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Prescription drugs: Abuse can be lethal

After losing her son to an overdose, San Ramon mom founds the National Coalition Against Prescription Drug Abuse

Read this story in Views magazine, available for free Jan. 31.

On Dec. 18, 2009, April Rovero and her family were blindsided by an epidemic.

Just a day before he was set to come home to San Ramon for Christmas break from Arizona State University, her 21-year-old son Joey died of a lethal combination of prescription drugs and alcohol and became a statistic in the growing epidemic of prescription drug abuse across the country.

Fifteen hours after ingesting two prescription medications and alcohol, Joey went to sleep and didn't wake up. A toxicology report showed that he had moderate levels of oxycodone, low levels of Xanax and was just over the legal level for alcohol.

"We were completely shocked to learn that Joey had been recreationally using these drugs and not thinking too much about it," Rovero says. "After Joey's death, we learned that the culture he was surrounded by was completely unaware that (prescription drugs) were dangerous to use. It was very prevalent in the environment he lived in."

Joey was the first of five students at ASU to die from prescription drugs in nine months, three of which were addiction-related suicides. On the nine-month anniversary of Joey's death, one of his roommates shot and killed himself in front of his girlfriend; he was under the influence of prescription drugs and alcohol when he ended his life.

Dr. Rick Levine, an addiction medicine specialist in Mill Valley, says Oxycotin is equivalent to anywhere between four and 16 Percocet and is released over time and in waves. "So it may not get people as high as they want to get, so they'll take more and that's when they die."

Prescription drug abuse is the fastest-growing drug problem in the United States, according to the Office of National Drug Control Policy. The 2009 Youth Risk Behavior Surveillance report released by the Centers for Disease Control and Prevention showed 20 percent of students nationwide have taken prescription drugs without a doctor's prescription one or more times.

Rovero believes that six or seven kids in the San Ramon Valley have died from doing this in the past year, and statistics point in the same direction. The 2008-09 California Healthy Kids Survey showed that 9 percent of 11th-graders in the San Ramon Valley Unified School District have tried prescription pain killers four or more times.

"This is definitely an issue in our community," says Linda Turnbull, director of the nonprofit education organization Teen Esteem. Turnbull says teachers and police are seeing more "low-risk" students developing prescription drug habits, making the growing problem that much more difficult to track.

In order to combat a growing epidemic of use, abuse and ignorance, Rovero founded the National Coalition Against Prescription Drug Abuse (NCAPDA), which has partnered with Teen Esteem, Arizona State University and other organizations to achieve awareness.

"In the past, the DARE and Character Counts programs didn't include any education about prescription drugs, and there is still very little being done now in our schools," Rovero says. "There was a general lack of awareness, and until this happened to Joey I had no idea people abused these drugs myself."

Rovero originally planned to simply develop an awareness video to help educate the public about prescription drug abuse but ultimately decided that more needed to be done. She founded NCAPDA in March 2009 and has since had speaking engagements throughout the East Bay and has conducted four panel discussions on campus at Arizona State University. Her presentations always include one of Joey's friends, who have rallied around the project.

"We also came to learn that most people don't really understand how dangerous prescription drugs can be, so it became important to us to spread the word and help others avoid what happened to our family," Rovero says.

The problem is so widespread and the lack of education so severe that Rovero says branches of NCAPDA are opening in Washington state, Chicago, Houston, Arizona, New York, Pennsylvania and the Laguna Nigel area of Orange County.

"One of our focuses this year is starting awareness campaigns operating under NCAPDA's banner in these other areas, and we'll do so with other parents and individuals who are as passionate as we are about saving lives," Rovero says.

She is working closely with the ASU's on-campus health department to put in place short- and long-term plans to combat abuse, including mandatory education for incoming freshmen, and parent and faculty education.

While there was literally no prescription drug abuse education at ASU before Rovero and Joey's friends got on the case, the school has been responsive and is committed to reaching as many of its 70,000 students as possible. Still, "there's a long way to go," Rovero says.

At a recent presentation to the Dougherty Valley Rotary Club, the dean of students at Diablo Valley College approached Rovero about starting an awareness program on campus. Students are dropping out all the time due to addiction, he said.

In addition to helping college students, whom Rovero says are at high risk because they had no education in middle or high school, NCAPDA has begun targeting younger children. Rovero has conducted awareness presentations at Every 15-Minute programs, student retreats, school assemblies, parent education nights and youth group meetings. She has conducted awareness presentations for Boy Scouts and will conduct two parent workshops at Soroptimist International's "She's All That" conference for middle school girls Feb. 12.

It's important to reach this age group because "pharm parties" or "skittles parties," where kids will find whatever medication they can and throw it all into a bowl at a party, happen more at the middle and high school level. Rovero says that communities such as those in the San Ramon Valley are at more risk for prescription drug abuse due to the level of affluence and availability of insurance that covers the cost of the medications.

"Middle class America is being hit especially hard because there is money to buy these drugs," Rovero says. "It's not a cheap high. A single 80 mg. Oxycotin can cost between $80-$120. People crush and snort or heat and inhale them for the instant euphoria they get when the sustained released feature of the painkiller is bypassed," Rovero says. "Addiction can happen quickly and recovery can be extremely difficult and costly."

The latest National Survey on Drug Use and Health reported that 56 percent of people age 12 or older who used pain relievers non-medically in the past year got the drug from a relative or friend for free. Another 18 percent said they got the drug from a doctor.

In Joey's case, a "dirty doctor" was involved. Rovero says dirty doctors are those "that are prescribing without medical purpose or not going through a legitimate health screening before determining need."

Nine days before his death, an osteopathic doctor in Southern California prescribed Joey 90 30-mg. strength oxycodone, 90 Soma and 30 Xanax. He was supposed to take one Xanax, three Soma and three oxycodone every day.

This particular doctor is thought to have killed at least 18 people and is under review by the DEA and Osteopathic Medical Board, which has revoked her narcotics prescribing license and is seeking to revoke her medical license, Rovero says.

"Doctors in general need to be better trained in how to safely and responsibly prescribe addictive and dangerous narcotics, especially those used to manage pain and anxiety, as they are among the ones most abused," she says, noting that there are more people addicted to medication that started out as legitimate patients.

This sentiment was echoed on KQED radio's "Forum" on Jan. 6. According to officials featured on the program, 1.2 million people were hospitalized for prescription drug abuse in 2008 -- double the number in 2003 -- which now causes more deaths than gunshots and car crashes.

"Legitimate doctors are also a problem in this epidemic and there is a crisis of good intentions," says Akhil Mehra, chief of psychiatry at Walden House, a drug and alcohol treatment facility in San Francisco, and assistant clinical professor of psychiatry at UCSF. "Problems with pain and psychiatric issues are so prevalent. Doctors don't get enough time to get to treat the complex social issues; we use our prescription pad to treat this.

"As doctors, we have to treat suffering. And we have to assume that you're going to need as many (pills) as in a worst-case scenario," he continues. "Our information technology about what's in your medicine cabinet and what other doctors have prescribed you a week ago is non-existent."

Mitch, a physician who called in to "Forum," says there is a tremendous amount of pressure to treat pain as part of a patient's vital signs and doctors have little ability to treat pain outside of the pharmaceutical cabinet.

"Pain, historically, has been undertreated and there has been a movement over the past 10 to 15 years to treat pain more aggressively," says Levine, who also appeared on "Forum." "There has been a very good effort to treat chronic and total pain; the downside is a greater availability of opiate drugs."

Levine says that while patients are paying attention, they aren't empowered and don't know what to do.

"The parents are quite hungry for the information, but they don't understand addiction and that their kids will lie to them -- they don't know how to penetrate that."

Rovero says that one of the biggest obstacles to becoming informed and empowered is simply talking about the issue.

"Families try to cover up (drug abuse) because they don't want people scrutinizing their kid or their family," she says. "We know we're a good family. Joey was a good kid but he got caught up in an environment in college that he didn't stand strong against."

Rovero says most of the overdose cases she's heard about are kids very similar to Joey -- well-liked and with no history of substance abuse or legal problems.

"Joey once walked two miles after drinking a couple of beers at a friend's house, so he wouldn't drive under the influence. He was definitely safety conscious and I'm sure he never would have taken what he did that night if he knew how dangerous it could be," Rovero says.

In order to help curb the epidemic, Rovero recommends that parents lock up their medication and dispose of unwanted and expired medication at drop-off centers, such as those at the Danville police station and Dougherty Valley Police sub-station. She encourages parents to know the warning signs of prescription drug abuse and not be afraid to take action, including drug testing their child if they suspect they may be abusing drugs.

"Don't assume that how they're acting is just a teenage stage they're going through," she says. "The more I learn about this whole environment the more scared I am for our society. This is a worldwide problem. How are we going to get control over it?"

For more information about prescription drug abuse, to learn about upcoming speaking events or to request a presentation for parents or students, visit www.ncapda.org.

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