.

    The feelings they transmit are as essential to our wellbeing as food and water, and we will do our damndest to get them.

    The quickest and most consistently effective source for these feelings is drugs and alcohol.

    The whole idea of increasing connectedness is almost too big for any one field (like the judicial one) to even begin to consider. But you are anyway.

    Approaches like restorative justice and family drug cout are making a dent in the isolation and meanness that characterizes way too much of our community life.

    Big gratitude to you who are engaged in those efforts, and hopes that you’ll stay afloat.

  20. Avatar of Debi Edwards
    Debi Edwards / May 6, 2011 at 1:59 pm

    I agree with this article but I believe the bigger problem is why we have sooooo many people who feel a need to use mind/mood altering drugs – why aren’t they able to fill voids in their lives with healthy/good choices?

  21. Avatar of nwrd
    nwrd / May 7, 2011 at 8:40 pm

    thankyou for the wider perspective

  22. D W Stegman / May 9, 2011 at 1:57 pm

    Do you know that the origibal formulary for “Coca” Cola contained cocaine?

  23. Steve Billiter / July 28, 2011 at 8:01 pm

    That’s funny, medical dictionaries syt that oxytocin is,”A nonapeptide posterior pituitary hormone that causes UTERINE CONTRACTIONS and stimulates MILK EJECTION.

    Which certainly does not fit your description.

  24. D W Stegman / May 9, 2011 at 1:55 pm

    Please tell me why people don’t make good choices? Is it demographis? Are they in pain? Are they …?

  25. D W Stegman / May 9, 2011 at 1:59 pm

    We must also rescue those who are going to die from an overdose if they are nor helped.

  26. Avatar of BSSM
    BSSM / February 19, 2014 at 4:48 am

    It’s very difficult to take a person seriously who would sentence an 84 year old to three years of prison for civil disobedience. That’s one of the dangers of a liberal immigration policy. A foreigner slips through the system can end up in the judiciary or law enforcement without knowing the Constitution or anything beyond the pledge of allegiance.

  27. D W Stegman / May 9, 2011 at 2:04 pm

    Take away the pills and they will find heroine. We must “cure” the addict as well as taking away the drug. Treatment for substance abuse if the best solution.

  28. Avatar of ellen
    ellen / July 12, 2011 at 12:29 pm

    I have a disease and one symptom of it is chronic severe nerve pain. I can not fix the enzyme I am missing in the liver that produces red blood cells. I have to control triggers in my environment and I become triggered in the world regularly. I use pain meds for work. I tried to work without and nearly lost my position. Now I can cope with many techniques including, tai chi, meditation, exercise and small amounts of pain meds. Are you saying I should go on disability? I can only treat my symptoms. What then Yvonne?

  29. Avatar of Lisa
    Lisa / August 5, 2011 at 5:18 pm

    Alternative medicine does offer good options for managing pain, stress, etc. However, sometimes these are not 100% effective and prescription pain medications become necessary. When managed properly by a pain management specialist or at least by an educated and knowledgeable doctor, nurse practitioner or other licensed care provider, and with patient education, the patient need not become tolerant or “addicted” to their pain medications. I am a public health nurse who deals with clients with addictions, including pills. Those abusing pills did not start out addicted, but were prescribed the pills by a doctor who did not do anything else to manage the person’s pain; providing refills until their patient was dependent and then “discharged” them from their practice. This of course meant the person either went “doctor shopping” or to the streets.

  30. Sandra, Vancouver, Canada / August 6, 2011 at 12:45 pm

    Judges and public opinion make poor medical decisions. Drug addiction is a disease. Chronic pain is a medical condition. Human beings have been using mind-altering substances, incorporated into societies in various ways, since we can remember, and it’s not going to stop because we smarten up our doctors, or lock up our medicine cabinets.

    We know that people of color are incarcerated 10 times as often as white people, even though white people use drugs more often. But drug addiction is a disease, and not a criminal justice problem. Portugal decriminalized the posession of drugs in 2001, and teen drug use, HIV incidence, and overdose deaths have gone down:
    http://www.time.com/time/health/article/0,8599,1893946,00.html
    People in the US with chronic pain, especially the elderly in Florida, are having difficulty finding doctors to prescrible medication for them if they require opiates for pain. Americans, and our Canadian leader, Stephen Harper, have a puritan attitude that addiction is morally wrong and should be, or is best dealt with by being punished, or at least not coddled. Harm reduction, in this view, promotes drug use by taking away the risk, or condones use, therefore even if it preserves life, or increases the number of addicts entering treatment, it should not be funded.

  31. Avatar of jacque
    jacque / July 14, 2011 at 1:11 pm

    Sounds like your managing your condition responsibly. Using prescription meds and abusing prescription meds is not the same thing. Thanks for the clarification.

  32. Lisa / August 5, 2011 at 5:27 pm

    So true Jerry Epstein: genetic vulnerability and envioronment (especially any childhood and adult trauma, abuse, etc.) play such a huge role in addiction. The majority of my clients (all women) “grew up” with abuse, neglect and a culture of AOD use which was perceived as “normal.” Prenatal exposure also plays a role, because of the brain development including the “hardwiring.” Treatment does work, not incarceration. I’d rather my tax dollars went to treatment. Not saying don’t lock up anyone, but treatment outside of prison should always be a possibility.

  33. Sandra, Vancouver, Canada / August 6, 2011 at 12:24 pm

    Steve, it causes the “let down” reflex that causes the milk ducts in mammals to contract when we nurse the baby, so the milk comes out easily. Milk is produced constantly in the breast tissue. The reflex is interesting in that it happens involuntarily at first, when the baby cries, or you think about a baby, but later on, it only happens when you nurse the baby. It does give you a warm, happy feeling, and also made me very thirsty every time. I was given an IV of oxytocin during labour in an attempt to make my uterine contractions move along, but I did not feel warm and happy at all as I walked up and down the ward with cramps pushing an IV pole. Strange chemical.

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