Social services see prescription drug abuse as part of a complex of problemsJoshua Sebold
Last week’s article focused on the law enforcement perspective on prescription drug abuse, addiction and misuse, which provides a good foundation for understanding the problem, but history and Plumas law enforcement leaders indicate cops are only part of the solution and usually only get to see part of the problem.
The California Highway Patrol usually becomes aware of drug abuse when someone makes a mistake behind the wheel. Sheriff’s officers encounter these issues as part of other problems, or when someone ends up in the emergency room.
In addition the reality is many people are less likely to speak frankly with a police officer than with their doctors, therapists or social services representatives for a variety of reasons.
One of the most basic questions about America’s traditional view on drugs has always been “how do they affect families?”
Bill Snitkin, a child protective services supervisor, explained that he encounters families with a vast variety of drug problems on a constant basis. In his opinion prescription drug addiction and abuse are now on par with methamphetamine in terms of the number of people using and the severity of problems caused in a household by that use.
He commented that most of the families he contacted had several drugs in their houses, that most had medical marijuana prescriptions and many had other substances as well.
Snitkin said the abuse of medical marijuana tended to make someone into a worse parent, as does alcohol, but the biggest issue associated with it is that people often smoke the plant inside, near their children.
Conversely, the family supervisor argued a parent with a methamphetamine or prescription drug abuse problem often became someone who wasn’t a parent at all.
Common symptoms of prescription drug addiction and abuse described by Snitkin included depression, laziness and an inability to function in general.
The CPS worker lamented that this often led to a situation where the family dynamic was completely disrupted.
“The kids are raising mom and each other.”
Mental Health Director John Sebold agreed it was common for many prescription drugs to cause depression because many pharmaceutical grade painkillers are depressants.
Child Protective Services Program Manager Leslie Mohawk said the severity of addiction to prescription drugs made it impossible in many cases to get kids back into their homes because social services only had six months to a year to get the parent ready, and the problems couldn’t be addressed that quickly in many cases due to a lack of addiction treatment options in the county.
She also didn’t know what social services would do without the help of the mental health department, which has contracted with the CPS program to give group therapy to parents with alcohol and drug issues.
Sebold also encountered prescription drug problems in his work in multiple ways as the mental health department deals with people who have addiction problems and has to decide when or when not to prescribe psychiatric medications.
He said prescription drug addiction “just complicates everything.”
The mental health director said everything a therapist tries to do to help someone was less effective until addiction problems could be dealt with.
Sebold also voiced his belief that mental health issues could compound substance abuse problems and vice versa.
He said people going though a lot of emotional problems were vulnerable to addiction and mind-altering drugs, prescription or otherwise, because they just wanted to feel different than they currently did.
The director said in general mental health drugs weren’t as dangerous as painkillers because they’re less likely to kill someone, but they could still be abused.
Sebold said anti-anxiety drugs were particularly concerning because they were habit forming and could impair driving abilities.
His department tried to treat people without medication whenever possible and had weekly staff meetings to discuss treatment options and complex cases and monthly meetings with the psychiatrist who contracts with the department to prescribe drugs.
Both social services experts and Sebold said they got clearance from clients to speak to their pharmacists and doctors about what medications they were receiving and whether or not there were indications of abuse or dangerous addiction.
The social services representatives said some doctors were very helpful in addressing their concerns about patients with possible addiction or abuse issues, but others weren’t responsive enough to their concerns.
They felt the public and some members of the medical profession didn’t recognize the level of sharing and illegal sales of medication that occurred in the county or the lengths people would go to get drugs.
They also said people with prescription drug problems usually learned what doctors were easiest to get drugs from.
When asked about the subject, Plumas District Hospital emergency room doctor and PDH board member Mark Satterfield said prescription drugs were a very difficult issue because doctors had recently been chastised by the federal government for not providing enough pain relief to patients and for under-prescribing drugs.
Satterfield commented pain and addiction were parts of the human experience that were still largely mysterious to scientists and doctors.
He argued pain thresholds could vary widely and described a situation where he gave a shot to a 3-year-old girl who didn’t bat an eye, while others are usually affected enough by the experience to flinch every time they see a needle.
The ER doctor said that overmedication of painkillers, ironically, could actually lead to more pain in the long run.
He added there was a large cultural belief that a prescription pill provided the solution to most problems, and in his opinion taking a Tylenol or Advil and gritting your teeth was a much better option in many cases.
Satterfield said the cultural affinity for drugs was something that affected kids as much as adults. Satterfield often sees 15-year-olds asking for Vicodin by name after experiencing small injuries like turning an ankle.
The doctor suggested methadone was probably the biggest problem drug right now because it and alcohol slow the breathing rate and could combine for catastrophic results.
He said another big issue was the Food and Drug Administration had historically preferred to prescribe narcotics when combined with acetaminophen, which he said didn’t make much sense because that meant you were combining an addictive and mind-altering drug, the narcotic, with a substance that had a risk of overdose, acetaminophen.
Vicodin is an example of a drug that contains both substances.
Satterfield said there has been a recent movement to change that and make it easier for doctors to prescribe narcotics alone.
The doctor added he thought addiction in general was underlying the prescription drug problem and more would have to be done to understand addiction in general.
He also commented he didn’t think Plumas County had a larger prescription drug problem for the population size than other places. Satterfield thought the problem was significantly smaller than in places like Oroville and Yuba City, before adding that didn’t mean the county didn’t have a large problem.
Though the experts may have different opinions about the relative size of Plumas County’s prescription drug problem compared to the rest of the state, most seemed to agree that the issue is very serious, use is still on the upswing, and the problem won’t go away anytime soon.
All the experts held some hope that networks like the state’s new Controlled Substance Utilization Review and Evaluation System would help combat the problem in the future by allowing law enforcement and medical professionals to share information about patients’ patterns of drug use. However, few had used it more than a couple of times at this point since it is still very new.
The social service experts were the only group that hadn’t been made aware of the program and suggested they could identify clients for doctors and law enforcement to monitor.
All the experts interviewed seemed to agree the public had many misconceptions about prescription drugs and some doctors hadn’t caught up with the issue and changed their prescribing habits.
They felt abuse, overmedication and addiction were all dangerous and the public wasn’t adequately aware prescription drugs could cause the same problems as illegal drugs.
They also agreed most problems with prescription medication began innocuously with an injury or other legitimate source of pain.
Finally they all agreed the issue could only be improved through more awareness of the problem from the public; better collaboration between agencies and adequate treatment options for people who need help with addiction.