Rx Addiction: One Family's 7,000 Pills

Feb 1, 2013
Prescription drug abuse comes with a large price tag. Learn more about one mother's worries about the impact of addiction on families.

Last weekend at the grocery store, I was scanning magazine covers while I waited in line to check out. That’s when I saw this headline on the cover of People magazine – “Deadly Pills: A National Epidemic” – accompanied by a picture of a little girl next to her mother’s grave.

I had to buy the magazine and read the story. As a member of the dedicated Express Scripts Fraud, Waste & Abuse team, I often have a front-row seat to cases of prescription-drug fraud and the impact it can have on families. Through our proactive data analytics, we routinely identify and investigate cases of potential fraud and abuse. Being on the front lines of the fight against the national epidemic of prescription-drug abuse makes me feel like I am making a difference.

Member fraud in ES investigations

But it can be tough. The cases, statistics and studies I see every day increase the worry that I am sure every parent feels for their children.

Prescription-drug overdose deaths surpass those from cocaine and heroin combined. And yet, a University of Michigan study about narcotic misuse indicated that a majority of parents do not consider prescription-drug abuse a major threat. In fact, only 38% of black parents, 26% of Hispanic parents and 13% of white parents were strongly concerned.

One Case: Nearly 7,000 Pills in Eight Months

A recent case of potential abuse I worked on is a good reason why I am one of those strongly concerned parents. The case involved a husband and wife who both demonstrated obvious addictive behavior. Over the course of eight months, they had more than 166 combined pharmacy claims, more than 120 of which were for controlled substances.

The wife had obtained 2,839 tablets from eight physicians and five different pharmacies, while the husband had visited nine physicians and 12 pharmacies and obtained nearly 4,000 tablets, including oxycodone, Endocet and hydrocodone. Upon contacting several of the physicians we found that in several instances, the couple had signed agreements that prohibited obtaining narcotics from other doctors. However, none of the physicians was aware of the couple’s visits to the others.
Narcotics play an important role in helping injured and sick people manage their condition and return to having a full life. But they also have the potential of serious harm and addiction. This potential is why many states have Prescription Drug Monitoring Programs and an FDA advisory panel is recommending tougher restrictions on hydrocodone.

The obviously addictive behavior demonstrated by the couple, and its impact on healthcare costs, is a cause for concern: the combined prescription costs were more than $3,700, meaning the potential impact in medical claims accumulated by the couple to obtain those drugs is nearly $150,000. (See our infographic about the medical multiplier.)

However, as a wife and mother, there are other things that worry me.

Someone with a substance abuse problem relies on their spouse or partner to guide them and help them get the treatment they need. Who would help the couple in this case since they both had a potential addiction issue? I hoped they didn’t have any children who would be impacted by any legal action or need for rehabilitation.

I take heart from the thought that our identifying the problem may have helped put the family on the track to recovery. It is what keeps me going and why I love what I do. Watching for potential red flags is second nature to me, both in my professional life and my personal life, and I hope that more people will consider the seriousness of the challenge and be more vigilant.

What To Do If You Suspect Prescription Drug Abuse

I would like to share a few signs of abuse you can learn to watch for:

  • Fake injuries: People seeking pain medications will sometimes fake injuries
  • Drastic changes in behavior or personality, depression, reduced social activities
  • Mood swings: Either extreme alertness or lethargy, or manic behavior
  • Excessive amounts of pill bottles in their personal belongings
  • Stealing: Someone addicted to prescription drugs may resort to stealing money or expensive items to sell
  • Visiting multiple doctors: Addicts will often visit various prescribers, including emergency rooms, to obtain prescription drugs

If you suspect someone you know of misusing or abusing prescription drugs, report it.

Author Bio

Ann Luecking
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