Prescription for Addiction

Heath Ledger was found dead with seven different drugs in his system. Three were narcotic painkillers, two were anti-anxiety agents, two were sleep medications, and all were legally prescribed.

Cindy McCain developed a habit of taking upwards of 20 narcotic painkillers per day, had doctors write scripts for her using three different people’s names, and narrowly avoided criminal charges.

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Rush Limbaugh was arrested for “doctor shopping” to get Oxycodone and Hydrocodone, both powerful narcotics; the charges against him were dropped only after his attorneys negotiated a $30,000 settlement to defray the cost of the investigation.

Closer to home, Mamaroneck physician Jennifer Bagg, MD, was arrested after being identified on a surveillance tape trying to pass a forged prescription stolen from her partner, Phyllis Mandel, MD, at a Rye Brook CVS. The forged prescription was for the narcotic Percocet, a painkiller, and the charges were fifth-degree criminal possession of a controlled substance (a felony), petty larceny, and fifth-degree possession of stolen property (both misdemeanors). Dr. Bagg had had a successful internist practice in New Rochelle. In 2007, she was selected by Castle Connolly Medical, Ltd., as one of Westchester’s top doctors.

The new hot drugs on the street aren’t crack, meth, or heroin. Today’s “in” drugs come from suppliers like CVS, Rite-Aid, and Walgreens, and they come in translucent bottles. Though abuse of prescription drugs is a national problem, many professionals believe Westchester County is particularly susceptible to prescription drug problems.

“The people of Westchester County have greater resources and, for the most part, have greater access to quality healthcare,” says Robert Anderson, managing director of Daytop in Westchester and Rockland Counties, an outreach center for drug abuse and addictions based in Hartsdale. “I wouldn’t want to make a blanket statement but that probably means they are more likely to be prescribed drugs for pain, anxiety, or conditions like ADD.”

The issue has spilled over into everyday life with Westchester prescription addicts more likely to be wearing power ties and Yves St. Laurent business wear than they are rags, torn jeans, and tie-dyes. It may be an addiction that appears cleaner and better kept, but to the minds, bodies, and lifestyles of those hooked, it is every bit as much a chemical dependency as main-lining street heroin. Prescription drug addicts are willing to go to the same extreme levels to get a hold of the drugs if they cannot regularly get them. It reaches all walks of life.

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“A realtor friend told me the other day that when he gave open houses he used to worry about jewelry and money being stolen,” says Harvey Rodgers, intake coordinator at the Lexington Center in Mount Kisco. “Now, he worries about people raiding the medicine cabinet.”

And those medicine cabinets are frequently filled with legal goodies. “In the inner city, doctors are less likely to prescribe people from the ‘hood’ controlled substances,” Michelle Rolle, an addictions counselor at the Lexington Center, says. “Up here, doctors think that people come from good homes and good families and aren’t likely to abuse drugs.”

When Dr. Bagg was arrested, Sgt. Dan McKenna of the New Rochelle Police Department reported that Dr. Bagg had complained of having “emotional problems and tough times,” and that “her taking prescription pills had gotten out of hand.”

How does a physician—or, for that matter, a rising movie star, the wife of a presidential candidate, and a conservative cult figure—have things “get out of hand?”

“You’re out of your head when you’re addicted,” says Andrea*, a medical professional and a former prescription drug addict. “It’s like an out-of-body experience. You know taking thirty Percocets a day is not normal, and you know from your education what it’s doing to your liver. You see yourself doing it, but you can’t physically stop it.”

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For Andrea, as for many prescription drug addicts, the use of legal drugs begins for a very legitimate reason. “I was taking painkillers for a back injury,” she says. “I took them as prescribed, but there were days when I needed to take more for the pain. When stress in my life escalated, I found myself taking them for emotional reasons.”

Like many others, Andrea eventually found herself addicted and in need of treatment. “In 2007, we had thirty-one thousand admissions into treatment programs for people who identified prescription drugs as a drug of abuse,” reports Karen Carpenter-Palumbo, commissioner of the New York State Office of Alcohol and Substance Abuse. “That’s up from sixteen thousand in 2000, which is a ninety-six-percent increase. In Westchester County, we see an increase from six hundred to one thousand. The use is across the board. We see teens and adults, and it’s especially a problem with seniors.”

It’s not hard to get the drugs. “I found a doctor who didn’t care what prescription he wrote as long as I gave him a check for the co-pay,” says Beth, a local woman in her late 30s, who hasn’t used drugs for the past five years. “I started looking in the PDR [Physician’s Desk Reference] for drugs to use, and then I would lie and tell the doctor that this was what my old doctor prescribed for me. They believed me or didn’t care enough to check.”

Treated for anxiety when an adolescent, Beth was introduced to Xanax, then chloral hydrate, and eventually other sleeping medications. She started to take the drugs as she saw fit, taking them for weeks at a time and then abruptly stopping when she thought she was losing control. The ability to stop was her way of proving to herself that she wasn’t hooked. “I didn’t realize it at the time, but I would go into withdrawal from suddenly stopping. As a result, I had a grand mal seizure one time.” Even that seizure didn’t stop her. More frightening was the fact that her dependence and threat of withdrawal didn’t stop her doctors from prescribing. “It got to the point where I would be under the influence so much that I actually fell down twice in front of the doctor and he still wrote the prescription. I was seeing two doctors at the time, and they were both easy touches. The ironic thing was that one was even working as a detox doctor at the time.”

Paying for the prescriptions with cash kept any insurance company from taking note of her addiction. “It was easy,” she says. Many teens can vouch for that. The number of students diagnosed with attention deficit disorder (ADD) continues to rise—and so does the number of teens prescribed medication for it. Strangely enough, it is common to prescribe a central nervous system stimulant for ADD. Adderall, Ritalin, and Dexedrine are powerful drugs in the same class as cocaine. The fact that you can pick them up at your local CVS for a $10 co-pay doesn’t mitigate their potency.

“A kid offered me an Adderall for free in school when I was fifteen,” says Chris, a Bethel resident, now 17. “That’s when I fell in love with pills. Then he told me how easy it was to get ADD medication, so I told my mom I had ADD, and she took me to a psychiatrist. I made up symptoms, said I couldn’t concentrate. I had the prescription right there and then.”

He details a daily routine that involved taking three 30-milligram Adderalls when he got up in the morning, then downing four Dilaududs (a powerful synthetic morphine) at lunch, drinking after school, and finally popping Xanax before bed so he could sleep. Chris got the drugs from his own prescription, from kids at school, and from dealers he met. He entered Arms Acres, a rehab in Carmel, New York, and reports that he’s now coming up on a year without drugs or alcohol.

Statistics from the U.S. Department of Health and Human Services (DHHS) let us know that Chris is just part of a wave of teens and young adults who’ve discovered the high of prescription drugs. The DHHS reports in its last study that prescription drug abuse among 18- to 25-year-olds has increased 500 percent and that the use of anti-anxiety medication like Xanax (“zanies”) and Valium has increased more than 50 percent in just one year. Pilfering the medicine cabinets of their parents, grandparents, and friends has become a commonplace routine.

“There’s a practice called ‘pharming’ where kids get whatever is in the family medicine cabinet and bring it to a party,” Carpenter-Palumbo says. “Then they throw it all in a big bowl, and everyone grabs handfuls of the drugs.”

While only mindful parents can prevent access to prescriptions at home, the first line of defense against inappropriate use of prescribed medications is the pharmacist. “It is the responsibility of the pharmacist to make sure everything is on the up and up,” says Joe Bova, pharmacist and owner of Cary’s Pharmacy in Dobbs Ferry, and formerly mayor of the village. “You’re not just filling prescriptions.”

There is no law that says a pharmacist is obligated to fill any prescription, and part of the standard of care involves a utilization review on each patient to identify his or her pattern of use. “A pharmacist is obliged to determine that there is a legitimate prescription, a legitimate patient, and a legitimate purpose for the prescriptions being filled,” explains Bova.

Undoubtedly, Dr. Jennifer Bagg knew the procedures involved at the pharmacy, knew the consequences of forgery, and knew what being reported to the Office of Professional Medical Conduct for drug charges would mean to her career—and her life. For a very intelligent and successful person to put so much in danger simply defies rational logic. Or maybe, it just defines addiction.

“No one who gets addicted wakes up one morning and thinks, ‘I just want to screw everything in my life up,’” says Andrea. “The public doesn’t see it as a disease.” Although statistics show that physicians develop addiction at the same rates as the general public, when given the chance (and threatened with the loss of their medical licenses), doctors have a greater chance of having a successful recovery. The key variable is whether the district attorney and the Office of Professional Medical Misconduct decide that the doctor in question deserves a second chance.

The question in Dr. Jennifer Bagg’s case is whether she will be given that chance.

Tom Schreck has been a credentialed addictions counselor for more than 20 years. He directed Seton Health’s Outpatient Program in Troy, New York, and has taught chemical dependency courses at Hudson Valley Community College for more than 15 years. He lives in Albany, New York.

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