“Electroshock is violence.” - Ramsey Clark, former U.S. Attorney General, in an invited address at the Annual Meeting of the American Psychiatric Association in New York City, May 1983.

“If the body is the temple of the spirit, the brain may be seen as the inner sanctum of the body, the holiest of places. To invade, violate and injure the brain, as electroshock unfailingly does, is a crime against the
spirit and a desecration of the soul.” – Leonard Roy Frank, shock survivor, editor and writer, 1991

Electroshock appears to be increasingly prescribed as a treatment for “clinical” depression and other so-called mental disorders. Women and elderly people, particularly old women, are its chief targets–more
damning evidence of psychiatry’s sexism and ageism. In the United States during the last ten years, an estimated 100,000 people have been shocked each year. In Canada, perhaps as many as 10,000 people, again mostly women, have been electroshocked each year, but nobody knows for sure because Health and Welfare Canada and the provincial health ministries do not publish ECT statistics, some of which are available on request.

Besides, ECT statistics are notoriously inaccurate and unreliable, because collection methods differ from province to province and state to state; hospitals aren’t required to keep accurate ECT records and not all
hospitals are required to report ECT to provincial health ministries or state mental health departments.

I have discovered some recent shock statistics in Ontario which point to alarming trends:the increasing use of ECT and the targeting of women and the elderly for electroshock. Consider these statistical highlights:

1) In 1993-94, 11,360 shock treatments were administered to approximately 1,600 people in Ontario’s general, community and psychiatric hospitals – an average of seven shocks per patients. In 1994-95, 12,865 shocks were administered to over 1,500 people, a 12 per cent increase.

2) Most electroshock (over 80 per cent) in Ontario is administered in the public general hospitals, not provincial or private psychiatric hospitals.

3) Over 40 per cent of electroshock has been administered to people 60 years and older during the last five years.

4) In 1994-95, 97 elderly people, including 72 women (60 years and older), were subjected to 1,023 shocks in Ontario’s provincial psychiatric hospitals – a high average of approximately 10 shocks per patient. In
Toronto’s Queen Street Mental Health Centre, over 70 per cent of the shock patients are from its psychogeriatric unit.

5) In 1993-94, approximately 600 elderly people (60+ years) were subjected to 4,033 electroshocks in Ontario’s general and community psychiatric hospitals.

6) In the provincial psychiatric hospitals, the number and proportion of elderly people (65+ years) shocked grew from 70 (33 per cent) in 1990-91, to 82 (40 per cent) in 1993-94, to 44 per cent in 1994-95.

7) Among elderly and other ECT patients, significantly more women than men are electroshocked: two to three timnes more women than men have been electroshocked in both Canada and the United Stastes for many years.

8- During 1994-95 in the provincial psychiatric hospitals, 72 per cent of elderly shock patients (75+ years) were women, and significantly more
ECT was administered to an elderly woman than an elderly man (average 10.9 ECTs vs. 8.7 ECTs).

9) Women in their eighties and nineties have been electroshocked in general, community and provincial psychiatric hospitals in Ontario. In 1993-94, a total of 102 shocks were administered to at least 10 women of 85 years and older in general and community psychiatric hospitals. In 1994-95, at least 14 women of 80 years and older were subjected to 158 shocks in eight provincial psychiatric hospitals,an average of 11 ECTs per patient.

10) During 1994-95 in Ontario, the estimated cost of one electroshck treatment, including physicians’ fees, drugs, use of a hospital bed and nursing care, was $400. The (under) estimated total cost for all ECT that year was well over $1,000,000.

Two very common psychiatric myths state: first, that electroshock can prevent or greatly reduce the risk of suicide in people diagnosed with “clinical depression” or “bipolar affective disorder”; and second, that
electroshock is safe and effective for old and physically ill people.

The first myth was exposed at least six years ago by Dr.Donald Black and four colleagues. This study involving more than 1,000 depressed patients in Iowa found that there were no significant differences in the
suicide rate among the various groups treated with electroshock, antidepressants and no treatment. However, the higher percentage of deaths among the shock patients (85 per cent higher at two-year follow-up than the non-shock patients) clearly implicates shock as a contributing factor in their deatths (Black et al.,1989).

Regarding the second myth, Drs.David Kroessler and Barry Fogel’s longitudinal study involving sixty-five depressed patients 80 years and older found that for the ECT group, 27 per cent died within one year
following the “treatment”, but only 4 per cent of the “medicated” group died. In addition, one patient died after undergoing two ECTs. In other words, this study together with several previous ones, clearly show that
electroshock threatens people’s survival, especially if they are old and sick (Kroessler and Fogel, 1993).

Deaths related to or caused by electroshock are usually attributed to medical conditions, not reported or simply covered up in the medical-psychiatric literature. For exmple, only six or seven ECT-related
deaths in Canada have been reported in the Canadian medical-psychiatric journals during the last fifty years. No doubt a serious underestimate or cover-up. Nevertheless, respecred shock investigator and psychiatric critic, Dr. Peter Breggin, has estimated the general ECT death rate as one death for every 1,000 patients shocked, and a much higher rate of one death per 200 for elderly patients. However, in its official
shock-promoting booklet the American Psychiatric Association claims the ECt death rate from shock is !1 in 10,000″ patirents and that only “1 in 200″ patients suffer permanent memory loss (APA,1990). The Canadian
Psychiatric Association also claims there have been virtually no deaths or medical complications from electroshock in Canada, despite the fact that approximately 500 shock-related deaths and many more serious medical complications (e.g.,cardiac arrest, other serious heart problems, permanent epileptic seizures, brain damage) have been reported in the English langugage medical-literature for over 50 years since the early 1940s when electroshock was first introduced in Canada and the United States.

Together with many shock survivors and other shock critics, Peter Breggin wants electroshock banned, because psychiatrists routinely fail to warn patients about the serious risks of permanent memory loss and brain damage (a serious violation of informed consent), and because elderly, sick and frail patients are being increasingly targeted for electroshock. He explained his position in a recent phone interview with me last March:

“The escalating rate of shocking the elderly is one reason why I   have come out in recent years for a complete ban on the treatment.   The elderly are less able to defend themselves against shock
treatment, and their brains are more susceptible to devastating damage.”   (Breggin, 1996)

Leonard Roy Frank, an electroshock-insulin shock survivor living in San Francisco, shock critic, author and editor,insists that “ECB – electroconvulsive brainwashing” is a more accurate term. He agrees with
Breggin and asserts, “the studies indicate that it’s the elderly who are getting the most shock, and they’re the most vulnerable, not only physically but politically” (Frank, 1996). A 1989 report from California’s
Department of Mental Health supports Frank’s assessment; it reveals that 48 per cent of the 2,503 people shocked that year in the state were 65 years and older. Frank claims the figure is currently over 50 per cent and climbing.

Electroshocking women and elderly patients is also on the rise in England. For example, in a 1993 critique, patients’ rights advocate Alison Cobb reports that “…women are the majority of ECT patients (about 70 per
cent), half are over 65 years of age. …59 per cent of the 100 (in the study) … were aged over 65, the oldest being 92 years. Given the vulnerability of older people’s memory and cognitive abilities, this has
to be a grave cause of concern…”,(Cobb,1993).

Douglas Cameron, another outspoken shock survivor, critic and co-founder (with Diann’a Loper) of the World Association of Electroshock survivors based in Texas, is extremely critical of the alleged safety of
psychiatry’s modern shock machines, which can deliver as much as 300 to 400 volts of electricity to the brain:

“All modern day Sine Wave and Brief Pulse ECT devices are more powerful than early instruments. Modern day Brief Pulse suprathreshold devices have not proved safer than Sine Wave suprathreshold devices. Side
effects have been >convincingly identified as products of electricity. These facts warrant the elimination of all ECT machines from the marketplace” (Cameron,1994).

Since 1995, there has been growing public protest against the only shock machine in Whitehorse in The Yukon, stored in Whitehorse General Hospital. Apparently, the shock machine hasn’t zapped anybody in
Whitehorse (yet). The Second Opinion Society (SOS), the Yukon’s self-help advocacy group in Whitehorse, isn’t waiting. SOS has been organising rallies and marches against the machine.

More than fifteen years ago in Toronto’s Sunnybrook Hospital (a teaching, research and veteran’s hospital affiliated with the University of Toronto), psychiatrists Harry Karlinsky and Kenneth Shulman were
electroshocking elderly people. Most were in their 70s, some in their 80s. Karlinsky and Shulman (1984) reported having electroshocked thrity-three elderly atients (62-85 years old). At a follow-up study six months later, after having been subjected teo an average of 9 ECTs, only one-third of ther patients “were doing well”. Karlinsky and Shulman concluded that “clinically one is compelled to use ECT on an urgent or demand basis”. Compelled? In my recent phone interview with Dr.Shulman, chief psychiatrist at Sunnybrook, he said that electroshock is still administered to old people but only “from time to time, a relatively small
number.” He couldn’t say how many, but recalled the average age of his elderly shock patients is “73 or 74″. Shulman added he has “never heard” of any deths or serius medical crises from ECT at Sunnybrook or any other hospital in Canada. The ECT “mortality rate”, he added, was “similar to that for (general) anaesthesia”. He insisted that electroshock “remains an effective treatment for some debilitating and life-threatening
depressions”, and claimed the only ECT risk was “short-term memory loss”. He also asserted that electroshock is not controversial, and claimed that most patients “completely recover”. Shulman explained the use of electroshock on the elderly in these terms: “If we didn’t use ECT, these people would suffer tremendously and be at risk of dying”.

It is difficult to find any study to support the common psychiatric claim that electroshock prevents suicide or minimises the suicide risk. Further, the relapse rate from shock is over 60 per cent, which, according
to the American Psychiatric Association, still greatly minimises permanent memory loss, brain damage and death from ECT (APA,1990).

Some elderly patients have also been electroshocked at Toronto’s Clarke Institute of Psychiatry. Apparently nobody knows how many, partly because no accurate,up-to-date ECT statistics are kept at the Clarke,
according to Dr. Barry Martin, head of its ECT Unit. In a recent phone interview I had with Dr. Martin, he speculated that a total of “about 100 courses” were administered at the Clarke in 1995. Each course consists of 8-10 ECTs, at least 80-90 people were electroshocked last year. According to Dr.Martin, the main reason for shocking old people is, “severe depression that has not responded to medication” (e.g.,antidepressants).
Martin estimated the ECT death rate as “3-4 per 100,000 ECTs”, similar to that for “general anaesthesia”, and said he was “not aware” of any ECT-related deaths in Canada or anywhere else.

During a 15-month period in 1993-94, eight people died in Texas,”within two weeks of receiving electroshock”; over half were elderly patients (Smith, 1995).The Texas elderly death rate from ECT at that time was probably higher than 1 in 200.

Some very courageous shock survivors and advocacy groups are fighting back and want electroshock abolished in the United States and Canada. For example, 81-year-old Lucille Austwick successfully refused to be shocked while languishing in a Chicago nursing home a couple of years ago (Fegelman, 1995). While confined in the home, Austwick was depresseed, had stopped eating and was becoming frail, so a psychiatrist wanted to shock her. She repeatedly refused the “lifesaving:” treatment which she called
“bullshit”, and received strong legal support from the Illinois Guardianship Commission and other advocates across the United States. Last September, the Appellate Court “reversed the trial court’s ruling” which
had ordered a series of ECTs for her two years earlier.

Psychiatrists and other medical staff at St.Mary’s Hospital in Madison, Wisconsin were found to be violating the human rights of several elderly patients subjected to electroshock against their will (Oaks, 1995). Sparked by the courageous whistleblowing of psychiatric nurse Stacie Neldaughter, who was “fired after refusing to directly assist with a shock treatment”, several women shock survivors and anti-shock activists
organised a public protest outside the hospital in September 1994. In January 1995, the Wisconsin Coalition for Advocacy issued a detailed and scathing 75-page report based on its own investigations, which documented serious violations of informed consent and other rights involving at least eight elderly women patients.
In Toronto from 1983 to 1992, there have been several anti-shock protest demonstrations, particularly in front of the Clarke Institute of Psychiatry and Queen Street Mental Health Centre. Non-violent civil
disobedience (“sit-ins”) were also held in the office of at least two Ontario health ministers, organised by the Ontario Coalition to Stop Electroshock (succeeded by Resistance Against Psychiatry). During a
non-violent public demonstration against electroshock in front of the Clarke in May 1988, shock survivor Jack Wild and I were charged with “trespass” and arrested while trying to hand out alternative and accurate
shock information to patients on one ward during visiting hours. We were arrested on the ward while engaged in a non-violent sit-in, fined over $50 each and lost our court appeals (Phoenix Rising, 1998).

Unfortunately, there have been no shock cases in Canada since “Mrs.T.” in 1983 (Weitz,1994). The “Mrs.T.” case involved a young, allegedly suicidal but cxompetent women who firmly and repeatedly refused
shock while being asked to consent by both her psychiatrist and a regional review board while incarcerated in Hamilton Psychiatric Hospital. Although the case lost, “Mrs.T.” was not electroshocked. The national publicity and public outcry arising over the fact that people in Canada could still be shocked against their will led to a few important amendments in Ontario’s Mental Health Act, which now prohibits electroshock or other treatment for any person who refuses. However, electroshock can still be adminsitered against the will of an “incapable” person if he or she did not instruct a substitute decision-maker otherwise while capable. (Note: The judge’s decision in a 1997 Ontario court case involving a mother’s refusal to consent to shock for her “incapable” daughter” is pending.)

In March 1994 at a public City Hall meeting before the Toronto Mayor’s Committee on Aging (TMCA), I presented some alarming ECT statistics from the Ontario government’s Ministry of Health which showed
that a disproportionately large number of people being electroshocked in Ontario’s psychiatric facilities were elderly people (over 40 per cent) and women (over 65 per cent). In one Final Report, the Committee recommend that, “the Chair of the TMCA should be asked to write to the Minister of Health to inform her of the data on ECT and the deep concern of the TMCA about the apparent misuse of this therapy.”

There is still no law banning electroshock in Ontario, Canada or the United States for elderly people or anybody else. However, some states have outlawed shock for young children. For example, Texas has banned shock for children under 16 years old, and California banned it for children under 14. There are no such age restrictions in Canada.

I believe that electroshocking old people is elder abuse. Electroshock is a crime against humanity. It should be abolished.

[acknowledgement - My sincere thanks to Lenard Roy Frank for his valuable editorial assistance.]

Don Weitz

References

American Psychiatric Association (1990). The practice of >electroconvulsive therapy. Washington: APA.

Black,D.W., Winokur,G., Mohandoss,E., Woolson,R.F. and Nasrallah,A. (1989) “Does treatment influence mortality in depressives?” Annals of Clinical Psychiatry, 1(3), 165-173.

Breggin,P.R. personal communication in March 1996. Also see: Breggin, Toxic Psychiatry (St. Martin’s Press,1991), and Breggin, Disabling Treatments in Psychiatry (Springer Publishing Co,1997)

California Department of Mental Health (1989). Electroconvulsive therapy (ECT) report. Sacramento,California.

Cameron,D.G. “ECT:sham statistics, the myth of convulsive therapy and the case for consumer misinformation”. Journal of Mind and Behaviour, 15(1-2),177-198.

Clark,R (1983) From an invited address during the annual meeting of the American Psychiatric Association in New York, May 1983.

Cobb,A. (1993) Safe and effective? MIND’s views on psychiatric drugs, ECT and psychosurgery. London: MIND Publications.

Fegelman,A. (1995) “Forced shock therapy faces key legal test”. Chicago Tribune, May 2, 2995.

Frank,L.R. (1991). “San Francisco puts electroshock on public trial:feature report”. The Rights Tenet, Winter 1991.

Frank,L.R. (1996) Personal communication on February 28, 1996.    Karlinsky,H. and Shulman,K. (1984). “The clinical use of electroconvulsive therapy in old age”. The Journal of American Geriatric
Society, 32, 83.

Kroessler,D. and Fogel,B.S. (1993) “Electroconvulsive therapy for major depression in the oldest old”. The American Journal of Geriatric Psychiatry, 1(1),30-37.

Oaks,D. (1995) :”Zap back against forced shock”. Dendron, 36,1-5.   Phoenix Rising (October 1988). “Toronto Protesters Arrested for Trying to Distribute Shock Information”, 22-23.

Smith,M. (1995) “Eight in Texas die after shock therapy in fifteen mnonth period”. The Houston Chronicle, March 7, 1a.

Weitz,D. (1984) “Shock case: a defeat and victory”. Phoenix Rising, 4,3/4,28a-30a.

Biographical note: Don Weitz is a psychiatric survivor, antipsychiatry and antipoverty activist in Toronto. He is co-founder of the former antipsychiatry magazine Phoenix Rising, former board member of Support
Coalition International (a coalition of approximately 100 survivor and human rights advocacy organizations in 14 countries), and co-founder of the Coalition Against Psychiatric Assault (CAPA). He is also host-producer of “Antipsychiatry Radio” on CKLN (88.1FM) in Toronto. This unique program airs around 6:30pm on the last Friday every month.

Source: capa.oise.utoronto.ca/electroshocking.doc

Related posts

• Prescription Drug Use and Abuse (4)
• Prescription Drug Abuse (0)

Tranquilizers, which slow down the central nervous system and cause drowsiness, numbed Ray’s agony, helped her sleep, and untied the relentless knot in her stomach. Soon, even if her doctor had prescribed one pill in an eight-hour period, she took two or three in an attempt to intensify the calming effect of the drug.

When the doctor stopped writing prescriptions for her and encouraged grief counseling, Ray began doctor-shopping–going from doctor to doctor, fabricating panic attacks, backaches, migraines, and other ailments that would get her multiple prescriptions for tranquilizers and pain killers. “I became a very good actress,” Ray says. “I thought I needed these drugs no matter what, even if I had to bamboozle the doctors to get them.”

Most patients take medicine responsibly, but approximately 9 million Americans used prescription drugs for non-medical purposes in 1999, according to the National Institute on Drug Abuse (NIDA). Non-medical purposes include misusing prescription drugs for recreation and for psychic effects–to get high, to have fun, to get a lift, or to calm down.

Experts stress that prescription drug abuse isn’t about bad drugs or even bad people. It involves a complex web of factors, including the power of addiction, misperceptions about drug abuse, and the difficulty both patients and doctors have discussing the topic.

There is also the delicate balance of curbing criminal activity related to drug abuse while making sure that people with legitimate health needs can still access care, says Alan I. Leshner, Ph.D., director of NIDA. “We recognize the very real issue that millions of lives are improved because of prescription drugs–the same drugs that are sometimes abused,” he says.
Consequences of Abuse

Ray had convinced herself that abusing prescription drugs was safer than abusing heroin, marijuana, and other “street drugs.” “I would never do those,” she says. “I figured I had a prescription for what I was doing, which made it OK.”

Scott Walker, program director for substance abuse at the Mountain Comprehensive Care Center in Prestonsburg, Ky., says he hears that rationalization over and over. “Some people tell themselves they aren’t using something old Joe cooked up in a garage somewhere,” Walker says. They may figure a legitimate manufacturer made this, “so what could be the harm?”

As Ray’s life unraveled, she found out the harm can be great, whether you’re using heroin or sleeping pills. She lost her job as a computer programmer after repeatedly showing up late for work and falling asleep at her desk. Her son, a preteen at the time, couldn’t understand her erratic behavior and didn’t want anything to do with her.

Then in 1995, she crashed her car three times in one month while under the influence of tranquilizers and painkillers, seriously injuring others each time. Her driver’s license was revoked, and she served a one-year jail sentence in 1998. “I will always know in my heart that I could have killed those people,” she says. “It doesn’t matter that I didn’t kill them; it matters that I could have.”

Walker says that roughly half of the people undergoing substance abuse treatment at Mountain Comprehensive Care Center come after realizing that they found themselves in a hole too deep to get out of on their own. The other half, like Ray, come because of some criminal charge related to drug possession or drug use.

OxyContin (oxycodone), a controlled drug approved in 1995 to treat chronic, moderate-to-severe pain, has received considerable attention because of deaths and crimes associated with its abuse. (For more on the classes–or schedule–of drugs, see “Controlled Substances”.) OxyContin is a morphine-like narcotic that contains a high dose of oxycodone. Manufactured by Purdue Pharma, Stamford, Conn., the drug was originally believed to pose a lower risk for abuse because it is a controlled-release drug designed to be taken orally and swallowed whole, says Deborah Leiderman, M.D., director of the Food and Drug Administration’s controlled substance staff. The drug’s active ingredient, oxycodone, is slowly released over a 12-hour period. “But the safety of the drug is based on taking the drug exactly as intended,” she says.

Abusers sometimes disrupt the time-release formula of the drug to speed up absorption, often chewing the tablets, crushing them and snorting the powder, or dissolving them in water and injecting the drug to get a fast high. Abusers have also used OxyContin with other painkillers, alcohol, and marijuana. Several deaths have resulted, mostly in rural areas of the Eastern United States, especially in Virginia and West Virginia.

Other products containing oxycodone such as Percodan and Percocet have also been abused over the years. Abuse of opiates is not new; what’s new is the recent surge in local epidemics of opiate abuse (see “Most Commonly Abused”).

The most highly abused stimulants are illicit drugs, including cocaine and methamphetamines. There also have been recent reports of Ritalin (methylphenidate) abuse among middle and high school students. The drug, which produces effects more potent than caffeine and less potent than amphetamine, is prescribed to treat attention-deficit/hyperactivity disorder and other conditions. But some have used it to suppress their appetite or to stay awake while studying. The DEA lists Ritalin as a “drug of concern” and reports that some abusers have dissolved the tablets in water and injected the mixture, which can block small blood vessels and damage the lungs and retina of the eye.
Complexities of Addiction

It’s not that potentially addictive medications shouldn’t be used, says Richard Brown, M.D., M.P.H., associate professor of family medicine at the University of Wisconsin Medical School. “They have an important place in the treatment of debilitating conditions.” According to NIDA, drug addiction–characterized by drug craving that is out of control–is actually uncommon among people who use drugs as prescribed.

NIDA, along with several health organizations, has launched a national initiative to educate the public about the dangers of the non-medical use of prescription drugs, and the potential for abuse and addiction. With psychological addiction, there is a preoccupation with obtaining and using drugs that persists despite the consequences. Psychological addiction is distinct from physical dependence and tolerance, but the presence of these problems can complicate the treatment of addiction, says Alice Young, Ph.D., a professor in the department of psychology at Wayne State University in Detroit. “It is true that both psychological addiction and physical dependence can happen together,” she says, “but they are not the same.”

Young says that physical dependence, which is sometimes unavoidable, develops when an individual is exposed to a drug at a high enough dose for long enough that the body adapts and develops a tolerance for the drug. This means that higher doses are needed to achieve a drug’s original effects. “If the patient stops taking the drug, then withdrawal will occur,” Young says.
But the development of physical dependence doesn’t necessarily lead to addiction in all cases, she explains. “It means that the individual can’t just stop taking the drug; the dose has to be tapered,” a method to gradually decrease a drug’s amount over time to prevent withdrawal reactions.

In addition to promoting public education, NIDA’s initiative will foster new research on why certain people become addicted, says Leshner. “Some choose prescription drugs as the drug of choice, and others become addicted inadvertently,” he says. “We want to learn more about what makes some people more likely to stray from the prescribed plan than others.” NIDA also will support research into the mechanisms by which certain substances produce addiction.
Appropriate Use Is Key

Physician supervision and appropriate use is critical for all prescription drugs. Doctors consider a patient’s diagnosis and whether non-addictive treatments should be considered first.

“Very strong opiate drugs play a critical role in pain management,” FDA’s Leiderman says. “But they aren’t appropriate for all pain. Treatment needs to be tailored depending on a patient’s specific condition.”

Brown says doctors must also consider the patient’s medical history and whether an individual has had addictive disorders in the past. But a history of substance abuse doesn’t necessarily rule out using potentially addictive medications. “Patients should be honest about their substance abuse history because then it tells me to watch them even more closely,” Brown says.

A good rapport between a patient and doctor can make it easier to discuss problems that come up, and health-care professionals should carefully monitor patients who take potentially addictive medication. For some, that might require a periodic urine drug screen, Brown says. “This is not an issue of distrust or intrusiveness,” he says. “I explain to patients that it’s a way to help protect them, especially because people who are addicted may not recognize it. Addiction can make people do things they wouldn’t normally do.”

A couple of Brown’s patients experienced trouble with opioids and impulsivity–symptoms that led them to take more medicine than prescribed instead of waiting for the initial medicine to work. Brown picked up on the problems because both patients requested early refills. He switched them to non-drug treatments, such as physical therapy and relaxation techniques, until they could more successfully take prescription drugs.

Complicating matters is the fact that physicians are vastly undertrained in identifying drug abuse. “The average physician gets little training in drug abuse, mainly because drug abuse has only been recently recognized as a health problem,” Leshner says.
Brown says that some doctors are so concerned about penalties for overprescribing potentially addictive medications that they don’t treat patients appropriately. “Other physicians mean well and prescribe the drugs, but don’t know the warning signs of abuse,” he says. “Then there are those who just can’t say ‘No’ to patients who violate the prescribed plan.”

One recent survey from the National Center on Addiction and Substance Abuse at Columbia University in New York City indicated that nearly half of primary care physicians report having difficulty talking about substance abuse with patients.
H. Westley Clark, M.D., J.D., director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA), says his agency began a training program last year to help address this major problem.

The joint project with the Health Resources and Services Administration will train faculty members in the health professions. “It’s not only for doctors,” Clark says. “Other health professionals, including nurses and pharmacists, should also learn about recognizing the signs of substance abuse, talking about it, and knowing when patients should be referred for treatment.”
There Is Help

For Ray, jail was the turning point. “There’s something about those metal bars slamming shut behind you that makes it all very real,” she says. A drug program in prison helped her beat addiction and taught her to cope with the triggers or life stressors that pushed her down the path to drug abuse.

“If you find yourself not following your doctor’s orders, buying drugs off the street, or doctor-shopping, know that there is effective treatment and you can get help,” Clark says. “If there is a treatment center within 100 miles of you, we can help you find it.” (See “Treatment Centers”.) Addiction is a brain disease typically treated with behavioral intervention, drug treatment, or often a combination.

Some treatments need to alleviate both withdrawal symptoms and the psychological addiction to drugs. Detoxification, the process by which the body recovers from tolerance and dependence, is considered a first stage in the sense that it purges drugs from the body. “It doesn’t constitute a treatment,” Young says. “Treatment has to address stopping future use.”

Methadone, a synthetic opioid, has been used for more than 30 years to treat some opioid addictions. Levo-alpha-acety/methadol (LAAM) is another opioid treatment.

With methadone treatment, the patient receives both behavioral intervention and an oral, daily dose that maintains the physical dependence. When people abuse drugs, they commonly use fast routes of administration such as injection or inhalation, which basically slam the drugs into the brain. Methadone treatment delivers the narcotic orally so that it is slowly released in the body. The intent is to lessen the chance that the patient will use illegal opioids, Young explains. Among the goals is to decrease cravings for the “rush” created when opioids are taken by fast routes, and to prevent the occurrence of withdrawal signs by maintaining a steady level of opiate in the body. “It’s a maintenance therapy over a long period of time, just like maintenance for diabetes, asthma, or any other chronic problem.”
Striking a Balance

Prescription drugs commonly are diverted through fraudulent prescriptions, doctor-shopping, over-prescribing, and pharmacy theft. Clark says that dealing with diversion requires the involvement of patients, physicians, and pharmacists, and that there are many variables linking these three groups.

“Sometimes it’s a matter of patients and physicians without adequate information about drug abuse,” Clark says. “Sometimes overworked pharmacies don’t notice when a patient is doubling up on a medication.”

But as pharmacists look out for false or altered prescription forms and doctors look out for suspicious complaints, patients with legitimate medical problems still need fair treatment, Clark says. “We don’t want to wind up punishing people in need.”

Ellen Stovall, president of the National Coalition of Cancer Survivorship, says some cancer patients have been frustrated with the lack of appreciation for assessment of their own pain. The last thing patients need is a setback to pain management, Stovall says. “We have all the important laws around the abuse of narcotics, but we need legislation and support to protect people who are experiencing real, honest suffering.”
FDA Strengthens Warnings for OxyContin

Because of continuing reports of abuse, the FDA has strengthened the warnings and precautions sections in the labeling of OxyContin controlled-release tablets, a narcotic drug approved for the treatment of moderate to severe pain. Some of these reported cases have been associated with serious consequences, including death.

OxyContin contains oxycodone HCl, an opioid agonist with addiction potential similar to that of morphine. Opioid agonists act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these drugs attach to certain opioid receptors in the brain and spinal cord, they can effectively block the transmission of pain messages to the brain.

OxyContin is a controlled substance in Schedule II of the Controlled Substances Act (CSA), which is administered by the Drug Enforcement Administration (DEA). Schedule II provides the maximum amount of control possible under the CSA for approved drug products. (For more on the classes–or schedule–of drugs, see “Controlled Substances”.)

To educate health-care providers about the risks of OxyContin, Purdue Pharma of Stamford, Conn., manufacturer of the product, has issued a warning in the form of a “Dear Health Care Professional” letter, which will be distributed to physicians, pharmacists, and other health-care professionals. The letter highlights the problems associated with OxyContin abuse and explains the changes to the labeling, including proper prescribing information.

OxyContin, like morphine, has a high potential for abuse. It is supplied in a controlled-release dosage form and is intended to provide up to 12 hours of relief from moderate to severe pain. The tablet must be taken whole and only by mouth. When the tablet is crushed and its contents are injected intravenously or snorted into the nostrils, the controlled release mechanism is defeated and a potentially lethal dose of oxycodone is released immediately.

The FDA has worked with Purdue to make specific changes to the OxyContin labeling. The new labeling is intended to change prescription practices, as well as increase the physicians’ focus on the potential for abuse and misuse. Changes include a “black box warning,” the strongest type of warning for an FDA-approved drug. The new warnings are intended to lessen the chance that OxyContin will be prescribed inappropriately for pain of lesser severity than the approved use or for other disorders or conditions inappropriate for a Schedule II narcotic.

The FDA-approved use for OxyContin is for the treatment of patients with moderate to severe pain who are expected to need continuous opioids for an extended time. An important factor that must be considered in prescribing OxyContin is the severity of pain that is being treated, not simply the disease causing the painful symptoms.

The FDA continues to recommend that appropriate pain control be provided to patients who are living with severe pain. Although abuse and misuse are potential problems for all opioids, including OxyContin, opioids are very important treatment options for pain management when used appropriately under the careful supervision of a physician.

Because of the ongoing problem of OxyContin abuse and diversion, the FDA has met with the DEA, the Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse, Purdue Pharma, and others. The FDA will continue to monitor reports of abuse and misuse of OxyContin and other opioids, and will work with other federal agencies and drug manufacturers to help ensure that these important drugs remain available to appropriate patients.

Because opioids are subject to abuse, the FDA is encouraging all manufacturers of opioids sold in the United States to review voluntarily, and revise as necessary, their products’ labeling to provide adequate warnings and precautions regarding these risks and to promote responsible prescribing practices.

For more information, patients and health-care providers can call Purdue Pharma at 1-800-745-7445, or go to the FDA’s Web site at www.fda.gov/cder/drug/infopage/oxycontin/.
Use Prescription Drugs Safely
Always follow medication directions carefully.
Don’t increase or decrease doses without talking with your doctor.
Don’t stop taking medication on your own.
Don’t crush or break pills.
Be clear about the drug’s effects on driving and other daily tasks.
Learn about the drug’s potential interactions with alcohol, other prescription medicines, and over-the-counter medicines.
Inform your doctor about your past history of substance abuse.
Don’t use other people’s prescription medications and don’t share yours.

by Michelle Meadows

Source: http://www.fda.gov/fdac/features/2001/501_drug.html

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Todd found an old bottle of painkillers that had been left over from his dad’s operation. He decided to try them. Because a doctor had prescribed the pills, Todd figured that meant they’d be OK to try.

Both Todd and Angie are taking risks, though. Prescription painkillers and other medications help lots of people live more productive lives, freeing them from the symptoms of medical conditions like depression or attention deficit hyperactivity disorder (ADHD). But that’s only when they’re prescribed for a particular individual to treat a specific condition.

Taking prescription drugs in a way that hasn’t been recommended by a doctor can be more dangerous than people think. In fact, it’s drug abuse. And it’s just as illegal as taking street drugs.
Why Do Some People Abuse Prescription Drugs?

Some people experiment with prescription drugs because they think they will help them have more fun, lose weight, fit in, and even study more effectively. Prescription drugs can be easier to get than street drugs: Family members or friends could have a prescription. But prescription drugs are also sometimes sold on the street like other illegal drugs. A 2006 National Survey on Drug Use and Health showed that among all youths aged 12 to 17, 6% had tried prescription drugs for recreational use in the last month.

Why? Some people think that prescription drugs are safer and less addictive than street drugs. After all, these are drugs that moms, dads, and even kid brothers and sisters use. To Angie, taking her brother’s ADHD medicine felt like a good way to keep her appetite in check. She’d heard how bad diet pills can be, and she wrongly thought that the ADHD drugs would be safer.

But prescription drugs are only safe for the individuals who actually have prescriptions for them. That’s because a doctor has examined these people and prescribed the right dose of medication for a specific medical condition. The doctor has also told them exactly how they should take the medicine, including things to avoid while taking the drug — such as drinking alcohol, smoking, or taking other medications. They also are aware of potentially dangerous side effects and can monitor patients closely for these.

Other people who try prescription drugs are like Todd. They think they’re not doing anything illegal because these drugs are prescribed by doctors. But taking drugs without a prescription — or sharing a prescription drug with friends — is actually breaking the law.
Which Drugs Are Abused?

The most commonly used prescription drugs fall into three classes:

1. Opioids
Examples: oxycodone (OxyContin), hydrocodone (Vicodin), and meperidine (Demerol)
Medical uses: Opioids are used to treat pain or relieve coughs or diarrhea.
How they work: Opioids attach to opioid receptors in the central nervous system (the brain and the spinal cord), preventing the brain from receiving pain messages.

2. Central Nervous System (CNS) Depressants
Examples: pentobarbital sodium (Nembutal), diazepam (Valium), and alprazolam (Xanax)
Medical uses: CNS depressants are used to treat anxiety, tension, panic attacks, and sleep disorders.
How they work: CNS depressants slow down brain activity by increasing the activity of a neurotransmitter called GABA. The result is a drowsy or calming effect.

3. Stimulants
Examples: methylphenidate (Ritalin) and amphetamine/dextroamphetamine (Adderall)
Medical uses: Stimulants can be used to treat narcolepsy and ADHD.
How they work: Stimulants increase brain activity, resulting in greater alertness, attention, and energy.
Over-the-Counter Drugs

Some people mistakenly think that prescription drugs are more powerful because you need a prescription for them. But it’s possible to abuse or become addicted to over-the-counter (OTC) medications, too.

For example, dextromethorphan (DXM) is found in some OTC cough medicines. When someone takes the number of teaspoons or tablets that are recommended, everything is fine. But high doses can cause problems with the senses (especially vision and hearing) and can lead to confusion, stomach pain, numbness, and even hallucinations.
What Are the Dangers of Abusing Medications?

Whether they’re using street drugs or medications, drug abusers often have trouble at school, at home, with friends, or with the law. The likelihood that someone will commit a crime, be a victim of a crime, or have an accident is higher when that person is abusing drugs — no matter whether those drugs are medications or street drugs.

Like all drug abuse, using prescription drugs for the wrong reasons has serious risks for a person’s health. This risk is higher when prescription drugs like opioids are taken with other substances like alcohol, antihistamines, and CNS depressants.

CNS depressants have risks, too. Abruptly stopping or reducing them too quickly can lead to seizures. Taking CNS depressants with other medications, such as prescription painkillers, some over-the-counter cold and allergy medications, or alcohol can slow a person’s heartbeat and breathing — and even kill.

Abusing stimulants (like some ADHD drugs) may cause heart failure or seizures. These risks are increased when stimulants are mixed with other medicines — even OTC ones like certain cold medicines. Taking too much of a stimulant can lead a person to develop a dangerously high body temperature or an irregular heartbeat. Taking several high doses over a short period of time may make a drug abuser aggressive or paranoid. Although stimulant abuse might not lead to physical dependence and withdrawal, the feelings these drugs give people can cause them to use the drugs more and more often so they become a habit that’s hard to break.

The dangers of prescription drug abuse can be made even worse if people take drugs in a way they aren’t supposed to. Ritalin may seem harmless because it’s prescribed even for little kids with ADHD. But when a person snorts or injects Ritalin, it can be serious. And because there can be many variations of the same medication, the dose of medication and how long it stays in the body can vary. The person who doesn’t have a prescription might not really know which one he or she has.

Probably the most common result of prescription drug abuse is addiction. People who abuse medications can become addicted just as easily as if they were taking street drugs. The reason many drugs have to be prescribed by a doctor is because some of them are quite addictive. That’s one of the reasons most doctors won’t usually renew a prescription unless they see the patient — they want to examine the patient to make sure he or she isn’t getting addicted.
How Do I Know if I’m Addicted?

Many different signs can point to drug addiction. The most obvious is feeling the need to have a particular drug or substance. Changes in mood, weight, or interests are other signs of drug addiction.

If you think you — or a friend — may be addicted to prescription drugs, talk to your doctor, school counselor, or nurse. They can help you get the help you need. It’s especially important for someone who is going through withdrawal from a CNS depressant to speak with a doctor or seek medical treatment. Withdrawal can be dangerous when it’s not monitored.

If someone has become addicted to prescription drugs, there are several kinds of treatment, depending on individual needs and the type of drug used. The two main categories of drug addiction treatment are behavioral and pharmacological.

Behavioral treatments teach people how to function without drugs — handling cravings, avoiding drugs and situations that could lead to drug use, and preventing and handling relapses. Pharmacological treatments involve giving patients a special type of medication to help them overcome withdrawal symptoms and drug cravings.
Tips for Taking Prescription Medication

What if a doctor prescribed a medication for you and you’re worried about becoming addicted? If you’re taking the medicine the way your doctor told you to, you can relax: Doctors know how much medication to prescribe so that it’s just enough for you. In the correct amount, the drug will relieve your symptoms without making you addicted.

If a doctor prescribes a pain medication, stimulant, or CNS depressant, follow the directions exactly. Here are some other ways to protect yourself:
Keep all doctor’s appointments. Your doctor will want you to visit often so he or she can monitor how well the medication is working for you and adjust the dose or change the medication as needed. Some medications must be stopped or changed after a while so that the person doesn’t become addicted.
Make a note of the effects the drug has on your body and emotions, especially in the first few days as your body gets used to it. Tell your doctor about these.
Keep any information your pharmacist gives you about any drugs or activities you should steer clear of while taking your prescription. Reread it often to remind yourself of what you should avoid. If the information is too long or complicated, ask a parent or your pharmacist to give you the highlights.
Don’t increase or decrease the dose of your medication without checking with your doctor’s office first — no matter how you’re feeling.

Finally, never use someone else’s prescription. And don’t allow a friend to use yours. Not only are you putting your friend at risk, but you could suffer, too: Pharmacists won’t refill a prescription if a medication has been used up before it should be. And if you’re found giving medication to someone else, it’s considered a crime and you could find yourself in court.
Reviewed by: Michele Van Vranken, MD
Date reviewed: November 2007

Source: http://kidshealth.org/teen/drug_alcohol/drugs/prescription_drug_abuse.html

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