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Crime And Prescription Drugs

  

According to Trends In Drug Abuse, a report from the Executive Office of the President, the ever growing use and misuse of prescription drugs and its association with criminal activity has been identified by many states as their greatest emerging problem.   In an affluent nation awash in legal drugs it is little wonder that crimes associated with prescription drug use have escalated.  This alarming trend is being fueled  by aggressive advertising by manufacturers, ease of internet access, and greater availability of health provider prescriptions.

 

Retail pharmacies filled over 3 billion prescriptions in 2001 totaling $164 billion.
This year's Chain Pharmacy Industry Profile, created by the National Association of Chain Drug Stores, reveals that four out of every five patients leave the doctor's office with a prescription. Since 1992, there has been a 50% increase in prescriptions filled at retail pharmacies. Using IMS HEALTH data, NACDS projects community pharmacies will fill $188.5 billion worth of prescriptions in 2002, nearly a 15% increase from 2001 sales of $164 billion.

There is a neighborhood drug store within 5 miles of nearly every American offering most consumers easy, convenient access.  Even more convenient are the drugs readily available on the internet only a click away and  all too often these drugs are obtained by fraudulent prescriptions from questionable medical providers.  And, there is currently no way to track the total number of internet sales of prescription drugs, which by all guestimates is staggering.  According to the National Association of Boards of Pharmacy, there are about 150 pharmacies offering drugs over the Internet to people without legitimate prescriptions. This includes 15 to 30 Web sites that provide easy access to dangerous narcotics, says Carmen Catizone, executive director of the NAPB.

Federal law prohibits narcotics from being distributed without a prescription. The law mandates that a pharmacist have the original written prescription in hand for the most addictive narcotics, such as morphine and OxyContin. "Because we haven't seen a significant prosecution, some of the Web sites have become emboldened, and we've seen a growth in the number offering narcotics," Catizone said.

 

Some of the crimes more commonly associated with prescription drugs are doctor shopping--patients getting prescriptions from multiple physicians--forged prescriptions by individuals, robbery of pharmacies or from patients, doctors who illegally prescribe drugs such as OxyContin in exchange for cash, and illegal sale of prescription drugs on the internet.  Of equal importance but less commonly associated with criminal activity are the prescription drugs that alone or in combination with others can lead to serious offenses such as DUI, rape, date rape and even murder. 

 

It is important to recognize that ANY DRUG has the potential to be an accomplice to crime in a known or unsuspecting user.  There is no such thing as a drug that does not have adverse effects and in the right individual or in the right combination prescription drugs can be a catalyst for crime.  However, there are certain prescription drugs that are more commonly associated with abuse and criminal activity.  The National Institutes of Drug Abuse, part of the National Institutes of Health, lists some of the more common on the chart below:

 

Opioids

·                       Oxycodone (OxyContin)

·                       Propoxyphene (Darvon)

·                       Hydrocodone (Vicodin)

·                       Hydromorphone (Dilaudid)

·                       Meperidine (Demerol)

·                       Diphenoxylate (Lomotil)

CNS Depressants

Barbiturates

·                       Mephobarbital (Mebaral)

·                       Pentobarbital sodium (Nembutal)

Benzodiazepines

·                       Diazepam (Valium)

·                       Chlordiazepoxide hydrochloride (Librium)

·                       Alprazolam (Xanax)

·                       Triazolam (Halcion)

·                       Estazolam (ProSom)

Stimulants

·                       Dextroamphetamine (Dexedrine)

·                       Methylphenidate (Ritalin)

·                       Sibutramine hydrochloride monohydrate (Meridia)

Generally prescribed for

·                       Postsurgical pain relief

·                       Management of acute or chronic pain

·                       Relief of coughs and diarrhea

Generally prescribed for

·                       Anxiety

·                       Tension

·                       Panic attacks

·                       Acute stress reactions

·                       Sleep disorders

·                       Anesthesia (at high doses)

Generally prescribed for

·                       Narcolepsy

·                       Attention-deficit hyperactivity disorder (ADHD)

·                       Depression that does not respond to other treatment

·                       Short-term treatment of obesity

·                       Asthma

In the body

Opioids attach to opioid receptors in the brain and spinal cord, blocking the transmission of pain messages to the brain.

In the body

CNS depressants slow brain activity through actions on the GABA system and, therefore, produce a calming effect.

In the body

Stimulants enhance brain activity, causing an increase in alertness, attention, and energy.

Effects of short-term use

·                       Blocked pain messages

·                       Drowsiness

·                       Constipation

·                       Depressed respiration
(depending on dose)

Effects of short-term use

·                       A "sleepy" and uncoordinated feeling during the first few days, as the body becomes accustomed - tolerant - to the effects, these feelings diminish.

Effects of short-term use

·                       Elevated blood pressure

·                       Increased heart rate

·                       Increased respiration

·                       Suppressed appetite

·                       Sleep deprivation

Effects of long-term use

·                       Potential for tolerance, physical dependence, withdrawal, and/or addiction

Effects of long-term use

·                       Potential for tolerance, physical dependence, withdrawal, and/or addiction

Effects of long-term use

·                       Potential for addiction

Possible negative effects

·                       Severe respiratory depression or death following a large single dose

Possible negative effects

·                       Seizures following a rebound in brain activity after reducing or discontinuing use

Possible negative effects

·                       Dangerously high body temperatures or an irregular heartbeat after taking high doses

·                       Cardiovascular failure or lethal seizures

·                       For some stimulants, hostility or feelings of paranoia after taking high doses repeatedly over a short period of time

Should not be used with

Other substances that cause CNS depression, including

·                       Alcohol

·                       Antihistamines

·                       Barbiturates

·                       Benzodiazepines

·                       General anesthetics

Should not be used with

Other substances that cause CNS depression, including

·                       Alcohol

·                       Prescription opioid pain medicines

·                       Some over-the-counter cold and allergy medications

Should not be used with

·                       Over-the-counter cold medicines containing decongestants

·                       Antidepressants, unless supervised by a physician

·                       Some asthma medications

 

Sextasy

 

Another type of abuse using prescription drugs is mixing a legal pharmaceutical such as Viagra with  illegal street drugs such as speed, ecstasy (used with Viagra is called “sextasy” or amyl nitrate (poppers).  Some of the illegal stimulants, such as crystal methadone, create an overwhelming desire for sex but constrict the blood vessels making it impossible to have an erection.   To counteract this adverse effect partiers use Viagra to compensate.  Many of these drug combinations can lead to unprotected sex with multiple partners or in all too many cases rape and other acts of violence.  One hospital spokesperson in Miami said they are having an epidemic of hospital admissions from “Sextasy” related drugs.  This is also echoed in the adverse event reports being filed with the FDA for drugs such as Viagra.

Drug-facilitated date rape

 Date-rape drugs cause sedation and amnesia to the extent that their victims cannot resist or may not be aware of a sexual assault.  Drug-facilitated rape is most commonly linked to the surreptitious administration of flunitrazepam (Rohypnol) or, gamma-hydroxybutyrate acid (GHB).  Rohypnol is a strong sedative and a member of the benzodiazepine family which includes drugs such as Librium, Xanax, and Valium, but Rohypnol’s strength is about ten times that of Valium. Although Rohypnol is used as a presurgical anesthetic or for the treatment of insomnia in many countries, the drug has never been approved for medical use in the United States because other safer drugs are available.

GHB (gamma-hydroxybutyrate) produces intoxication followed by deep sedation. Once ingested, the drug will begin to take effect in 15 minutes to an hour, lasting one to three hours. GHB can cause nausea, vomiting, delusions, depression, vertigo, visual disturbances, seizures, respiratory distress, loss of consciousness, amnesia, and coma. When combined with alcohol and other drugs, the potential for deadly overdoses escalates rapidly.  In 1990, the FDA banned the used of GHB except under the supervision of a physician because of many reports of severe, uncontrollable side effects.

 

These two drugs are the most commonly used; however, it should be remembered that any substance that is administered to lower sexual inhibition and enhance the possibility of unwanted sexual intercourse is potentially a date-rape drug.

 

Crimes committed by individuals taking their prescriptions as prescribed

 

Perhaps the most troubling aspect of the crime and prescription drug issue are those individuals that are under the care of their treating physician taking their prescription drugs as prescribed and then unintentionally become guilty of a crime.   By far the most common is the driver charged with DUI even though his BAC (blood alcohol concentration) may be well below the .08 limit.  In one North Carolina case a driver was charged with first degree murder after the car he was driving erratically struck and killed two people and injured three others.  Evidence showed that the driver had been drinking, though his blood alcohol level of .046 percent was well below the legal level of intoxication.  He had also been taking prescription drugs that conflicted with alcohol.

 

In another case a man stabbed his wife over 200 times and was found not guilty of murder by reason of insanity from the drug cocktail he had been prescribed by his physician.  At the time of the killing, the man had been prescribed Librium and Doxepin for depression, Librax and Zantac for stomach problems, Klonopan for involuntary muscle spasms as well as Captopril and Hydrochlorothloro-thiazide. Prozac was later added to the regimen.  He subsequently sued for negligent prescription and an alleged failure on the part of the pharmaceutical company to warn adequately of the drugs' propensity to cause violent behavior.

 

These are just two extreme examples of  a problem that is becoming all too common at every level of  our society from preteens to senior citizens.  As more and more drugs are prescribed the danger of creating a lethal drug cocktail in an unsuspecting individual  becomes even greater.   Additionally each person is unique and sometimes it only takes one ill advised  prescription  to create a nightmare for them and their families.  Perhaps it is time to “just say no” to casual use of prescription drugs and for manufactures to stop being the new drug pushers and really pay attention to their “duty to warn.”  And, perhaps it is also time for physicians to really start paying attention to their “practice guidelines” and only write prescriptions  when absolutely necessary.   If we are vigilant perhaps we can turn the tide on crime and prescription drugs before it becomes our new drug war.
 

 

 

©  2002 MEDICAL & TOXICOLOGICAL INFORMATION

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