Pubdate: Sun, 10 Feb 2008
Source: Observer, The (UK)
Copyright: 2008 The Observer
Author: Elizabeth Day, in New York


Once it was cocaine, speed or heroin, but now the fashion is for 
legal pills, washed down by spirits. Last week's news that actor 
Heath Ledger, right, died from an overdose of prescription tablets 
shed light on a startling new trend - misuse of over-the-counter 
pills now kills more Americans than illegal drugs. Elizabeth Day in New York

Alex is a man who prides himself on sticking to routine. He likes to 
start the day with a large cappuccino from Starbucks and to end it 
with a handful of anti-depressants washed down with vodka. 'It's my 
treat after coming home from work,' he says. 'I guess it just chills 
me out a little.' In many ways Alex, 31, is a typical well-heeled 
young New Yorker. He works in finance, holidays in the Hamptons and 
enjoys partying at the sort of exclusive nightclubs where having your 
name on the guest list is a prerequisite to entry. He also likes to 
get high on prescription drugs.

Tonight he is celebrating a friend's birthday at Marquee, one of the 
city's hippest nightspots. The main bar, lined with leather 
banquettes, is cast in a shadowy half-light. In the upstairs lavatory 
there is a small framed sign on the back of the door reminding guests 
the use of illegal drugs will not be permitted.

But Alex would not consider himself a drug abuser. For him, those 
small white Xanax tablets on his bathroom shelves are simply a 
recreational accompaniment to the $15 Grey Goose vodka martini he has 
just been served. And, what's more, they're entirely legal.

Over the past five years the United States has seen a ferocious 
increase in prescription drug abuse. According to the 2006 National 
Survey on Drug Use and Health, 49.8 million Americans over the age of 
12 have reported non-medical use of illicit drugs in their lifetime, 
20.3 per cent of the population. Among teenagers aged 12-17, 
prescription drugs are second only to marijuana in popularity, and in 
the past 15 years there has been a 140 per cent increase in 
painkiller abuse. It is the fastest-growing type of drug abuse in the 
US. Even more worryingly, prescription drugs have made it on to the 
party scene as a legal, seemingly safe, way to recreate an illicit high.

Until last month this was a largely silent epidemic. But the death of 
Heath Ledger, a regular at Marquee and other nightclubs, thrust it 
into the spotlight. The 28-year-old actor died from 'acute 
intoxication' caused by an accidental overdose of anti-anxiety 
medication and prescription painkillers.

'Americans love to get pills for everything that ails them,' says Dr 
Howard Markel, a professor of paediatrics and psychiatry at the 
University of Michigan. 'The misuse of those drugs has become one of 
the major health problems of our time.' The UK has less of a 
prescription culture than the US, although many experts believe the 
advent of internet pharmacies means it is only a matter of time. In 
the US, where pharmaceuticals are advertised on prime-time 
television, pill-popping has become normalised, a socially acceptable 
means of alleviating stress, sleeplessness or anxiety.

The most commonly abused prescription medications fall into three 
categories: opiate-based painkillers (OxyContin and Percocet); 
central nervous system depressants prescribed for anxiety and sleep 
disorders (Valium and Xanax); and stimulants, used to treat attention 
deficit disorders (Ritalin and Adderall).

Within these categories, the pharmaceutical industry has provided a 
full set of substitutes for just about every illegal narcotic 
available. Methylphenidate, the active chemical in Ritalin, targets 
the brain's pleasure-producing centres in the same way as cocaine. 
Antidepressants can act as serotonin-boosting 'uppers'. A few years 
ago OxyContin, an extremely powerful painkiller developed for cancer 
patients, became known as 'hillbilly heroin' after an epidemic of 
abuse took root in poor rural communities.

Such mishandled drugs now kill 20,000 a year, nearly twice as many as 
10 years ago.

Dependence on legal drugs is not a new problem - during the American 
Civil War morphine abuse was labelled 'the soldiers' disease' - but 
the practice of prescribing drugs has metamorphosed from a medical 
treatment of last resort to a way of life. 'The problem has been 
greatly worsened by the internet, and that affects all countries - 
including Britain,' says Susan Foster, of the National Centre on 
Addiction and Substance Abuse at Columbia University, New York. 'As 
long as you have a credit card, anyone can log on and have 
potentially lethal drugs delivered to their door. You don't even need 
a prescription. You have what's called an "online consultation" where 
you are asked how old you are, how bad your pain is.'

The substances most commonly traded over the internet are 
tranquilisers such as diazepam and stimulants like Ritalin. However, 
the most dangerous are the opiates, which include codeine and morphine.

The painkiller fentanyl can act like heroin and traffickers get hold 
of supplies by forging stolen prescriptions, breaking into pharmacies 
and stealing stocks or buying the drugs from patients who have been 
prescribed it. Another opiate painkiller, buprenorphine - prescribed 
for heroin addicts trying to kick their habit - is peddled in 
countries as diverse as India, Iran, Finland and France. From 
2001-05, the global consumption of buprenorphine more than tripled to 
1.5 billion daily doses.

Doctors are woefully ignorant of the dangers; a 2005 study by Casa 
found that 43.3 per cent of them did not ask about drug abuse when 
taking histories. Even if they do, the seasoned drug abuser will go 
from one doctor to the next until they get the quantities they want - 
a practice known as 'doctor-shopping'.

This was Jeana Hutsell's experience. A petite 35-year-old from 
Canton, Ohio, with cropped peroxide blonde hair and square-framed 
glasses, Hutsell became hooked on Percocet, an opiate-based 
painkiller, when she was prescribed it 12 years ago after an 
operation for Crohn's disease. 'I went to the doctor with abdominal 
cramps and he began writing me copious prescriptions,' she says. 
Within a year, her habit had escalated to 60 pills a day and she was 
sewing emergency stashes into the lining of her handbag. 'I felt they 
gave me personality. They made me chattier, friendlier.'

Hutsell began forging prescriptions, sometimes walking into hospital 
casualty departments over the weekend and saying she had run out. 'I 
felt justified and safe because my doctor was giving them to me. I 
wasn't getting them on the streets - I was going to a pharmacy.'

Whereas illegal street narcotics - heroin or crack cocaine - are more 
likely to be used by the poorer socio-economic classes, prescription 
drugs have become the preserve of the rich. In the privatised 
American healthcare industry, these pills do not come cheaply: an 
antidepressant like Wellbutrin can cost from $1,000 to $2,400 a year.

Wealthy individuals also enjoy the luxury of paying private 
physicians - known as 'script doctors' - to provide them with 
prescriptions. And often, because the drugs are viewed as 
performance-enhancers, they will be taken by those at the higher end 
of the social strata: by the college students and Wall Street 
traders. In the 1980s cocaine was the glamour yuppie drug. Now, the 
line of white powder is being overtaken by the little white capsule.

Phoenix House is a tall, grey stone building on the Upper West Side, 
a former 19th-century hotel with mosaic-tiled floors in the hall. The 
genteel appearance belies its gritty purpose: Phoenix House is a 
rehabilitation centre for drug and alcohol abusers, treating 6,000 
people a day. In recent years, such centres have seen a substantial 
increase in prescription drug admissions - some counsellors say that 
they account for 90 per cent of new patients.

Professor David Deitch, the chief clinical officer, does not want to 
use the word 'epidemic', but he concedes that 'the genie is out of 
the bottle'. 'You see prescription drug abuse in the same circles 
that you saw cocaine abuse - the high-performing executive class. 
They might have a big day, so they take some something to get to 
sleep. Then they'll take another pill the next morning to enhance 
their performance. Then they'll go out and use all kinds of drugs at 
a party, and then to recover from the party the next morning they'll 
take a different pill. It's pervasive.'

Celebrities who have admitted their own struggles with prescription 
medication include Elizabeth Taylor, the talkshow host Rush Limbaugh, 
and Cindy McCain, the wife of the Republican presidential candidate 
John McCain. More recently, there have been rumours that Britney 
Spears has been self-medicating. The impact has percolated down to 
impressionable adolescents. One of the most popular forms of 
recreation among high-school students is the 'pharm party'. Teenagers 
raid their parents' medicine cabinets, then pool their resources. 
'You throw your drugs into a bowl in the middle of the room, then 
people pick pills out and chase them with alcohol,' says Susan 
Foster. 'We've seen these internet recipe sites where you go online 
to find out how to mix drugs for a certain effect. You can trade 
drugs online - in fact, at one college the students reported that 
they had a prescription drug trade forum on the university website.'

Markel tells the story of one of his patients, a 16-year-old student 
called Mary, who liked to down a few tablets of OxyContin with a 
single shot of vodka. She called the combination 'the sorority girl's 
diet cocktail' because it gave a stronger kick of inebriation with 
fewer calories than alcohol alone.

'There's a cachet to this sort of drug abuse, encouraged by the Paris 
Hiltons and the Lindsay Lohans going into rehab, so it becomes a 
really cool druggy, party culture,' Markel says. 'Now teenagers don't 
want to smoke and drink, they want to take a pill because it's so 
easy to get and some of them can really make you feel good.'

But it is easy to overdose on prescription drugs, partly because your 
consciousness is impaired and it can be difficult to remember how 
many you've taken, and partly because mixing medication without 
specialised knowledge can produce fatally toxic results. And however 
legal these drugs might be, their misuse carries the same 
consequences as illegal narcotics: the familiar, dispiriting tale of 
the addict losing their family, friends, job, home and, sometimes, 
their life. After two years of Percocet addiction, Jeana Hutsell took 
stock of the wreckage her life had become: 'I was homeless, I didn't 
have a car, my family didn't like me. I realised that I was the cause 
of all my problems. That was the turning point.'

Others are not so lucky. Randy Colvin, an abuser of Valium, Xanax and 
Percocet, died of a drug overdose on his 35th birthday. 'We tried to 
save him and we lost,' says his older brother Rod. 'For 15 years we 
tried to get him into treatment and each time he would be in denial, 
he would be furious with us. My mother and I even tried to get a 
court order so that he could be sectioned. We did everything we 
possibly could. Addiction is a family disease. His death was very painful. '

For Heath Ledger's parents, the grieving process is still in the 
rawest stages. Their son cemented his fame for reasons that were 
nothing to do with his talent. Instead he is for ever associated with 
a seedy death on the floor of a Manhattan apartment, just one more 
victim of the pill-popping epidemic that has become America's secret illness.

Danger Zone Painkillers

Popular brands include Nurofen and Solpadeine, which can prove addictive.

Anti-anxiety drugs

Tranquillisers have been involved in numerous recent fatal overdoses.

Sleeping tablets

Users can become dependent in just two weeks. Ledger was taking Restoril.


Prozac withdrawal symptoms are common and can be physically painful
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