The news of the arrest of former vice-president Al Gore’s son highlights a drug problem that has largely remained below the threshold of a major national concern. That is, abuse of prescription drugs in America. Most notably, these include Vicodin ®, Lortab®, Xanax®, Valium®, Oxycontin®, and Darvocet®. Several of these were found in the possession of Al Gore, III after being stopped for speeding in California.

As statistics from the National Institute on Drug Abuse report, this is a demon that has been visited on families of all types; wealthy, poor, white, black, north, south, rural or urban. There is no particular pattern except to note that the problem is worsening in exponential fashion. “The numbers of persons using prescription pain relievers nonmedically for the first time increased from 600,000 in 1990 to more than 2 million in 2001,” according to the National Survey on Drug Use and Health. The survey reports further that by 2002 the number rose to 4.7 million! (NSDUH) Data from more recent years indicates little deviation from the established curve.

This statistic is consistent with my personal experience over the past thirty years as an ER physician. My medical career began in western Illinois in 1980. In the early days of my practice the over-use or abuse of prescription drugs was relatively uncommon, so-much-so that my colleagues and I would inform each other each time we encountered a patient who seemed to like a particular controlled substance a little too much; a heads up warning to the others, so to speak.

The drugs of abuse in those days were Valium®, Tylenol with Codeine® and a variety of diet pills. But, still, it didn’t seem an overwhelming problem, and most of us were able to care for our patients with little concern about “drug seekers.” They were an occasional annoyance but they didn’t affect the way we practiced medicine.

Since the early nineties the incidence of prescription drug abuse and the concomitant abuse of emergency rooms for the purpose of obtaining drugs has reached new highs year after year. So now, unless the patient has an obvious injury or has objective signs of distress we approach the situation cautiously with a slightly jaundiced eye, waiting for that first clue that this is an attempt to procure drugs for illicit use. Only when we are certain that the patient has a legitimate problem and is not seeking drugs can we let down our guard and begin to interact with the patient in the proper manner of physician and patient.

Heroin, crystal meth, cocaine and crack remain leading drugs of abuse and make daily headlines but they also remain slightly beyond the reach of many youth. Not so with prescription drugs that can easily be obtained with a visit to the family doctor or ER with complaints of headache, back pain or insomnia. Further, controlled substances are often stolen from parents, grand parents, other relatives and friends. They can be bought on the street with their lunch money. Abuse of these drugs has reached levels far beyond what was seen only a few years ago, with no sign of abating. The toll these drugs take on individuals and families is incalculable, but can be witnessed in every ER and out-patient clinic. At this rate today’s youth might some day come to be known as “Generation Rx.”

Dr. Hatcher is a practicing physician and university professor living in Indianapolis, Indiana.

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