ELKHART — Indiana is putting an emphasis on prescription drug abuse with the recent launch of a new website (www.in.gov/bitter pill), but should people in Elkhart County be paying attention? Local experts — including health care providers and law enforcement officers — said recently that Elkhart County residents are struggling with prescription drug abuse.
A tremendous amount of death
John White, Elkhart County coroner, said Monday, Aug. 19, that he's seen a “tremendous amount” of deaths from prescription drug overdose in the past few years. He said the usual culprit in his death investigations is methadone, a synthetic opiate meant to treat long-term pain. He started noticing people dying from methadone abuse in 2008 and he said it's been a significant issue since then.
“From 2008, when we first starting noticing it, to 2012, we've had 36 deaths (due to methadone overdose),” White said.
Methadone is usually prescribed for chronic pain, said White, but “most of the people who we've found with this drug at a toxic level in their system did not have a prescription for it.”
White thinks methadone is being abused over other prescription drugs because it is less expensive than another commonly abused painkiller, Vicodin.
He said a surviving family member in a local methadone death case said the person who overdosed thought they were taking methamphetamine. He believes that others might be getting methadone confused with methamphetamine, which is a stimulant.
“If people think they are taking a stimulant and they think it's not doing anything for them, they will take more,” White said. This is a problem, he added, because methadone stays in the body for about 24 hours.
Dr. P. Poovendran, medical director of IU Health Goshen hospital's pain clinic, said Tuesday, Aug. 20, that prescription drug abuse is “not an uncommon problem” in Elkhart County.
“We do have a significant population that have what we call drug-seeking behavior,” Poovendran said.
All of the patients at the pain center are complaining of some type of pain, Poovendran explained. The problem is that it can be difficult for health care providers to distinguish between patients who are legitimately in pain and patients who are using medication for another reason.
“There is nothing to measure pain,” Poovendran explained. “It's very difficult to prove (the patient) does not have pain.”
Poovendran said that the pain clinic will rarely turn patients away who are asking for medicine to treat pain. Patients do agree to a contract saying they won't get the same medication from other health care providers or give the medication to somebody else. The pain clinic also does a urine test to ensure that patients are actually taking their medicine and to ensure they aren't taking other drugs.
Poovendran said that methadone may be more common in prescription drug overdose deaths because it is cheaper and more available than other drugs. But he added that while methadone may cause more deaths, “addicts who are living and walking” are more likely to be addicted to Vicodin.
Vicodin, he said, could be prescribed after an injury and it's used for short-term relief of pain.
People taking painkillers who aren't really in pain may experience a feeling of elation similar to the effect of alcohol, Poovendran said.
He said that the pain clinic works to refer prescription drug addicts to treatment centers in the area.
Impossible to say no
Dr. David Taylor, a psychiatrist at Elkhart General Hospital, said he's seen “quite a bit” of prescription drug abuse among his patients.
“Particularly, the abuse of prescription opiates (such as Vicodin, Percocet and OxyContin) is going up,” Taylor said Wednesday, Aug. 21. “That's risen at the same time that there's been a rise in the use of heroin. We are seeing more people abusing heroin and prescription narcotic abuse in the past five years.”
Taylor said that heroin addicts may be using prescription drugs when they run out of heroin, or to deal with withdrawal symptoms.
“A lot of the people we see (abusing prescription drugs) are younger — late teens and college age,” Taylor said. “This is a group where we probably weren't seeing much of (this problem) 10 years ago.”
So why is prescription drug abuse becoming more common?
Taylor believes it's because doctors are handing out more prescriptions.
“There are more prescription drugs out there (now),” Taylor said. “They are more available.”
Taylor said there are probably some genetic predispositions that make a person more likely to become dependent on a certain drug.
“If (the person) goes through their whole life and they are never exposed to these medicines, they may never have a problem with it,” Taylor said. “But if you're 18 and you break your leg, and someone gives you a prescription ... it may make you feel better than you ever have before.”
At that point, Taylor said, “It's very hard to say, 'I don't want any more of that.'”
Some people may not have a problem when they stop taking the drug,” said Taylor. Others “may find it impossible to say no,” he added.
A culture of pills
John Horsley is the director of addiction services at Oaklawn Psychiatric Center. He said Wednesday that he's seen more people die from prescription drug overdose in the last two years of his career than in the previous 16 years.
“Part of the problem is that there is so much medication out there and people leave it laying around,” Horsley said. “We see a high number of people with prescription drug issues. It's a huge problem in Elkhart County.”
He continued, “We see a lot of younger people (addicted to prescription drugs). It's something we are paying a lot of attention to at this point because of the prevalence of it.”
Horsley said that he believes young people between the ages of 18 and 25 are abusing prescription drugs because they have been programmed to think they need medication.
“I think we've become a culture of pills,” Horsley said. “Pharmaceutical companies are on TV all the time for this pill or that pill. I think this generation has been programmed to think, 'What pill can I take to solve this problem?' And that's a big issue.”
At Oaklawn, Horsley said that addicts may go through treatment involving intensive therapy that can teach them what their “triggers” are and how to deal with them.
“Recovery is complex for people who do have pain, because they have to find another way to treat their pain,” Horsley said. “The issue becomes, nothing is going to be as immediate as the drug. You're not going to just take a pill and get instant relief.”
For people who don't have pain, the recovery process is similar to the recovery process for people addicted to illegal drugs, Horsley said.
Horsley also mentioned that it can be diffiicult for people abusing prescription drugs to admit that they have a problem. Since the pills came from a doctor, addicts may not see the harm in taking more and more of the medicine — even when they don't need it anymore, said Horsley.
“Sometimes (people) will come in and say, well, my doctor is prescribing this (medication),” Horsley said. “Then you look, and find out that five doctors are prescribing it.”
He added that while Oaklawn does get walk-in patients, many are referred to treatment by a doctor, a judge or a family member.
Elkhart County Sheriff Brad Rogers said that his officers have seen “pharm parties” happening in Elkhart County.
A pharm party, according to Rogers, involves young people gathering an assortment of prescription drugs and taking them randomly to see what happens.
“This is usually used in conjunction with consuming alcohol and other drugs,” Rogers said. “Many younger people also take prescriptions from their parents and grandparents, unknown to them because they only take one or two.”
Pain pills such as OxyContin, said Rogers, have also been the target of store robbery or home invasion cases locally.
“Typically, cancer patients and those in serious pain have prescription drugs that seem to appeal to those that wish to abuse,” Rogers said.
He added that the Elkhart County Sheriff's Department works with the Elkhart County Drug-Free partnership to give people a safe place to dispose of their prescription drugs when they are no longer needed. There is a drug return box located in the jail lobby. More drop box locations can be found at www.elkhartdrugfree.org.
How to get help
If you think you may be addicted to prescription drugs, here are a some local organizations where you can get help.
Addiction Recovery Center, 204 S. Main St., Elkhart: The Addiction Recovery Center offers individual and group therapy. Options range from a one-day education class to a 24-week intensive addiction program. There is no physician on staff, so treatment does not include medication or medical supervision. Fees can range from $20 to $50 per week. Addiction Recovery Center does not currently accept insurance. Call the center at 574-293-1086.
Center for Problem Resolution, 211 S. Fifth St., Elkhart: The Center for Problem Resolution offers outpatient services. Individuals seeking treatment will first complete an assessment to determine what kind of help is needed. There is an assessment fee of $40, then sessions of group therapy are $30 each. Sessions last for about two hours. There are two financial assistance programs available: Access to Recovery, which can pay up to half of treatment costs, and an Elkhart County Drug-Free grant. The grant is income-based and it can cover up to $900 of treatment. Call the Center for Problem Resolution at 574-294-7447.
YWCA: The YWCA offers inpatient and outpatient services for chemical dependency for women. Women are allowed to bring their children and child care is available. To qualify for services at YWCA, the person seeking help must complete an assessment over the phone with a case manager. Then qualified individuals are placed on waiting list. Women can join support groups and take life skills and empowerment classes. There are no fees except to pay for meals offered. YWCA also has a dual program that treats domestic violence and chemical dependency at the same time. Help for chemical dependency is only offered at the St. Joseph County location at 1102 S. Fellows Street, South Bend. Call the YWCA at 574-233-9491.
Oaklawn Psychiatric Center, 2600 Oakland Ave, Elkhart: Oaklawn offers outpatient treatment, including medication management services and family and individual counseling. Session length and intensity varies depending on the individual's needs. Before treatment starts, the person seeking help will be asked questions about their personal history, substance abuse, medical issues and personal goals. Oaklawn does accept insurance but will work with people without insurance coverage. Sliding fee scales and discounts based on income are available. Call Oaklawn at 574-533-1234.
Editor's note: Recovery Journey is a local organization that was not included in this list in an earlier version of this story due to reporter error.
Recovery Journey, 3110 Windsor Court, Elkhart: Recovery Journey offers two types of treatment for people struggling with substance abuse. Modified outpatient treatment takes place twice a week for eight weeks, with continued care. Intensive outpatient treatment takes place three times a week for eight weeks, also including continued care. Both treatment programs consist of group therapy.
Recovery Journey also offers education classes, relapse prevention groups, family programs, and individual counseling. A counselor on staff will assess a new patient to determine what type of treatment might be best for them.
The assessment fee is $35. Modified outpatient therapy is $40 per week and intensive outpatient therapy is $50 per week, including continued care. Recovery Journey does not work directly with insurance companies. However, the patient is provided with a statement and may chose to seek reimbursement from their insurance provider. Call the Recovery Journey at 574-264-5840.
To find more help with prescription drug abuse, including signs that you may be addicted, visit www.in.gov/bitterpill.