Awareness is key in the fight against prescription drug abuse
By GWEN FLORIO Missoulian

MISSOULA — Allison McKenzie doesn’t consider herself naïve.

When her sons were teenagers, she knew what to look out for.

The slurring and stumbles associated with booze. The reek of pot.

“I was on top of it,” she said.

But when it came to prescription medication, “I had not a clue.”
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McKenzie got a very expensive education — about $80,000 in treatment and rehabilitation since Thanksgiving for two of her sons, now in their 20s, to kick the methadone they were given at a clinic as part of their effort to get out from under opiate addiction.

Discussing her family’s issues publicly is painful, said McKenzie. “But I can’t not say anything because it’s so horrific.” Everybody, she said, needs to know about the danger of prescription medication.

Then she mentioned the Montana Meth Project.

“As soon as those commercials came on TV, they made a huge impact” on the problem, she said of the Meth Project’s graphic and disturbing warnings about the effects of methamphetamine use.

In fact, talk for a few minutes with just about anyone who deals with the problem of prescription drug abuse, and the Meth Project comes up.

Why, wonder doctors and pharmacists and cops and even addicts, isn’t there a similar effort that takes aim at prescription drugs?

Public awareness

“The best way to deal with this silent epidemic is public awareness,” said Dr. Marc Mentel, medical director for the Community Physician Group at Missoula’s Community Medical Center.

Mentel is at the forefront of the Community Safe Prescriber program, a prevention effort that requires physicians to sign contracts with patients for whom they prescribe opiates.

The contracts state that physicians will closely monitor those patients. “They’ll have open discussions, letting (the patients) know that opiates are not a cure. They’ll ask the patients to be responsible and treat these like a gun in the household,” he said.

Physicians who sign on as Community Safe Prescribers receive stickers to place in their offices. “These are providers you can trust,” Mentel said. “We also hope (the stickers) will deter those who are looking for medications” for illegal use.

Even with such precautions, he said, “these are very difficult for patients to wean off. I imagine it’s similar to tobacco. Even six months to a year after (ceasing the medication),” he said, “it’s almost like an itch they have to scratch.”

The prescription drug abuse epidemic is rooted in the best of intentions.

In the late 1990s, physicians were urged — in the interest of their patients’ quality of life – to monitor pain as a vital sign, Mentel said. On a scale of zero to 10, with 10 being unbearable pain, anything above 4 was considered undesirable, he said.

Opiates worked. Prescriptions have increased fivefold since the turn of the century, Mentel said.

“A green light was turned on. A Pandora’s box was opened,” he said.

Not only were more opiates prescribed, more were distributed, he said. “Fifty percent of those (legally prescribed) are handed out to other people,” not necessarily with nefarious intent, he said. “It could be a family member saying, ‘Here, you’ve got a headache?’ ”

The fact that the pills are prescribed to help people can create a false sense of security, he said. “There’s this notion that they’re safe … but they’re probably the deadliest medications out there.”

Only recently did the number of deaths — some 50 a day around the country — associated with opiate overdoses become apparent, he said.

“It’s the collateral damage,” he said, “the price of what we were trying to do.”

In his four years as the Missoula Police Department’s sole officer devoted to prescription drug abuse, Detective Dean Chrestenson said he’s seen too many deaths and near-deaths.

Not all are due solely to the drugs. People combine them — intentionally or not — with alcohol, or they take a mixture of drugs. Caitlin Stanich of Missoula, who died in March at the age of 27, drank heavily and took methadone.

McKenzie feared a similar fate for her sons.

Methadone, dispensed at a Missoula clinic where her sons sought help for their prescription drug habit, turned into an even greater addiction, she said.

“Oh, God, it was hell. It was so hard dealing with them because they were so out of it constantly. I finally contacted several facilities last summer. I thought, ‘I’ve got to do something.’ I could tell the one wasn’t going to be around very long,” she said.

She found spots for them at a Michigan treatment center. Health insurance covered about two-thirds of the cost. Now they’re in sober living centers in other states, and McKenzie realizes that their struggle is far from over.

“The rehab is just the beginning,” she said. “The goal is to stay sober, get a job, be around sober people.” The cost — between $600 and $800 a month in rent — is worth it, she said. “If they came back to their old stomping grounds, they could walk right back into the (methadone) clinic again.”

When prevention fails, private rehab is one, albeit very expensive, option. Others include outpatient treatment, even the courts — and not infrequently, a combination of those.

“The solution has to be not just law enforcement, but the medical people, the prescribers, physicians, pharmacists, counselors, therapists, people themselves,” said Chrestenson.

Around Montana, agencies and treatment centers are evolving quickly to deal with the issue.

Outpatient treatment options include individual counseling or group sessions. Inpatient centers around Montana are few and far between, and in high demand: All 16 beds at the Western Montana Mental Health Center’s new Recovery Center Missoula were filled when it opened last month. Both Great Falls and Billings have long had inpatient centers.

Courts’ role

Missoula County Justice of the Peace Karen Orzech, who often sees people when they’re first charged with crimes involving prescription drugs, said such programs probably give addicts their best shot at success. Oftentimes, she said, it can take three or four months for an addict to really be ready, both physically and mentally, not just to get clean but to stay clean.

“It happens all the time in DUI court. The first, second, third months, they’re fighting all the way,” she said.

In fact, the court system can be a useful component of getting people clean.

A new tool aimed at drunken drivers — the 24/7 Sobriety and Accountability Program that requires twice-daily alcohol tests for some people convicted of DUI — can be adapted to the reality of drugged driving, Orzech said.

“We have a patch that people can be ordered to wear that tests for just about everything except alcohol,” said Orzech. “There’s also urinalysis that can happen, and blood tests, which are happening all the time.”

Those blood tests are ordered for some DUI suspects who refuse breath tests. Unlike breath tests, they detect substances other than alcohol.

Involvement in the justice system can, of course, lead to the state Department of Corrections, with its own treatment programs. Five of the DOC’s seven treatment programs target substance abuse as compared to two dealing with alcohol abuse. In the last six years, DOC programs that include drug and alcohol treatment increased 13 percent, even though the overall prison population declined 1 percent, according to the agency’s biannual report released this year. The DOC has added 54 treatment and prerelease beds, according to the report.

Solutions can be as mundane as getting rid of unused opiates prescribed after, say, surgery or an injury. That keeps them from falling into the wrong hands. A surprising amount of drugs that go on to be abused, according to law enforcement officers, are simply snatched from the medicine cabinets of parents, friends and neighbors.

There is a prescription drug drop box at the Law Enforcement Center in Helena that is accessible Monday through Friday from 8 a.m. to 5 p.m. The procedure is anonymous; participants just simply put the bottles into the box.

If you can’t make it to the drop box but still want to get rid of medications, don’t just flush them — that’s bad for the water supply. Instead, throw them away after burying them in a bag filled with coffee grounds or kitty litter to keep them from being pilfered, said Chrestenson.

If you’re still taking such medications, treat them as you would a loaded gun, advised Mentel, the physician.

It all comes back to awareness, said McKenzie, whose sons are in recovery.

“It’s huge. Huge,” she said. “… I don’t think people (who use or abuse such medications) know where they are going to end up, most likely.”