MESSAGE
| DATE | 2005-11-15 |
| FROM | Ruben Safir
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| SUBJECT | Subject: [NYLXS - HANGOUT] Amy Harmon is at it again
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November 16, 2005
Being a Patient
Young, Assured and Playing Pharmacist to Friends
By AMY HARMON
Nathan Tylutki arrived late in New York, tired but eager to go out
dancing. When his friend Katherine K. offered him the Ritalin she had
inherited from someone who had stopped taking his prescription, he
popped two pills and stayed out all night.
For the two college friends, now 25 and out in the working world, there
was nothing remarkable about the transaction. A few weeks later,
Katherine gave the tranquilizer Ativan to another friend who complained
of feeling short of breath and panicky.
"Clear-cut anxiety disorder," Katherine decreed.
The Ativan came from a former colleague who had traded it to her for the
Vicodin that Katherine's boyfriend had been prescribed by a dentist. The
boyfriend did not mind, but he preferred that she not give away the
Ambien she got from a doctor by exaggerating her sleeping problems. It
helps him relax after a stressful day.
"I acquire quite a few medications and then dispense them to my friends
as needed. I usually know what I'm talking about," said Katherine, who
lives in Manhattan and who, like many other people interviewed for this
article, did not want her last name used because of concerns that her
behavior could get her in trouble with her employer, law enforcement
authorities or at least her parents.
For a sizable group of people in their 20's and 30's, deciding on their
own what drugs to take - in particular, stimulants, antidepressants and
other psychiatric medications - is becoming the norm. Confident of their
abilities and often skeptical of psychiatrists' expertise, they choose
to rely on their own research and each other's experience in treating
problems like depression, fatigue, anxiety or a lack of concentration. A
medical degree, in their view, is useful, but not essential, and
certainly not sufficient.
They trade unused prescription drugs, get medications without
prescriptions from the Internet and, in some cases, lie to doctors to
obtain medications that in their judgment they need.
A spokeswoman for the Drug Enforcement Administration says it is illegal
to give prescription medication to another person, although it is
questionable whether the offense would be prosecuted.
The behavior, drug abuse prevention experts say, is notably different
from the use of drugs like marijuana or cocaine, or even the abuse of
prescription painkillers, which is also on the rise. The goal for many
young adults is not to get high but to feel better - less depressed,
less stressed out, more focused, better rested. It is just that the
easiest route to that end often seems to be medication for which they do
not have a prescription.
Some seek to regulate every minor mood fluctuation, some want to enhance
their performance at school or work, some simply want to find the best
drug to treat a genuine mental illness. And patients say that many
general practitioners, pressed for time and unfamiliar with the
ever-growing inventory of psychiatric drugs, are happy to take their
suggestions, so it pays to be informed.
Health officials say they worry that as prescription pills get passed
around in small batches, information about risks and dosage are not
included. Even careful self-medicators, they say, may not realize the
harmful interaction that drugs can have when used together or may react
unpredictably to a drug - Mr. Tylutki and Katherine each had a bad
experience with a medication taken without a prescription.
But doctors and experts in drug abuse also say they are flummoxed about
how to address the increasing casual misuse of prescription medications
by young people for purposes other than getting high.
Carol Boyd, the former head of the Addiction Research Center at the
University of Michigan, said medical professionals needed to find ways
to evaluate these risks.
"Kids get messages about street drugs," Ms. Boyd said. "They know
smoking crack is a bad deal. This country needs to have a serious
conversation about both the marketing of prescription drugs and where we
draw the boundaries between illegal use and misuse."
To some extent, the embrace by young adults of better living through
chemistry is driven by familiarity. Unlike previous generations, they
have for many years been taking drugs prescribed by doctors for
depression, anxiety or attention deficit disorder.
Direct-to-consumer drug advertising, approved by the Food and Drug
Administration in 1997, has for most of their adult lives sent the
message that pills offer a cure for any ill. Which ones to take, many
advertisements suggest, is largely a matter of personal choice.
"If a person is having a problem in life, someone who is 42 might not
know where to go - 'Do I need acupuncture, do I need a new haircut, do I
need to read Suze Orman?' " said Casey Greenfield, 32, a writer in Los
Angeles, referring to the personal-finance guru. "Someone my age will be
like, 'Do I need to switch from Paxil to Prozac?' "
For Ms. Greenfield, who could recite the pros and cons of every
selective serotonin reuptake inhibitor on the market by the time she
graduated from college, years of watching doctors try to find the right
drug cocktails for her and for assorted friends has not bolstered faith
in their expertise.
"I would never just do what the doctor told me because the person is a
doctor," said Ms. Greenfield, who dictates to her doctors what to
prescribe for her headaches and sleep problems, and sometimes gives her
pills to friends. "I'm sure lots of patients don't know what they're
talking about. But lots of doctors don't know what they're talking about
either."
Prescriptions to treat attention deficit disorder in adults age 20 to 30
nearly tripled from 2000 to 2004, according to Medco, a prescription
management company. Medications for sleeping disorders in the same age
group showed a similar increase.
Antidepressants are now prescribed to as many as half of the college
students seen at student health centers, according to a recent report in
The New England Journal of Medicine, and increasing numbers of students
fake the symptoms of depression or attention disorder to get
prescriptions that they believe will give them an edge. Another study,
published recently in The Journal of American College Health, found that
14 percent of students at a Midwestern liberal arts college reported
borrowing or buying prescription stimulants from each other, and that 44
percent knew of someone who had.
"There's this increasingly widespread attitude that 'we are our own best
pharmacists,' " said Bessie Oster, the director of Facts on Tap, a drug
abuse prevention program for college students that has begun to focus on
prescription drugs. "You'll take something, and if it's not quite right,
you'll take a little more or a little less, and there's no notion that
you need a doctor to do that."
Now, Going Online for Pills
The new crop of amateur pharmacists varies from those who have gotten
prescriptions - after doing their own research and finding a doctor who
agreed with them - to those who obtain pills through friends or through
some online pharmacies that illegally dispense drugs without
prescriptions.
"The mother's little helpers of the 1960's and 1970's are all available
now on the Internet," said Catherine Wood, a clinical social worker in
Evanston, Ill., who treated one young client who became addicted to
Xanax after buying it online. "You don't have to go and steal a
prescription pad anymore."
In dozens of interviews, via e-mail and in person, young people spoke of
a sense of empowerment that comes from knowing what to prescribe for
themselves, or at least where to turn to figure it out. They are as
careful with themselves, they say, as any doctor would be with a
patient.
"It's not like we're passing out Oxycontin, crushing it up and snorting
it," said Katherine, who showed a reporter a stockpile that included
stimulants, tranquilizers and sleeping pills. "I don't think it's
unethical when I have the medication that someone clearly needs to make
them feel better to give them a pill or two."
Besides, they say, they have grown up watching their psychiatrists mix
and match drugs in a manner that sometimes seems arbitrary, and they
feel an obligation to supervise. "I tried Zoloft because my doctor said,
'I've had a lot of success with Zoloft,' no other reason," said Laurie,
26, who says researching medications to treat her depressive disorder
has become something of a compulsion. "It's insane. I feel like you have
to be informed because you're controlling your brain."
When a new psychiatrist suggested Seraquil, Laurie, who works in film
production and who did not want her last name used, refused it because
it can lead to weight gain. When the doctor suggested Wellbutrin XL, she
replied with a line from the commercial she had seen dozens of times on
television: "It has a low risk of sexual side effects. I like that."
But before agreeing to take the drug, Laurie consulted several Internet
sites and the latest edition of the Physicians' Desk Reference guide to
prescription drugs at the Barnes & Noble bookstore in Union Square.
On a page of her notebook, she copied down the generic and brand names
of seven alternatives. Effexor, she noted, helps with anxiety - a plus.
But Wellbutrin suppresses appetite - even better.
At the weekly meetings of an "under-30" mood-disorder support group in
New York that Laurie attends, the discussion inevitably turns to
medication. Group members trade notes on side effects that, they
complain, doctors often fail to inform them about. Some say they are
increasingly suspicious of how pharmaceutical companies influence the
drugs they are prescribed.
"Lamictal is the new rage," said one man who attended the group, "but in
part that's because there's a big money interest in it. You have to do
research on your own because the research provided to you is not based
on an objective source of what may be best."
Recent reports that widely prescribed antidepressants could be
responsible for suicidal thoughts or behavior in some adolescents have
underscored for Laurie and other young adults how little is known about
the risks of some drugs, and why different people respond to them
differently.
Moreover, drugs widely billed as nonaddictive, like Paxil or Effexor,
can cause withdrawal symptoms, which some patients say they only learned
of from their friends or fellow sufferers.
"This view of psychology as a series of problems that can be solved with
pills is relatively brand new," said Andrea Tone, a professor of the
social history of medicine at McGill University. "It's more elastic, and
more subjective, so it lends itself more to taking matters into our own
hands."
To that end, it helps to have come of age with the Internet, which
offers new possibilities for communication and commerce to those who
want to supplement their knowledge or circumvent doctors.
Fluent in Psychopharmacology
People of all ages gather on public Internet forums to trade notes on
"head meds," but participants say the conversations are dominated by a
younger crowd for whom anonymous exchanges of highly personal
information are second nature.
On patient-generated sites like CrazyBoards, fluency in the language of
psychopharmacology is taken for granted. Dozens of drugs are referred to
in passing by both brand name and generic, and no one is reticent about
suggesting medications and dosage levels.
"Do you guys think that bumping up the dosage was a good idea, or should
I have asked for a different drug?" asked someone who called herself
Maggie earlier this month, saying she had told her doctor she wanted to
double her daily intake of the antidepressant fluoxetine to 40
milligrams.
In another recent posting, a participant wrote that his supply of the
beta blocker Inderal, acquired in Costa Rica, was running out. He uses
the drug for panic attacks, he said, but he has not told his doctor
about it. "What do I do/say to get her to prescribe me some?" he asked.
"CraZgirl," who said she was not currently taking any medications,
received a resounding "yes" to her posting that asked, "If you wouldn't
go on meds for yourself, is it reasonable to do it to keep your marriage
intact?"
Still, for some young adults, consulting their peers leads to taking
less medicine, not more. When Eric Wisch, 20, reported to an anonymous
online group that he was having problems remembering things, several
members suggested that he stop taking Risperdal, one of four medications
in a cocktail that had been mixed different ways by different doctors.
"I decided to cut back," said Mr. Wisch, a sophomore at the University
of Rochester who runs www.thebipolarblog.com, where he posts his
thoughts on medications and other subjects. "And I'm doing better."
Despite frequent admonitions on all the sites to "check with your Pdoc,"
an abbreviation for psychiatrist, there are also plenty of tips on how
to get medications without a prescription.
"I know I shouldn't order drugs online," one participant wrote in a
Sept. 26 posting on the Psycho-babble discussion group. "But I've been
suffering with insomnia and my Pdoc isn't keen on sleep aids."
What should he do, the poster wanted to know, after an order he placed
with an online pharmacy that promised to provide sleeping pills without
a prescription failed to deliver?
Another regular participant, known as "med-empowered," replied that the
poster was out of luck, and went on to suggest a private e-mail
exchange. "I think I know some sites where you could post your
experience and also get info about more reliable sites."
For a hefty markup, dozens of Web sites fill orders for a drugs, no
prescription required, though to do so is not legal. Instead, customers
are asked to fill out a form describing themselves and their symptoms,
often with all the right boxes helpfully pre-checked.
Erin, 26, a slender hair stylist, remembers laughing to herself as she
listed her weight as 250 pounds to order Adipex, a diet pill, for $113.
One recent night, she took an Adipex to stay up cleaning her house,
followed by a Xanax when she needed to sleep.
Like many other self-medicators, Erin, who has been on and off
antidepressants and sleeping pills since she was in high school, has
considered weaning herself from the pills. She wishes she had opted for
chamomile tea instead of the Xanax when she wanted to sleep.
"I feel like I have been so programmed to think, 'If I feel like this
then I should take this pill,' " she said. "I hate that."
But the problem with the tea, she said, is the same one she faces when
she is coloring hair: "It's not predictable. I know how these drugs are
going to affect me. I don't know if the chamomile tea will work."
Online pharmacies are not the only way for determined self-prescribers
to get their pills. Suffering from mood swings a decade after his
illness was diagnosed as bipolar disorder, Rich R., 31, heard in an
online discussion group about an antidepressant not available in the
United States. A contractor in the Midwest, Rich scanned an old
prescription into his computer, rearranged the information and faxed it
to pharmacies in Canada to get the drug.
"My initial experience with physicians who are supposed to be experts in
the field was disappointing," Rich said. "So I concluded I can do things
better than they can."
Even for psychiatrists, patients say, the practice of prescribing
psychotropic drugs is often hit and miss. New drugs for depression,
anxiety and other problems proliferate. Stimulants like Adderall are
frequently prescribed "as needed." Research has found that
antidepressants affect different patients differently, so many try
several drugs before finding one that helps. And in many cases, getting
doctors to prescribe antidepressants, sleeping pills or other
psychiatric medications is far from difficult, patients say.
The result is a surplus of half-empty pill bottles that provides a
storehouse for those who wish to play pharmacist for their friends.
The rules of the CrazyBoards Web site prohibit participants from openly
offering or soliciting pharmaceuticals. But it is standard practice for
people who visit the site to complain, tongue-in-cheek, that they simply
"don't know what to do" with their leftovers.
The rest takes place by private e-mail. Sometimes, the person requesting
the drugs already has a prescription, but because the medications are so
expensive, receiving them free from other people has its merits.
A Post-Hurricane Care Package
Dan Todd, marooned in Covington, La., after Hurricane Katrina, said he
would be forever grateful to a woman in New Hampshire who organized a
donation drive for him among the site's regular participants.
Within two days of posting a message saying that he had run out of his
medications, he received several care packages of assorted mood
stabilizers and anti-anxiety drugs, including Wellbutrin, Klonopin,
Trileptal, Cymbalta and Neurontin.
"I had to drive down to meet the FedEx driver because his truck couldn't
get past the trees on part of the main highway," said Mr. Todd, 58. "I
had tears in my eyes when I got those packages."
It doesn't always work out so well. When Katherine took a Xanax to ease
her anxiety before a gynecologist appointment, she found that she could
not keep her eyes open. She had traded a friend for the blue oval pill
and she had no idea what the dosage was.
An Adderall given to her by another friend, she said, "did weird things
to me." And Mr. Tylutki, who took the Ritalin she offered one weekend
last fall, began a downward spiral soon after.
"I completely regretted and felt really guilty about it," Katherine
said.
Taking Katherine's pills with him when he returned to Minneapolis, Mr.
Tylutki took several a day while pursuing a nursing degree and working
full time. Like many other students, he found Ritalin a useful study
aid. One night, he read a book, lay down to sleep, wrote the paper in
his head, got up, wrote it down, and received an A-minus.
But he also began using cocaine and drinking too much alcohol. A few
months ago, Mr. Tylutki took a break from school. He flushed the Ritalin
down the toilet and stopped taking all drugs, including the Prozac that
he had asked a doctor for when he began feeling down.
"I kind of made it seem like I needed it," Mr. Tylutki said, referring
to what he told the doctor. "Now I think I was just lacking sleep."
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