Webinar: Prescription Drug Abuse & Mental Health

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In our weekly webinars, we talk about various industry scenarios and challenges of rehabs across the country along with the de-addiction and mental health challenges faced by the mental health community and people in general.

In the seventh webinar of the series, we invited Dr Amar Shinde – Founder of Jagruti Rehabilitation Centre, Pune. The webinar was hosted by Mr Vikram Kumar – Managing Director of RehabPath, India. In the webinar, Dr Shinde shared his views on prescription drug abuse and mental health problems in India.

In this blog, you can read the summary of the webinar, or you can watch it online here.

https://www.facebook.com/DeAddictionCentres/videos/995029667633431/?__so__=permalink&__rv__=related_videos

Vikram: Please tell us about your background and throw some light on the history of Jagruti Rehab and your journey in India.

Dr Amar Shinde: I am a practising psychiatrist for the last 16 years. We started the rehab centre because the OPD facility for psychiatric patients was not enough. We started this facility for psychiatry, addiction, and dementia patients in Pune with 15 beds. Now it has been upgraded to a 200-bed facility. After getting a good response to all the services, we decided to expand and start a new branch in Mumbai. We also try to engage addiction patients in enjoyable activities so that their mind does not feel the need to consume.

Vikram: Would you like to share your presentation on the abuse of prescription drugs?

Dr Shinde: Yes, it is one of the neglected issues as many people are addicted to prescription drugs these days. This addiction is a common problem among people from every age group as most over-the-counter medications are readily available in India.

Slide 2: What is Prescription Drug Abuse?

Prescription drug abuse means taking drugs or medications in a manner or dose that has not been prescribed by the doctor. It also includes taking medicines from another person who is not qualified to prescribe medicine to you. Sometimes, these medicines are also used for non-medical purposes like getting high. We take one tablet thinking that it will do no harm. But, there is a good risk that even consuming one tablet of painkiller can sometimes make a person addicted to it. It might become really difficult to treat such patients.

Slide 3: Why to Worry?

Every day, thousands of young teenagers abuse drugs for the first time. Prescription drugs are the most commonly abused drugs by teens after alcohol, marijuana, and tobacco. Since the young generation can access these drugs easily, they tend to get hooked and become dependent on these drugs.

Slide 4: The Three Classes of Medication

Usually, three types of medicines can cause dependence, these are painkillers, antidepressants, and stimulants.

The first medication is for pain. Initially, it gives relief from pain, but its prolonged use can make a person addicted to it.

The second type of drug is central nervous system depressant, usually prescribed by general physicians or psychiatrists.

Stimulants are generally prescribed in case of ADHD disorder and consuming them keeps the user high. We can also see them being taken by people in the gym.

Slide 5: Pain Prescription Abuse

You can understand the gravity of prescription drug abuse problem by the fact that in 2002, nearly 30 million people aged above 12 used prescribed pain relievers to cure pain; out of which 1.5 million became dependent. Initially, these pain relievers give you temporary relief, but their prolonged and regular use can make you an addict.

Slide 6: From Pain Relief to Addiction

You can take painkiller drugs to relieve pain and suffering or to feel high. But, they can make you dependent, especially if they are opioid-based painkillers like tramadol as they are very addictive.

Slide 7: Central Nervous System (CNS) Depressants

CNS depressants are used to treat anxiety or sleep disorders. Sometimes, people also use them as tranquilisers, sedatives, or hypnotics. In this COVID-19 situation, many people are facing restlessness or anxiety. Some people might need medications for anxiety. They must take a doctor’s prescription before buying medicines.

Slide 8: Stimulants

Stimulants like amphetamine are used for the treatment of ADHD. They can make you feel very high. One of the major sub-drugs of amphetamine is MD, which is widely used and abused. If you get addicted to MD, there is a good chance that you may get relapsed after treatment. Mephentermine and steroids are stimulants which are commonly abused by people going to the gym. These can be very harmful for the body. 

Slide 9: Myths About Prescription Drugs

Sometimes, people feel that abusing prescription drugs is safer than abusing other drugs. Since they are prescribed by doctors and people can easily switch from one prescription drug to another, they may feel that these drugs are safe to abuse.

Stimulant drugs are abused with a misconception that they improve focus and performance. But the truth is that such improvements are temporary.

Slide 10: Increased Media Attention

There is a lot of media coverage being given to prescription drugs. Some of them are being portrayed as hot drugs that offer instant relief.  Often these drugs are readily available over-the-counter.

Slide 11: Easy Access: Role of the Internet

Easy access to prescription drugs is causing a problem. Home delivery has further aggravated the problem.

Slide 12: Overdose Deaths

Prescription drugs are being used heavily due to their easy availability. For example, you can just go to a nearby pharmacy and get a pain reliever. However, the misuse of prescription drugs can have serious consequences. They can be detrimental to your health. Overdose of such drugs can also cause death. Their regular use can make you dependent over time and you may end up recovering in a rehab centre.

Slide 13: Prescription Abusing Populations

People belonging to every gender and age group abuse prescription drugs. Many pain patients abuse opioid drugs which may result in addiction. People with comorbid psychiatric conditions have also been found to abuse their prescribed drugs. There are some people who only abuse prescription drugs, while there are others who abuse prescription drugs along with other substances like alcohol or heroin. They are called polydrug abusers.

Slide 14: Youth Prescription Abuse

Young people can easily get opioids from friends and family. Initially, there is an enthusiasm for using drugs, which eventually turns into an addiction. Female prescription drug abusers outnumber male drug abusers as males have greater access to other forms of drugs. There is a lack of good prevention programmes. People are generally unaware of the consequences of using these drugs over a long period of time and only realise it when they face major health issues from long-term abuse of prescription drugs.

Slide 15: The Elderly Prescription Abuser

Older people generally have many chronic illnesses. They might misunderstand and think that they are just consuming drugs for routine use, but it could actually be drug abuse. They also have multiple drug prescribers due to multiple illnesses. They face several problems like rationalisation and denial of their problems by family members, deficits assumed to be due to ageing, interaction with alcohol or other drugs, and so on. These problems contribute to making an elderly a prescription drug abuser.

Slide 16: Women and Prescription Drug Abuse

Like I said earlier, women are more likely to become a prescription drug abuser. Currently, there are 4 million women abusing prescription drugs. Men tend to have lower prescription drug abuse problems as they have easy access to various other drugs. Females are diagnosed with depression and anxiety more often for which they are prescribed drugs. Once they have a prescription, they continue buying prescribed medicines again and again without going for a follow-up with the doctors.

Slide 17: What Predicts Addiction?

Usually, if we see a person using some prescribed drugs regularly, we need to look at certain factors to understand if the person is addicted to those drugs. By studying factors like personal and family history of drug abuse, current addiction to alcohol or cigarettes, history of problems with prescriptions, and presence of comorbid psychiatric disorders, we can predict if the person is addicted to prescribed drugs or not. 

Slide 18: Ongoing Warning Signs

There are many warning signs that can help us identify if a person is addicted to prescription drugs or not. Addicts may indulge in activities like forging prescriptions, stealing prescription pads, making frequent appointments with their doctor, requesting early refills of their prescribed medicines, and so on. 

Slide 19: Mental Health and Drugs

Mental health issues can cause drug abuse problems. If a person has mental health issues or if there is someone in the family with such issues, the person may tend to abuse prescription drugs. Abusing drugs, in turn, can cause mental issues like depression, anxiety, personality problems, and psychosis. This is a vicious cycle.

When we treat a patient, we see their situation in two ways – mental health problems due to drug abuse or drug abuse problems due to mental health issues. Both of these situations can lead to suicide in severe cases.

Slide 20: Prevention

Prevention is the most important thing we can teach our children and learn ourselves. It is always better than cure. What we can do is never take advice from other people and only listen to our doctors. We can also give good psychological support to people by identifying their underlying psychological issues. Patients need to make sure that they do regular follow-ups with their doctor. Pharmacists must not sell medicines if the prescriptions are outdated. It is important to identify prescription drug abuse in its initial stage, otherwise, it becomes difficult to treat.

Slide 21: What is the Treatment?

Usually, we can treat drug abusers with caution, provide them with a support system, treat comorbidities, and increase recovery-related activities. In India, many opioid analgesics are banned, but they are still often prescribed. Non-opioid analgesics can prove more beneficial than opioids in some cases. Non-pharmacological treatments like cognitive behaviour therapies are essential for people who are suffering from prescription drug abuse problems.

Prescription drug abuse treatment is as important as treating any other addiction problem.

Vikram: Many painkillers are advertised in India that are a little strong for regular use. Are there any government policies to regulate the sale of these drugs?

Dr Shinde: If you look at the current situation, there is a black market of medicines. The tablet that costs Rs 5 is being sold for Rs 100. Pharmacists usually give medicines without prescriptions. People & pharmacists both must act against this lousy practice. Strict government control is required to regulate the sale of prescription drugs. The government has taken some measures like ensuring that many drugs are not sold without a prescription. We must understand that consuming prescription drugs without consulting a physician can be very dangerous.

Vikram: There are two broad categories of prescription drug addicts as per my understanding. One category is of people who received prescription drugs to treat a condition but later got addicted to such drugs. Another category is of addicts (of alcohol and drugs) who went to rehabs for treatment and later got hooked to prescription drugs used on them during the treatment. How can we handle them separately?

Dr Shinde: People who are not previously addicted to anything and abuse prescription drugs are easier to treat than the ones having a history of addiction. Usually, opioids are like brown sugar for a non-addict person. Currently, many new drugs that are not addictive are coming up in the market that can be used to treat such people.

For people having an addiction history, we can use prescription drugs that can replace the substance they are addicted to. But we have to be very careful as they can get addicted to them. Addicts also have a tendency to switch their addiction. With social support and family understanding, they can come out of it subsequently.

Vikram: How do we know that someone in our family is addicted to prescription drugs? When is the right time to get help?

Dr Shinde: There is a very thin line between using and abusing drugs. We usually have three categories – use, abuse, and addiction. Let’s understand by taking the example of an alcohol consumer. If the person drinks alcohol once or twice a week – they are called users. If they binge drink on occasions, we consider them abusers. If they consume alcohol daily, they fall in the addict or dependent category. We can see prescription drug abusers taking many doses throughout the day. They also have persistent acidity and other symptoms to indicate the abuse of drugs. We must recognise the problem and give them the required help.

Vikram: Since there are no strict regulations or control over some prescription drugs, they are easily accessible in the market. Do you think even school-going children may have access to such things?

Dr Shinde: Yes, it is happening these days. Young children are getting addicted to various drugs like whiteners, which are being taken by children studying in 6^th and 7^th standard. They are easily available. Even sleeping pills are easily accessible, which teenagers sometimes take with alcohol. Gym related addiction is also there with adolescents. They sometimes inject themselves with drugs to get the desired physique. This is a growing problem in the country for which we need to take strict action.

Vikram: Is there a way for parents to know if their children are taking drugs?

Dr Shinde: We have to look after our children cautiously. If their academic performance goes down, it may be due to drug abuse. Parents usually shout at their children during such scenarios or punish them. As a parent, you must try to understand the reason behind it. Many children sleep excessively during the day and stay awake the entire night, which may indicate ongoing drug abuse. If there is any change in the behaviour of your child, you must talk to them and bring them to a psychiatrist to find the problem.

Vikram: How is Jagruti helping addicts with drug abuse? What is the time period of treatment for prescription drug addicts advised at Jagruti?

Dr Shinde: For prescription drug treatment, usually 1-2 months of admission is advised at Jagruti. Similarly, 45 days for alcohol and 90 days for cannabis. We also counsel the family as they play an important role in the recovery journey of the addict. We need to understand the root cause behind addiction and then give relevant treatment. Treatment in the early stages of addiction is usually better for every patient, as it is challenging to treat them later. We evaluate the patient’s psychology, personality, and addiction problem to give proper treatment.

Vikram: What should we do if anxiety or depression is not treatable without medicines?

Dr Shinde: Anxiety and mild depression are treatable with psychological treatment, cognitive therapy, and counselling. If the problem is moderate to severe, the person needs medicinal treatment along with the help of psychologists. If a person feels too low consistently for an extended period, only then they are treated through medicines. Usually, medicine courses are run for around 6-9 months only. The drugs do not create dependency if taken with proper prescription and care.

Vikram: In the case of long-term dementia, does it help to continue or discontinue the medication?

Dr Shinde: For dementia, we usually advise to use drugs till the last day of life because there is a sudden shift in the patient’s routine. We use anti-dementia medicines for them to make their lives better.

Vikram: Can drug abuse become a reason for suicide?

Dr Shinde: Yes. Under the influence of drugs people’s judgement is often clouded. People often start abusing to cope with their anxiety or depression, which in turn  aggravates the condition.  

Vikram: Does taking a higher dose than prescribed be counted as abuse?

Dr Shinde: Yes. But, if a high dose is prescribed by the doctor, it is not considered as prescription drug abuse.

Vikram: What are the other options for opioid dependent people who are not getting OSD during the ongoing lockdown?

Dr Shinde: Due to the lockdown, people are not getting oral supplements to counter their addictions. Addicts are suffering as they cannot get their medications. They may try to find alternative medicines on their own in the absence of prescribed ones and may get addicted to them. Hence, the government needs to allow such people to go to their rehab centres and get their medicines.

Vikram: There are still many medical stores that sell medicines without any prescription. Is there any way we can stop this practice?

Dr Shinde: We can complain to the respective authorities.

Vikram: There are many places where dealing with the social stigma around mental health can be difficult. How can we help such people break the stereotype & offer help?

Dr Shinde: We can start teaching people and spread awareness about mental health.

Vikram: Sometimes people use tablets for erectile dysfunction. Is it considered a prescription drug abuse?

Dr Shinde: Yes, if such drugs are used without a prescription, then it is considered abuse of drugs. It is recommended to consult a sexologist for the identification and treatment of such problems. It has been observed that in 99% of cases, erectile dysfunction happens as a result of underlying psychological issues and not due to any physical disability.

Vikram: How can we bring a change in our society regarding the abuse of prescription drugs? Who do you think are in a responsible position for driving such a change?

Dr Shinde: It is one of the important topics we covered today because prescription drug abuse is neglected these days. It has become a routine for people to take painkillers. They don’t understand that their body can get damaged because of it. People should learn about it. All psychologists and psychiatrists must speak about its abuse whenever there is a discussion on any addiction. It will also improve the  quality of life for everyone.

Vikram: It has been great to have you on the panel and get to learn about prescription drug abuse, an issue that has been ignored for a long time. What is one message you’d like to give all of us?

Dr Shinde: We need to educate ourselves about all types of addiction. We must all be cautious when taking prescription drugs. Let’s all also share this information with others as much as possible. 

You can reach out to Dr Shinde through his website.

If you have any other substance abuse problem, get help as fast as you can. Go to your nearest psychiatrist or a rehab centre and get the help you need. All the rehabilitation centres are open.  For more webinars like this, follow us on Facebook.