The Drug Seeker Threat in Disasters, by Dr. Bob

People in the general public have little to no idea just how bad the drug abuse of prescriptions medications is here in the US.  Our recent discussion with our church small group spurred us to write this review for your thoughtful review.  Some fun facts to start us off, courtesy of one of my reliable medical reference sites, UpToDate:
 
6.2 million Americans in 2008 admitted to non-medical use of prescription drugs, 2.5 % of the population.
The number of Americans who have abused prescription drugs exceeds those who have used cocaine, heroin, hallucinogens, ecstasy, and inhalants combined.
A 2005 survey of 50,000 US high school students found that while overall illicit drug use declined among adolescents over the prior decade, their non-medical use of prescription pain relievers and sedatives has increased.
Only marijuana use among illicit drugs (although becoming more “legal” everyday in some states) exceeds non-medical use of prescription drugs.
 
We start with those fun facts to shock you into reading further in addition to alerting you as to the depth and severity of the problem. WTSHTF, these 6 to 10 million seekers are going to be unhappy, withdrawing, and looking to score some pills.  They may be coming to your house, as 2.5% of the population is one out of 40 folks.  Most of us involved in primary care medicine would probably double that estimate, and in some areas of the country the rate will be much higher.  And this is just prescription medications, not to mention the illicit drug users that will become prescription seekers that will have to “make do” with pain pills or tranquilizers as a substitute for the drug that they are going without.
 
In our current, happy, open-pharmacy world, there are some risk factors that can identify those more likely to be abusing prescription medications, but there are many more folks abusing those drugs that don’t fit the profile at all.  Those found to be at increased likelihood of abusing prescription drugs include:
• Past or current substance abuse or addiction
• Use of controlled substances in non-prescribed doses and routes of administration
• Use of controlled substances for reasons other than indications for which they were prescribed
• Patients of younger age
• Patients who work in health care settings
 
From observational experience, drug abuse of prescription medications has certainly been on the rise since my initial start in the medical field 17 years ago.  It is one of the heartbreaking aspects of our day to day existence.  Almost every day in the clinics, urgent care facilities and ERs, all doctors and health professionals must deal with multiple drug seekers trying to get them to prescribe them a little “somethin’ somethin”.  These are first or second hand, real life excuses or behaviors that drug seekers have used in the ERs, Urgent Cares, and clinics to try to obtain drugs:
 
Death of a generic loved one (when they are not dead, Grandfathers the most common)
Death of a wife (usually a living wife, ex-wife, or common-law has no knowledge of their death)
Death of a child (particularly tough to resist urge to punch seeker in face, but hasn’t happened…yet)
Sexual assault
Domestic violence
Pricking finger with needle to put blood in urine sample (makes it look like kidney stone)
Using child’s pain to obtain meds (again, resolve fading…fist rising…must not punch)
Stealing dying relatives’ medications (Hospice patients, cancer patients especially.  One took the narcotic patch right off the dying relative for himself.)
 
These are just some of the more heinous examples above, the classic excuses are always still worth mentioning:  dog ate them, fell in toilet, fell in sink, fell in some wet area, fell in some dirty area, washed in the laundry, pharmacist is against me, wife/girlfriend/neighbor/mailman/etc is against me, lost it, was stolen, took too many because it wasn’t working, took too many because you are a terrible doctor and didn’t give me the medicine that works, another terrible doctor wouldn’t fill it because they are horrible and you are the greatest ever.  All of these are from personal examples.  All were confirmed to be fabrications.  90+ percent of these excuses are false, every time.  This is why it gets to be so heartbreaking.  It really takes your faith in humanity and grinds it up into bits.  And it’s getting worse.  Just yesterday from my writing of this, a gentleman told me that “it is your duty as a doctor to help people” when he was lying about his medication abuse.  They know the lines, and they use them.  It didn’t work by the way.
 
So, what to do in TEOTWAWKI.  Avoid.  Plain and simple.  Anyone on controlled substance meds should be weaned off immediately if they are in your group.  Off.  We will all have to figure out a way to live without them then, no time like the present.  Do NOT have any controlled substance medications in your possession.  If Ibuprofen and Acetaminophen don’t take the pain down, it will probably make you stronger.  Seriously, that is our advice.  The risk does not exceed the benefit in regard to these meds.  We don’t take them, we don’t have them…so why would we stock them?  Ask yourself the same question.
 
Okay, how do you spot the withdrawing seeker in a post-pharmacy world?  Withdrawal symptoms for the different medications are worth mentioning by category.  First, the pain medications.  Opiate withdrawal has the following classic symptoms:  in the hours after the last dose will come drug craving, anxiety, fear of withdrawal.  Then in a day to days will be:  anxiety, restlessness, insomnia, yawning, runny nose, watery eyes, sweating, stomach cramps, and small pupils.  In the days that follow to a week:  tremors, muscle spasms, vomiting, diarrhea, chills, goosebumps, and rapid heart beat.
 
Benzodiazepine withdrawal symptoms are similar, but different in some ways and timing:  rapid stopping of chronic benzo use can actually result in death.  Tremors, anxiety, hallucinations, negativity, psychosis and seizures can occur.  The scale and dependence of benzo use and abuse is truly staggering.  Many of these folks are your neighbors, relatives, and friends.  They have been taking Ativan, Xanax, Valium, Klonopin, Libruim, Tranxene, Restoril, Serax, ProSom, Dalmane, and Halcion for a long time now.  They are likely not abusing these drugs, but certainly are dependent and are not going to be happy and pleasant without these medications.  Anyone on more than 20 per month of these meds needs to wean down now and try to get off.  Again, Cognitive Behavioral Therapy (CBT) does work for people and is highly recommended.
 
Stimulant withdrawal, specifically cocaine and amphetamines, can show withdrawal symptoms in:  negativity, lack of pleasure in things, fatigue, sleepiness, vivid dreams, insomnia, agitation, anxiety, depression, suicidal thoughts and actions, drug craving, and hunger.  As a society, we also provide stimulants to people regularly for their ADD and ADHD diagnoses, and the symptoms of withdrawal will be very similar to those of the illicit stimulants above.  These stimulant-withdrawal symptoms usually peak by two days and then decrease within two weeks, but can be the most dramatic and therefore dangerous when loosed near you and yours.
 
Many of these withdrawal symptoms will also be experienced by many “non-addicts” who are unprepared for a disaster.  Isolating yourselves for the first few weeks after any major disaster is certainly the best policy.  By 14 days, almost all types of acute drug withdrawal have ended physically.   Seekers will be dangerous in those first days, but remember that most seekers have up to a month of medication that they have available before they run out, some dealers could have much more than that.  The first two months all of us will be at risk to encounter and possibly be harmed by the drug seeker.  I can’t emphasize enough how far people who are addicts will go to try to obtain even a small amount of their drug of choice or any type of substitute.  Many of these people will rob, lie, con, steal and kill for drugs if given the chance, so continue your vigilance.  But most importantly, heed our sound advice: To reduce your risk,  do not keep these medication stored on your property.

JWR Adds: Dr. Bob is is one of the few consulting physicians in the U.S. who prescribes antibiotics for disaster preparedness as part of his normal scope of practice. His web site is: SurvivingHealthy.com.

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