Is The Current Prescription Opioid Abuse Epidemic In The US Spreading To Thailand?

The snack bowl at a “pharm party” includes a mix of prescription drugs-from Adderall to OxyContin to Xanax-and most of them come directly from the household medicine cabinet.

The ABC News program, ‘Pharm Country’, examines a disturbing and rapidly growing trend in teenage drug abuse: getting high on legal drugs, often obtained through parents’ prescriptions or from questionable sources over the Internet. Presenting studies showing a rapid spike in pharmaceutical abuse among students as young as eighth-graders, the program visits a Houston substance-abuse treatment center where recovering teenage addicts and their parents share their eye-opening experiences. (Pharm, 03:12)

This study will take a closer look at the origins of the current opioid epidemic, it’s roots in the US, and is spreading across the globe.

Here in Thailand, I have experienced first-hand the evidence that the epidemic is alive and well and on the rise in Asia.

The goal of this study is to provide knowledge of the dangers of these drugs to physicians here in Thailand who are already prescribing them, and by distributing the survey located at the end of this article to physicians throughout the Kingdom of Thailand.

My qualifications:

On the 22nd of May 1988, I checked in to The Santa Barbara New House, an Alcoholics Anonymous 12-Step Recovery Center.

Best decision I ever made. I’ve been living life on life’s terms ever since without having to take any ‘mind altering’ substances that effect me from the neck up.

Santa Barbara New House is an ‘AA 12-Step House’ for men.

However, a majority of the residents are struggling, not just from the disease of “alcoholism”, but also from the wider definition of the disease of “addiction”. This includes a very wide spectrum of doctor prescribed, “mind altering” substances that do, in fact, effect the user from the neck up.

I come from an AA school of thought that states that we have to be very careful not to take anything that effects us “from the neck up”.

AA is the original twelve-step program that was created for ‘alcoholics’ who suffer from the disease of ‘alcoholism’. The traditions and “primary purpose” of AA provide an interesting loophole for some alcoholics who tend to advocate for big Pharma and the use of prescription drugs.

The incident:

“By far the worst day, hour, minute, moment in my 27+ years of sobriety.”

When I got the call from my daughter-in-law, I could only think of the worst.

She called at around 1:30 in the afternoon to say that my son wasn’t picking up his phone and that she hadn’t been able to wake him up in the morning because he was too, “out of it”.

I knew he’d been using again and suspected it started with his recent knee surgery. I was with him the previous Saturday night at an AA meeting I’d asked him to chair and he was actually nodding out. Instead of facing my fears and confronting him directly, I took the easier softer route of passively checking in on him, “give it the light touch”, (as my old sponsor would warn me about matters involving family).

As I drove the 30 minutes or so from my office to their house, I couldn’t chase the images of his lifeless body from my mind’s eye. I prayed for his life to be spared. I promised to devote my entire remaining days to service in recovery.

By the time I pulled up in front of his house, I expected to find the worst. I’d already thought about what I would do if the door had been locked and I imagined all the painful calls to family and friends. I also knew it had been a good 4 or 5 hours since anyone saw him breath.

The door was open and when I went in, all my fears became a tragic reality.

His lifeless body was lying face up on the bed and his life color was gone.

The only difference between what I’d imagined during my drive over and what I was looking at now reminded me of the scene from a TV series. Where a girl had overdosed on opiates and was choking on her vomit. The girl had all this froth coming out of her mouth. I remembered how I’d thought at the time that the effects of drugs and overdose were always sensationalized in Hollywood, yet this was what I was looking at, and my son’s lifeless body was lying on the bed in front of me. It also appeared to be past what I’d seen on the television. All that was left was that froth on his mouth. He was pale yellowish-white and he wasn’t moving.

Back in my active addition days, I’d brought back a total of three people after they OD’d, all three had overdosed on opiates, and none of which had that foam. Keep in mind I’ve been sober for over 25 years and don’t see much from the inside anymore. I just hear the newcomer stories and can only imagine.

I listened for signs of any life left and frantically tried to find a plus in his neck, nothing.

I immediately started yelling at the top of my lungs, “wake up, wake up”! I thought that would at least kill two birds with one stone and get some help from the neighbors at the same time. It didn’t. It became like a ghost town, not a soul. Just us.

I intuitively sat him up and started pushing him back and forth and yelling, “spit it out, spit it out”. I heard a gurgle.

I grabbed the trashcan out of the bathroom and filled it with cold water, rushed back and dumped it on him.

He moved so I just kept up the screaming and pulled him from the bed. For a moment I thought I was instantly given divine power and adrenaline until I tried picking him up. (Like six or seven bags of old stale rice!)

I called my daughter-in-law and told her to get an ambulance.

By then he started coming around and kept slurring, “What happened?” and “I can’t hear you”. After a while I thought the “I can’t hear you’s” were in response to my direct questioning about what he took. He was clearly damaged beyond opiate overdose and I knew I had to get him to the hospital.

My son had finally passed my bottom with this disease. I don’t think I ever really overdosed and I’m sure I never made it to the point of that froth. He’s always compared his addiction to mine and I always saw that was an excuse to keep using.

Finally, people started showing up. Neighbors, relatives, my daughter-in-law. The only thing missing was an ambulance so I decided to give up and drive him to the hospital myself.

One of the most absurd things I’ve ever witnessed in my sober life was right before we gave up on the ambulance and were about to head to the hospital in my car. I’d opened the refrigerator to get him some water and he grabbed a little bottle of liquid and quickly drank it. I said, “what was that?” and he said, “Retox”. Come to find out it was more Methadone.

“There in lies the rub… ”

Several factors are likely to have contributed to the severity of the current prescription drug abuse problem. They include drastic increases in the number of prescriptions written and dispensed, greater social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies. These factors together have helped create the broad “environmental availability” of prescription medications in general and opioid analgesics in particular. (Volkow)

Some types of opioid drugs include:

codeine (only available in generic form)
fentanyl (Actiq, Duragesic, Fentora)
hydrocodone (Hysingla ER, Zohydro ER)
hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)
hydromorphone (Dilaudid, Exalgo)
meperidine (Demerol)
methadone (Dolophine, Methadose)
morphine (Astramorph, Avinza, Kadian, MS Contin, Ora-Morph SR)
oxycodone (OxyContin, Oxecta, Roxicodone)
oxycodone and acetaminophen (Percocet, Endocet, Roxicet)
oxycodone and naloxone (Targiniq ER)

The typical scenario is that the patient is prescribed any of the above for pain, gets hooked, can’t successfully detox and graduates to street opioids.

All of the above are readily available and prescribed in Thailand and I believe, without proper Physician knowledge of the dangers involved.

The five-question survey at the end of this document is intended to provoke and inspire Doctor attention to this problem.

In his book, “Overcoming Prescription Drug Addiction: A Guide to Coping and Understanding”, author Rod Colvin compiles stories from individuals in recovery from addiction to prescription drugs. The concept of an “unwitting addict” is identified as someone who has been prescribed pain medication and becomes addicted. (Colvin)

In the book, “Managing Patients with Chronic Pain and Opioid Addiction”, Dr Donald Taylor’s interest in the treatment of opioid addiction arose from his observations of the development of addiction in his own patients with chronic pain, and his recognition of the fact that few pain specialists knew how to manage this group of patients.

Dr Taylor currently divides his practice between treating patients with chronic pain without addiction, patients with chronic pain with addiction, and patients without pain but with drug addiction. He is a Diplomat of the American Board of Addiction Medicine and a Diplomat of the American Board of Anesthesiology, with added qualifications in Pain Medicine. (Taylor)

“The Long Winding Road of Opioid Substitution Therapy Implementation in South-East Asia: Challenges to Scale Up”, is a study in the South-East Asia Region which contains an estimated 400,000-500,000 people who inject drugs (PWID). HIV prevalence among PWID is commonly 20% or higher in Indonesia, Thailand, Myanmar and some regions of India. Opioid substitution therapy (OST) is an important HIV prevention intervention in this part of the world. (Reid et al.)

Although this World Health Organization sanctioned “substitution” program is effective in the spread of HIV, I have to ask myself whether it will fuel the increase of the prescription drug epidemic.

The deadly combination of Benzodiazepines and Opioids are behind the bulk of deaths in the current prescription drug epidemic. Benzodiazepines are prescribed for “Anxiety”, (fear of future), and “Depression”, (regret from past actions). There’s a healthy solution, outlaw these harmful drugs and treat with cognitive behavioral counseling. (Bachhuber et al.)

The article, “Expanded Access to Naloxone: Options for Critical Response to the Epidemic of Opioid Overdose Mortality”, published in the American Journal of Medicine, describes “Naloxone”, (‘Narcon’) which is used in overdose to instantly wash the system of opiates. The drug is now ironically combined with buprenorphine to produce the same effects of an opioid and at the same time block any true opiates. (Kim et al.)

Since “The Incident”, (now just about a year ago), my son has had several seizures as a result of Tramadol overdose; (Tramadol is a synthetic opiate that can be easily obtained here in Thailand without a prescription). He got a local diagnosis for anxiety and depression and has all his prescriptions justified. As for me, I now go to Al-Anon, a support and discussion group for the relatives of people suffering from alcoholism… and addiction.

The Survey

Some types of opioid drugs include:

codeine (only available in generic form)
fentanyl (Actiq, Duragesic, Fentora)
hydrocodone (Hysingla ER, Zohydro ER)
hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)
hydromorphone (Dilaudid, Exalgo)
meperidine (Demerol)
methadone (Dolophine, Methadose)
morphine (Astramorph, Avinza, Kadian, MS Contin, Ora-Morph SR)
oxycodone (OxyContin, Oxecta, Roxicodone)
oxycodone and acetaminophen (Percocet, Endocet, Roxicet)
oxycodone and naloxone (Targiniq ER)
other opioid pain medication __________________________

(Please write name of drug)

Please complete the following five-question survey below:

1. Which of the opioid drugs listed above are you aware of?

2. Which of the opioid drugs listed above are safe to prescribe for pain?

3. Which of the opioid drugs listed above have you prescribed in the past 12 months?

4. Which of the opioid drugs listed above do you feel there is a risk of patient addiction?

5. What duration do you recommend for each of the above?

Up to 30 days
Up to 60 days
Up to 90 days
Up to 6 months
Over 6 months

Works Cited

Bachhuber et al. “Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States.” American Journal of Public Health. 106.4 (2016): 686-688. Web.

Colvin, Rod. “Overcoming Prescription Drug Addiction: A Guide to Coping and Understanding.” Omaha, Neb. Addicus Books. 2008. Print.

Engdahl, Sylvia. “Prescription drugs.” Farmington Hills, Mich.: Greenhaven Press, a part of Gale, Cengage Learning. 2014. Print.

Haerens, Margaret and Lynn M Zott. “Prescription drug abuse.” Detroit: Gale, Cengage Learning. 2013. Print.

Kim et al. “Expanded Access to Naloxone: Options for Critical Response to the Epidemic of Opioid Overdose Mortality.” American Journal of Public Health. 99.3, (2009): 402-407. Print.

“Pharm Country.” Films On Demand. Films Media Group, 2006. Web. 20 May 2016.

“Pills: Never Enough!” Films On Demand. Films Media Group, 2007. Web. 20 May 2016.

Reid, Gary, et al. “The Long Winding Road of Opioid Substitution Therapy Implementation in South-East Asia: Challenges to Scale Up.” PagePress. March 26, 2014. Print.

Talbot, Tony. “Painkiller Guidelines #1603151723300288.” AP Images. Associated Press. 19 March 2013. Web. 15 March 2016.

Taylor, Donald. “Managing Patients with Chronic Pain and Opioid Addiction.” Adis: Springer International Publishing Switzerland 2015. Print.

Volkow, Nora D. “America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.” 14 May 2014. National Institute on Drug Abuse. Web. 20 March 2016.