Here is a shocking statistic – the United States makes up only 5% of the world’s population but uses 80% of world’s narcotic prescriptions. And here is another shocker – while the majority of narcotic addicts began the path to addiction by using prescribed narcotics, only 20% of those drugs were prescribed for that individual. The others were prescribed for somebody else and got into the hands of an evolving addict. How did they get there? They were diverted – out of medicine closets, from the tops of dressers, from the kitchen cabinet. Some were stolen, some were sold and some were given freely.
To begin with, there are too many prescriptions written for narcotics in this country. In 2012 alone, there were 259 million prescriptions written for narcotic painkillers. That’s nearly enough narcotic to supply one bottle to every man, woman and child in the country. No other nation on earth comes close to the United States’ appetite for narcotics. It begins with prescribers – doctors, dentists, nurse practitioners, and physician’s assistants who try to relieve suffering when treating a problem that involves pain. The practice of prescribing narcotics is formed during healthcare training where the system prioritizes patient needs. Then it is reinforced by quality initiatives where pain control is a core metric of quality-of- care, where time is short and where patients rate providers on responsiveness to their needs. It also cannot be denied that some practitioners are simply too free with the prescription pad. In the end, all these factors can be exploited by patients who know that pain is hard to quantify on an objective scale.
The problem of too much narcotic has also been fed by the average American. You and me. It is not so much that we ask for narcotics when we can manage without them. We often get them for legitimate and serious pain, but we fill those prescriptions in quantities that exceed our need and we store the excess in our medicine cabinets, on our dressers and in our kitchens where they can easily be diverted.
I understand this. I am one of those people who didn’t throw away old drugs …at least, I used to be. When I pay for something, especially something I cannot easily get, I am not inclined to discard what I didn’t use. I have dozens of leftover ingredients in the kitchen from a single attempt at a gourmet recipe. My cosmetic cabinet is swollen with items I use only occasionally; my sewing room is stuffed with fabric scraps from earlier quilts and crafts. I’m not a pack rat; I’m a Yankee. I live in New Hampshire where thrift is elevated to an art form and where we battle over the right to trade leftover goods at the local transfer station. Nearly every object is saved until the last breath of utility can be extracted from it. So, like many of my neighbors, I have had a cache of unused medication in my medicine cabinet. Not anymore. Where narcotics (and other prescription medications) are concerned, I have changed my ways. Here’s why.
Last September, my daughter had a serious cycling accident that required
surgery. She lives in the west, so I flew out to be with her during surgery and the recovery period. She had a great surgeon – technically skilled, very pleasant and a good communicator. When she was discharged, he wrote a script for 30 narcotic pills. I am a nurse, and I practiced as a nurse practitioner for 20 years, so I understood the plan. But by the end of the first 24 hours, she was profoundly nauseated and actively vomiting – probably from the medication, so I called the surgeon’s office to request a change of pain med. He responded instantly (remember the patient satisfaction measure) and prescribed 30 pills of a slightly different narcotic. The new drug controlled her pain without the side effects. Success. As a nurse, I knew that her pain would steadily decrease by the end of the fourth post-op day, and I was right. Her doctor hadn’t set a goal for reducing dependence on the narcotic, but I did. I have seen too many people come to rely on the euphoric feeling narcotics provide and migrate into addiction. So, I worked with her to transition from narcotics to over-the-counter medications for pain relief. She was happy to comply. By day four, her pain was controlled using Motrin, but she now had a surplus of some 43 narcotic pills.
I returned to New Hampshire on day five, but not before warning her not to give her leftover drug to anyone. I cautioned her that there was a street value to narcotics and, to keep herself safe, she should not tell anyone she had the meds. Later she told me she didn’t have to tell anyone about her leftover drugs; people approached her about them: “You must have had some nice pain meds, eh? Got any left? Can I have them? Can I buy them?” She wisely avoided their prodding but felt a little frightened and lost more than a little trust. It frightened me too. There are only two reasons for anyone to ask about her narcotics. Either they were users or they were sellers. Neither option sat well with me. It didn’t feel good that they viewed her surgery as a possible way to find narcotics. Some people out there are trolling for unused narcotics; simply having them places the owner at risk.
Here’s the other reason I don’t hang on to old meds anymore, and I have learned this from my patients. When extra drug is in the medicine cabinet, it is an invitation to misuse by anyone in the house. Maybe someone has a restless night and can’t sleep, so they reach for the old Percocet – just to take the edge off. No harm, no foul, right? Wrong. Once a person starts using a med not prescribed for them or for that purpose, it is abuse. It is very easy to slide into the habit of taking it again and again until true addiction forms. Every dose can be a lure to someone else in the house who wants it for pain control, to self-treat mental anguish or just to have a good time. Maybe that someone is a grandchild, a niece a nephew, a workman. That’s how it begins. Years ago when I was a visiting nurse in Washington DC, I arrived a patient’s home to learn he had just been burglarized for drugs. The patient was certain that one of the masked thieves was his neighbor who knew that my patient had been recently hospitalized.
Washington DC may seem a long way off, but the same thing can and does happen in New England. In our hospice program, we provide care to all kinds of people, including some who have a known addiction or have an addict in the family. In those cases, at least we know what precautions to take. In others, when narcotics go missing, we know someone is diverting them but we don’t know whom. That question creates tension and sometimes, police involvement. We increasingly use lock boxes for meds and caution families to guard narcotics. And…we encourage them to discard 100% of the leftover narcotics after death. We give the same recommendations for those recovering after surgery in our home health program. Leftover drugs are a risk – to patients, to their families and to the community. Surplus narcotic creates and lures addicts, and it destroys families. Too many of our neighbors have sadly discovered that their leftover drug fed a loved one’s evolving addiction.
The problem of addiction has become one of the top concerns of the state of New Hampshire. It affects our neighbors, our communities, our employers and our economy. The solution is not in the hands of the police alone. Each of us must do our part to stop feeding the beast. In the healthcare professions, most clinicians are working very hard to reduce the risk of drug use and diversion. Providers are screening patients more thoroughly, encouraging the use of non-narcotic methods of pain management – especially in chronic pain, limiting the amount of narcotic prescribed and consulting the NH Prescription Drug Monitoring Program to view patients’ prescription drug history.
Consumers must be another arm of the solution. We must be sensible about the amount of drug we request, be willing to employ non-narcotic methods of pain control instead of or in conjunction with prescribed medications. Importantly, we must discard all the narcotics we have leftover, and we must do it safely. Safely does not mean throwing meds down the toilet where they can affect the water supply. Safely means crushing the medication in coffee grounds and discarding it in the sealed trash. Alternatively, consumers can transport the meds to an authorized, safe disposal location. In the Lakes Region of New Hampshire where I live, the Laconia police department offers a no-questions-asked disposal unit with 24 hour access. Other communities should be encouraged to do the same.
Control of opioid addiction begins with us and our willingness to understand that storing narcotics is not thrifty, it is risky. It’s too risky. It feeds the beast. It destroys families. We are smarter than that. We can get rid of it – safely.
ABOUT the Author: Margaret Franckhauser is Chief Executive Officer of Central New Hampshire VNA & Hospice. The Mission of Central New Hampshire VNA & Hospice is “Promoting dignity, independence, and well-being through the delivery of quality home health, hospice and community-based care services.” Central New Hampshire VNA & Hospice serves Lakes Region communities in Belknap and Southern Carroll County and provides Home Care (nursing and rehabilitation services in the home); Pediatric Care (direct health care, education and support services for children and families); and a comprehensive, team-based Hospice program. Central New Hampshire VNA & Hospice is a not-for-profit, Medicare-certified provider of home care and hospice services, licensed by the State of New Hampshire. The agency is governed by a volunteer Board of Trustees and supported by private and corporate donations.