Doc Gurley

Prescription drug abuse has exploded in the last few years. Rush Limbaugh is perhaps the most famous person to become addicted to them, and commit crimes to obtain them. Corey Haim may (or may not) be the latest in a too-frequent series of celebrities-who-died-too-young from drugs that were obtained from a dealer with an M.D. Did these docs know those drugs would end up in the wrong hands? Who knows – but, whether it’s docs, the internet, friends, or all of the above, the fact is that more and more prescription narcotics are floating around than ever before. In my pre-Haiti preparations, one of the most eye-opening events was when I asked lots of people in my community to donate unused narcotics (if they had any). Families in my community, motivated by both a true sense of altruism, and a desire to safely get these meds out of their medicine cabinet, managed to produce an eye-popping amount of controlled substances. So much so that I was worried I might get a particularly invasive body-cavity search while going through JFK (especially since I also had a large amount of cash – for me – in small bills as my “get out of Haiti” emergency stash…). How many narcotic pills did I get? Let’s just say, having only spread the word through a few people, I got a gallon ziplock bag over half full of Vicodins (just take a moment to imagine the bulging sack), a hefty number of other controlled substances, and even a large handful of methadone (donated by a family whose grandma died in hospice).

So, if you don’t know a reliable doc heading to Haiti, how DO you safely protect, and dispose of, narcotics (assuming, of course, that none of us wants to be an unwitting enabler to the tragic overdose deaths that are all too common)?

Wikimedia Commons

Couple of these, and a shot of whiskey = death

First, the warnings:

Cases have been prosecuted where users visited homes purely for the purpose of pawing through medicine cabinets to steal narcotics. As you can imagine, most people don’t even notice these pills are gone until days or even months later. How will you even notice one or two missing? How are you ever even going to find out who took them? What about those friends-of-friends who came to a cocktail party? Could it have been them? Even real estate agents have noticed that pills go missing after an open house. What about the situation (like that of Rush Limbaugh’s housekeeper) where a friend (or employer) wants to bum a few off you? What are you supposed to do then?

Here’s the bottom line when it comes to controlled substances:

1) Time for the tough talk with yourself. As much as any of us wants to be empathetic to pain, these pills can (and often do) kill. That means you need to take responsibility for having them in your house. Maybe you’ve been telling yourself that you’re going to get well. Maybe you just hate the idea that you-being-on-pain-meds may now be your new normal. The fact is, if you’ve had three months of chronic pain without a changeable, progressive, condition, you’re now, officially, a person with a chronic pain disorder. And, if you’ve been on narcotics round-the-clock for over three weeks, there’s a good chance you are physically dependent on them (keep in mind, dependent is not the same as addicted). Why am I going over all this? Because anyone who’s been on round-the-clock pain meds for over three weeks needs to have that hard discussion with themselves – the one where you admit that it’s time to accept responsibility for having pain meds permanently in your home. You, indeed, need to get a serious, hidden, locking location for your narcotic meds (that includes medical marijuana, which can, despite widespread rumors to the contrary, lead to coma - and it’s corollary, death - if ingested by very young children). Is buying one and installing a locked pill-cabinet a (har) pain? Yes. Is it emotionally difficult to do? Oh yes. But the fact is, you still need to do it.

2) Be real. However, not many of us are going to buy, much less install, a Fort-Knox-style locking cabinet for our half-forgotten eight pills of Vicodin from a wisdom tooth extraction two years ago. That means you need to get rid of unused narcotics (even a couple), as soon as you stop taking them. Why is this so hard for so many of us to do? I’d say it’s a kind of PTSD – a sign that we’ve been subjected to way too many a$$hole doctors, the kind who dismiss our pain and poo-poo our misery as so much whining. Even one experience of being on the receiving end of that kind of condescension can turn the best of us into a narcotic-hoarder. However, once you realize the coma/death you may be risking by keeping those little nuggets of addiction in your house, especially for vulnerable people you love, you may decide, despite your own future risk of untreated pain, to actively embrace the leap-of-faith necessary in order to discard your hoarded pain-pills. Do it. Trust in the future so you can protect the ones you love. Toss those suckers.

3) But where do they go? You can’t flush them, and even double-bagging them in plastic and tossing them in the trash can have risks (find out why at this great site). So where do you go? Many police stations, in only the last few years, have created safe disposal sites. Why police stations? By federal law, only the police are authorized to dispose of controlled substances like prescription narcotics. Wonderfully, you can go here to find the nearest safe-narcotic-disposal location that serves your area. Keep in mind that “prescription controlled drugs” (and addiction/death risks) also include that whole family of pills known as benzodiazepines – Xanax, Ativan, Lunesta and other “downers.” A great docgurley-reader pointed out that ADHD drugs should also be included in this list. What about other controlled substances? Since pretty much all these containers are located inside police stations, I can’t say what might happen if you decided to drop off a dime-bag, or a half-kilo of blow, but I’m guessing that act, however altruistic, wouldn’t end well for you… In other words, when it comes to the illegal kinds of drugs, we don’t have (yet) a safe disposal process.

4) Pro-active is pro-tective. Be honest with your doctor. If you’ve got a good one, he/she will be VERY receptive when you say “I only want a prescription for exactly as many as you think I’ll need – but, on the other hand, I sure don’t want to be hurting for days if I can’t get in touch with you. How can I get more, rapidly, if I need them?” A decent doctor will work hard to make sure you get as many as you might need up front, and easy access to more if that doesn’t work. Be sure to express your concerns about having too many (possibly-excessive) narcotic pills around your house. Some doctors are all too likely, in the interest of saving time, to just write for many more than you’re likely to need. Hey, it saves everyone some phone-call answering-service hassle, right? Except, that is, for the teen who dies of a multi-drug overdose at the next beer-bash.

5) Sometimes, paranoia is a good thing. Keep an eye on your pills. The only thing worse than someone sneaking a few of your meds every now and then, is having someone you love die from a preventable death. You want to know exactly where, how many, and how secure your pills are at all times. It’s not unreasonable to check your medicine cabinet after a party. Check them all. Maybe it’s not narcotics, but cough syrup, pseudephrine, Viagra-type meds, early-refills for ADHD drugs, or other pills that go missing. If you notice stuff gradually dwindling, you’ve got a home-security problem. Get help, before it escalates. Even if a medication helps you, when it comes to someone else, your pill can kill. If you’re baffled by a missing pill, discuss it with a healthcare provider you trust. A blood pressure medicine, clonidine (not the more commonly misused pill, “Klonipin”) can be used to extend the effectiveness of abused drugs (as well as to blunt withdrawal symptoms). While it may not immediately make sense to you exactly why grandpa’s blood pressure medicine (“clonidine”) is slowly disappearing, talking it over with a trusted professional could be your only chance to get help for someone you love. Before it’s too late.

6) Spread the word. As more and more people die from a mix of pills, drugs, and alcohol, teach your friends, loved ones and teens that you have to be on the look-out for anyone who’s too groggy to care for themselves. The days of assuming someone has just had one drink too many are gone. Anyone who can’t control their vomit, or isn’t shake-awakeable at a party, needs professional help. You can’t know what’s percolating through their blood, or how bad it’s going to get. Several states have even passed laws protecting underage drinkers who call 911 on behalf of friends. Saving a life, when all someone needs is help breathing, is pretty darn easy. And cheap. Don’t miss the chance to be a bona fide hero. Call if you’re worried.

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