DBs Unit 7

DB 7.1: Prescription Drug Dependency and Addiction

Prescription drug dependency often begins innocuously as patients adhere to their doctor’s instructions. However, several factors can contribute to dependency, especially when dealing with medications like opioids or benzodiazepines, which are commonly prescribed for pain or anxiety. These drugs affect the brain’s reward system by increasing dopamine levels, reinforcing the desire to continue using the medication. Over time, the body builds tolerance, leading to the need for higher doses to achieve the same effect, fostering dependency. This gradual escalation is often where the line between “following doctor’s orders” and addiction begins to blur (Marsden et al., 2019).

The distinction between addiction and dependency can be subtle. Addiction is defined as exposing the patient to a drug in a compulsive manner with negative repercussions due to an irresistible desire for the substance while following the doctor’s orders implies the regular intake of the drug in a controlled manner as prescribed by the doctor (Szalavitz et al., 2021). However, addiction can develop even if medication is taken correctly. However, the patient does not know the possible negative effects of long-term usage or incorrect dosing of the medication or stopping it.

Accessibility is a primary difference between prescription medication and OTC medicines or drugs. Other drugs that can be easily obtained over the counter, like cough syrups containing codeine, are considered to be safe drugs due to their accessibility. However, the same drugs can result in drug dependency when abused (Preuss et al., 2023). The idea that any medication that is prescribed by a doctor is safe is one of the major causes of substance abuse. From the year 1999 to 2016, opioid prescriptions in the United States increased three and a half times, causing an increase in the number of people who became addicted and those who died from opioid overdose. A large number of people who receive prescription drugs do not know the risks associated with the mixture of drugs, especially when the patient is treated by more than one doctor, making it possible for people to overdose and die accidentally (Brain, 2019). As a result, addressing prescription drug misuse requires greater patient education and more stringent prescription practices to prevent these outcomes.

References

Brain. (2019, August 31). The Science of Addiction: Here’s Your Brain on Drugs | National Geographic. [Video]. YouTube. https://youtu.be/JVQy-LUE9Ss?si=qc2F5e-vA-NIzfvp

Marsden, J., White, M., Annand, F., Burkinshaw, P., Carville, S., Eastwood, B., Kelleher, M., Knight, J., O’Connor, R., Tran, A., Willey, P., Greaves, F., & Taylor, S. (2019). Medicines associated with dependence or withdrawal: a mixed-methods public health review and national database study in England. The Lancet Psychiatry, 6(11), 935–950. https://doi.org/10.1016/s2215-0366(19)30331-1

Preuss, C. V., Kalava, A., & King, K. C. (2023, April 29). Prescription of Controlled Substances: Benefits and Risks. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537318/

Szalavitz, M., Rigg, K. K., & Wakeman, S. E. (2021). Drug dependence is not addiction—and it matters. Annals of Medicine, 53(1), 1989–1992. https://doi.org/10.1080/07853890.2021.1995623

DB 7.2: Heath Ledger’s Death and Prescription Drug Use in the Elderly

Heath Ledger’s tragic death from a prescription drug overdose in 2008 serves as a stark reminder of the dangers of mixing medications. Ledger died from acute intoxication due to a combination of six prescription drugs, including opioids and benzodiazepines, which were likely prescribed to manage anxiety and pain (ETAccess, 2008). This case parallels many incidents involving elderly individuals, who often face similar risks due to polypharmacy—the use of multiple medications to treat chronic conditions.

As demonstrated in both cases, there are potentially severe consequences due to unintended drug interactions. In Ledger’s tragedy, for example, the drugs that he had ingested simply had a cumulative toxic effect that finally put his body to complete shutdown and resulted in death due to respiratory failure. Likewise, the patient’s multimedication with diverse practitioners is often unaware of the lethal adverse effects risk. Polypharmacy is most threatening among the elderly because there are alterations in metabolism and drug absorption among the elderly, which worsens the consequences of certain drugs on the individuals taking them, raising vulnerability to overdose (Varghese & Haseer Koya, 2024).

The key similarity between Ledger’s case and that of many elderly patients is the accidental nature of the overdose. In both instances, there was likely no intention to misuse the medication; rather, it was the combination of drugs, particularly opioids and benzodiazepines, that proved fatal. This underlines the importance of regulation of prescription, especially with multiple prescriptions of drugs that have interaction with others in a way that may be dangerous to the patient (Schiller & Mechanic, 2023).

However, there are also differences involved. Ledger’s overdose was a result of pills he took for a short-term illness, while most elderly patients take medication for a long-term illness. It prolongs their susceptibility to unfavorable drug reactions because their internal systems for breaking down drugs become less effective over time. In both instances, the need to counsel patients about polypharmacy and having other doctors’ prescriptions closely scrutinized before the patient is prescribed different medications, which can otherwise lead to such a terrible result as an overdose, is very crucial.

References

ETAccess. (2008, February 7). HEATH LEDGER: “He Just Stopped Breathing” CNN Part 1 of 2. [Video]. YouTube. https://youtu.be/NI-viBKGasg

Schiller, E. Y., & Mechanic, O. J. (2023). Opioid overdose. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK470415/

Varghese, D., & Haseer Koya, H. (2024). Polypharmacy. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532953/

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DB 7.1

• Unfortunately, many individuals who use medications as prescribed can become dependent during the process. How do you think that this happens? When does a person become “addicted” versus “following doctor’s orders?” Is there any difference between the use of prescription and over-the-counter drug use? Why are so many people becoming addicted or being harmed (or even dying)?

DB 7.2

• In thinking about the video, highlighting the death of actor Health Ledger, how are the circumstances of his untimely death similar or different from many of the elderly individuals who die each year in similar circumstances?
  

  DBs Unit 7

Readings:

• Review the information listed about abuse versus dependence throughThe Science of Addiction (2017) by clicking HERE.
• Read a NIDA’s Topics report on prescription drug abuse by clicking  HERE 
• Read NIDA’s research report by clicking  HERE 
• Read NIDA’s prescription drug and abuse information by clicking  HERE 
• When Prescription Drugs Kill: Please view the video and review the article below to aid in your discussion as well as the required readings.
  • Video: Prescription Drug Abuse Dangers
  • Article: FDA Drug Safety Communications
• Doctor Shopping: All too common in the field of human services are individuals who go from “doctor to doctor” to obtain large amounts and quantities of medications. These individuals engage in what is referred to as “doctor shopping” and often either illegally sell or use the medications. Please view the video below to aid in your discussion as well as the required readings.
  • Video: Dr. Shopping
• Prescriptions and the Elderly:Usually, when thinking of an elderly person, the word “addict” does not come to mind. However, each year hundreds of elderly individuals die from incorrect use of prescription medication. More strikingly, many of these individuals unknowingly have placed themselves at risk most likely many times before for death due to prescription drug combinations that could prove lethal.
  • HEATH LEDGER : “He Just Stopped Breathing” CNN Part 1 of 2