Maryland Bar Bulletin
Publications : Bar Bulletin : March 2006

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WORK/LIFE
SUPPORT

MSBA Lawyer Assistance Program

Take Only as Prescribed

"It happened without any warning, a sudden wave of terror," Jane recalled. "My heart was pounding, I could not catch my breath and my feet were unstable. I thought that I was having a heart attack!"

In the emergency room, Jane tested negative for any type of heart problem. However, it was found that she did suffer from anxiety attacks. Accordingly, Jane was prescribed a central nervous system (CNS) depressant in the form of a barbiturate. Soon, the anxiety attacks all but disappeared.

Today, however, Jane suffers from another problem. Believing that she had been prescribed a "miracle drug", Jane began taking more than the prescribed amount. At first, she experienced difficulty in coping with life events without taking a pill. Then

Jane found herself using a combination of drugs to achieve a certain mood and feel normal. Eventually, Jane's work and family were adversely affected by her abuse of prescription drugs. Finally, Jane realized that for years she had not been taking her prescribed CNS depressants as prescribed, oblivious to the potential danger involved in misusing and/or abusing the prescription.

♦♦♦

Generally, medicines are prescribed to combat illness, relieve pain and to make us feel better. Prescriptions, though, are often more powerful than many of us realize, and the side effects can be dangerous – especially when used incorrectly. Alan I. Leshner, Ph.D., Director of the National Institute on Drug Abuse, states: "Most people who take prescription medications take them responsibly; however, the non-medical use of abuse of prescription drugs remains a serious public health concern. Certain prescription drugs – opioids, central nervous system (CNS) depressants, and stimulants – when abused, can alter the brain's activity and lead to dependence and possibly addiction." Dr. Leshner states further that "an estimated 9 million people aged 12 and older used prescription drugs for non-medical reasons in 1999; more than a quarter of that number reported using prescription drugs non-medically for the first time in the previous year."

Also, as reported by the Performance Resource Press:

bullet More deaths and injuries are caused by the abuse of prescription drugs than from the use of all illegal drugs combined.
bullet Fifty percent of older adults regularly use over-the-counter medicine. One out of every four adults over the age of 60 takes four or more prescribed medications at once. One-third of older adults take medications prescribed by more than one doctor, and 77 percent of this group do not discuss with one doctor the medications prescribed by another.

Unfortunately more than one-half of all prescription drugs are taken incorrectly (i.e., taking medicine in larger doses or more frequently than prescribed or mixing them with other drugs). Generally, a medication may be safe when used alone, but can be potentially deadly when used in combination with other drugs, including alcohol.

Commonly-Abused Prescription Drugs

Although any prescription drug can be misused and/or abused, the big three are: (1) Opioids (Narcotics); (2) CNS Depressants (Tranquilizers) and (3) Stimulants.

bullet Opioids. Opioids (a.k.a. narcotics) are commonly prescribed because of their effective analgesic or pain-relieving properties. Medications in this class include but are not limited to morphine, codeine, oxycodone (OxyContin), propoxyphen (Darvon), hydro- codone (Vicodin), and hydromorphone (Dilaudid) and meperidine (Demerol).

This group of prescribed medications act by attaching to specific proteins (called opioid receptors) in the brain, spinal cord and gastrointestinal tract. When these drugs attach to specific opioid receptors, they can block the transmission of pain messages to the brain. Opioids can cause euphoria by affecting the brain regions that mediate what we perceive as pleasure.

The possible consequences of opioid use and abuse can result in tolerance for the drug. In other words, this means that users must take higher doses to achieve the same initial effects. Long-term use can also lead to physical dependence and addiction – the body adapts to the presence of the drug, and physical withdrawal symptoms occur as use is reduced or stopped. Symptoms of withdrawal include but are not limited to restlessness, muscle and bone pain, insomia, diarrhea, vomiting, cold flashes and involuntary movements. When opioids are taken exactly as prescribed, they can be used to manage pain effectively.

bullet CNS depressants. This class is comprised of substances that can slow normal brain function. CNS depressants are useful in the treatment of anxiety and sleep disorders. Among the medications that are commonly prescribed for this purpose are:

bullet Barbiturates – include mephobarbital and Nembutal, which are used normally to treat anxiety, tension and sleep disorders.
bullet Benzodiazepines – include diazepam (Valium), cholorodiaze-poxide HCl (Librium) and alprazolam (Xanax), which are used normally to treat anxiety, acute stress reactions and panic attacks.

There are many CNS depressants, and most act on the brain by affecting the neurotransmitter gamma-aminobutyric acid (GABA). In other words, neurotransmitters are brain chemicals that facilitate communication between brain cells. GABA works by decreasing brain activity. More specifically, different classes of CNS depressants work in their own way to increase GABA activity in order to produce a calming effect that is beneficial to those suffering from anxiety or sleep disorders.

Barbiturates and benzodiazepines have the potential for abuse and should be used only as prescribed. When an individual uses such drugs long-term, his or her body will develop tolerance for the drugs, and larger doses will be needed to achieve the same initial effects.

Furthermore, insofar as CNS depressants work by slowing the brain's activity when an individual stops taking them, the brain's activity can rebound and race out of control, possibly leading to seizures and other harmful consequences. Consequently, someone who is thinking about discontinuing CNS-depressant therapy or who is suffering withdrawal from CNS depressant should speak with a physician or seek medical treatment before so doing.

bullet Stimulants. Stimulants are a group of drugs that enhance brain activity – they cause an increase in alertness, attention and energy that are accompanied by elevated blood pressure and increased heart rate and respiration. This group is used to treat asthma and other respiratory problems, obesity, neurological disorders and a variety of other ailments.

Today, commonly-known stimulants include dextroamphetamine (Dexedrine) and methylphenidate (Ritalin). Their chemical structures increase the norephinephrine and dopamine in the brain. For that reason the consequences of stimulant abuse can be dangerous. Stimulants can be addictive in that individuals begin to use them compulsively. Taking high does of some stimulants repeatedly over a short time can lead to feelings of hostility or paranoia.

So what are you to do if you find yourself like our friend Jane or how do you keep medicines from becoming an additional or new problem? Needless to say, careful use and knowledge of the medicines prescribed to you should prevent mishaps. Also, adhere to the following:

bullet Take exactly the amount of drug prescribed and follow the dosage scheduled as closely as possible. If you have questions, call your doctor or pharmacist.
bullet Never take drugs prescribed for a friend or relative, even though your symptoms may be the same. Medicines do not produce the same effects in all people.
bullet Always tell your doctor about problems you have had with drugs, such as rashes, indigestion, dizziness or lack of appetite.
bullet When your doctor prescribes a new drug be sure to mention all of the others medicines you are currently taking, including those prescribed by another doctor and those you buy without prescription.

If you believe that you (or someone you know) may have a problem with prescription drugs, contact the MSBA Lawyer Assistance Program at (410) 685-7878 or (800) 492-1964, ext. 3041, or e-mail cwaldhauser@msba.org. Remember, we are a free, confidential lawyer (and employee) assistance program for legal professionals in Maryland.

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Publications : Bar Bulletin: March 2006

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