Reality+is+just+a+crutch+for+people+who+can't+handle+drugs

Student Number: N8865493 Tutor: Michelle Newcomb



==== The two Cultural Artefacts selected are a series of images reflecting the social norms which have come to be accepted over the last several decades and given rise to the latest epidemic in drug addiction and drug related death. The series depicts a conversation between a doctor and a patient in which the doctor dismisses the patient's concern about developing an addiction to a prescribed medication by reassuring her that if she takes it everyday to cover her symptoms she won't become addicted. This statement alone is fairly contradictory as addiction is synonymous with dependency. ====

====In 2010, one in 24 people in Australia aged 14 years and older (4.2%) had used pharmaceutical drugs for non-medical reasons in the past 12 months (Australian Institue of Health and Wellbeing, 2011). Addiction is defined as the state of being enslaved to a habit or practice or to do something that is psychologically or physically habit-forming, such as narcotics, despite adverse consequences (Benotsch, 2011). Drug addiction is considered a brain disease because drugs change the brain; they change its structure and how it functions (USA Government, 2012). These neurological changes can be long lasting and can lead to harmful, self-destructive behaviours. However, over the last two decades there has been a shift in the trend of drug addiction which has seen a growing epidemic in addiction to prescription drugs. Prescription drug addiction increases medical expenses, unemployment, and is a major contributor to increased drug related crime (Hall, P. 2010). ====

====Whilst illicit drug addiction has the ability to reach people from all walks of life, indiscriminate of race, socio-economic position, education, income or ethnicity, prescription drug addiction has the potential to penetrate a new market of possible addicts. Prescription drug abuse is not a new concept or something that has only recently become a significant public health issue, it is a problem that has been around since befor the Institution of the Harrison Narcotic Tax Act of 1914 (psychology.illinoisstate.edu). Prescription opioids, or narcotics, include morphine, hydrocodine, Vicodin, Lortab, oxycodone, hydromorphine, meperdine and propoxyphene, along with other related drugs (L, Righter et al. (2005). The prescriptions filled for opioids such as hydrocodone (Vicodin) and oxycodone increased by 376% and 380%, respectively, between 1992 and 2002 (L, Righter et al. 2005). When compared with an overall prescription increase of only 61% and a population growth of 12% in the U.S. during the same period, there is a clear trend for doctors to prescribe opioid drugs with much less caution. An example of the haphazard prescription of narcotic drugs is evident in the article The New Drug Crisis: Addiction By Prescription, in the TIME magazine, where a patient tells her story of addiction, "When my physician refused to prescribe me more pills, he sent me to a clinic. The doctor there didn't even ask me my name at first. He wrote me a prescription while he was on the phone dealing with some court case he was involved in. When you're well dressed and you have insurance, they don't think of you as an addict." (Jefferey, K. 2010). Another patient reported that after her doctor stop prescribing hydrocodone, she turned to illegal methods of obtaining the drug and reported that "In a pharmacy, I [she] paid $8 for 160 pills. On the street, I [she] was paying $25 each," (Jefferey, K. 2010). These two examples represent an enormous number of people who have fallen victim to an industry influenced by large pharmaceutical companies and a 'pill for everything' culture. ====

==== Between 1994 and 2001, the number of emergency department hospital admissions involving the same two opioids increased by 352% (oxycodone) and 131% (hydrocodone), a figure which has continued to increase over the last decade (L, Righter. et al. 2005). Evidence published by Hall in 2008 indicated that between 1999-2004, West Virginia experienced the nation's largest rise (550%) in unintentional prescription medication associated deaths. In Australia, in 2008, approximately 262 million prescriptions were dispensed through pharmaciese, an increase of 4% from 2007 (Australian Institute of Health and Welfare, 2011). This equates to approximately 12 prescriptions per person (Australian Institute of Health and Welfare, 2011). Although many of these prescriptions were cholesterol-lowering drugs, antibiotics or drugs to treat high blood pressure, prescription most commonly written by general practitioners were for the nervous system, including analgesics (pain killers) and antidepressants, accounting for one in five prescriptions (21.6%) (Australian Institute of Health and Welfare, 2011). The age group most likely to use pharmaceuticals for non-medical purposes in their lifetime were those aged between 20–29 (10.3%) and in the previous 12 months (5.6%). While those aged 40+ years were most likely to use pharmaceuticals for non-medical purposes daily or weekly (33.8%) (Australian Institute of Health and Welfare, 2011). According to the Australian Institute of Health and Welfare (2011), males and females are almost equal in terms of using pharmaceuticals for non-medical purposes in the last 12 months (females 4.1%, males 4.2%). However males were significantly more likely to use pharmaceuticals for non-medical purposes in their life time (females 6.9%, males 7.9%) (Australian Institute of Health and Welfare, 2011). Of those who had used pharmaceuticals for non-medical reasons in the past 12 months, three in five (59.2%) obtained them from a shop/retail outlet, (32.4%) from a 'Friend or acquaintance' and (30.1%) a 'prescription for a medical condition', these were the most commonly selected methods of supply for recent users or tranquillisers/sleeping pills (Australian Institute of Health and Welfare, 2011). ====

==== These statistics support that accessability of prescription drugs, an increased sharing culture and insufficiently monitored doctors are predominantely to blame for rise in use of prescription drugs for non-medical reasons. There have also been links associated between the prescription addiction epidemic over the last two decades and several reforms, policies and medical advancements made around the same period. In the U.S., in 2000, the new JCAHO (Joint Commission on the Accreditation of Healthcare Orginizations) policies went into effect which treated pain more proactively and took a new perspective on pain as not only a side effect of illness, but as a vital sign, along with heart rate, temperature, respiratory rate and blood pressure (Jefferey, K. 2010). These policies were vigorously advocated for, not only by doctors and patients, but by patient-advocacy groups, and most importantly, pharmaceutical companies, which were set to experience a significant increase in prescriptions written in lieu of the new policies (Jefferey, K. 2010). ====

CULTURAL AND SOCIAL ANALYSIS
====It is crucial that the culture surrounding prescription addiction is properly understood in order to attack the public health issue in the most effective way and ensure that prescription medication is only used for medical purposes in the future. There are four cultures of prescription drug addiction including, the sharing culture, the income-driven culture, the substance abuse culture and the addiction culture. ====

==== Although the sharing culture is not a particularly sinister culture, it is one that puts uneducated participants at huge risk of bad drug-drug interactions, drug-disease interactions, side effects or allergies by the users of these medications (M, O'Neill, et al. 2010). The sharing culture is characterised by the perception that prescription drugs are safe because they were prescribed by a medical professional and dispensed by a pharmacist, however, this activity is still illegal and a type of drug diversion (M, O'Neill, et al. 2010). Commonly shared prescription medications include opioids, antibiotics, allergy medications, antidepressants, and anxiolytics (M, O'Neill, et al. 2010). ====

==== The income driven culture has three subgroups, the first subgroup is maintained through prescription drug theft, prescription forgeries, doctor shopping, and illegal Internet acquisition of prescription drugs (M, O'Neill, et al. 2010). These are all methods, which are used, in the illegal acquisition of prescription dugs by patients or other individuals. The second subgroup is made up of those who are appropriately prescribed medications, but sell their prescription drugs for income. A third subgroup are the health care professionals who operate “pill mills” (M, O'Neill, et al. 2010). These operations are characterised by patients who must pay cash for their prescriptions and are required to return monthly to get a new prescription filled (M, O'Neill, et al. 2010). Medical documentation in these operations is often missing, inaccurate or fraudulent. Clients frequently travel hundreds of miles for a single visit. ====

==== The substance abuse culture can be divided into two major subgroups, experimenters and mood modifiers (M, O'Neill, et al. 2010). The intent of prescription drug abuse is to obtain an altered state of mood or behaviour. The experimenters try a prescription drug to evaluate their likes or dislikes of the drug's effects, experimentation is encouraged by peer pressure, and often there is little thought put into consideration of the potential dangers. If the experience produced is perceived as positive and leads to a more routine use of the prescription drug, the user may then be classified in the mood-modifying subculture. Peer pressure is evident in the teen trend known as "pharming" parties", which require participants to bring prescription medications from any source, usually the medicine cabinet, and empty the contents of the prescription bottle into a fish bowl or container (M, O'Neill, et al. 2010) . As part of that night's experimental experience, the participants are required to randomly take and ingest one to five pills from the container. The doses are intentionally increased beyond the recommended dosage to try to achieve these enhanced effects. This self-medicating often comes hand in hand with an eventual addiction to prescription drugs. ====

==== The addiction culture consists of drug addicts who are abusing daily to achieve their desired psychological effects and to prevent drug withdrawal (M, O'Neill, et al. 2010). The active addict's day is characterised by motives, feelings and behaviours that include drug craving, a continued compulsion to misuse, continued misuse in spite of known negative consequences such as self injury, injury to others and loss of control over their drug intake (M, O'Neill, et al. 2010). All forms of drug addiction effect society in a negative way in terms of the possible danger everyone is subject to as a result of criminal activity, which comes along with the selling and buying of drugs illegally. The analysis of the trends and cultures pertaining to drug addiction reveal that public health expert's resources would be best spent in education of the general population, a more vigorous investigation into the activities of health practitioners and in the rehabilitation of those who are already addicted. ====

==== The artefact presents to the viewer in a simplistic manner the reality of the careless fashion in which pharmaceutical drugs are sometimes prescribed by doctors, regardless of the potential risks of severe addiction and serious side affects. The images support the concept that prescription drug abuse is an issue that needs to be attacked at the route of the problem, being the doctors who over prescribe, and implementation of other forms of pain management need to be investigated and enforced. This would be more effective than a method which simply covers symptoms, and perhaps does more harm than good. This assessment opened my eyes to the fact that although regulations regarding more addictive opioid prescription drugs have been revised and that these drugs are more heavily controlled by appropriate authorities, prescription drug abuse is still a major problem and the number of prescriptions written continues to increase. I have realised the relevance and importance of drug abuse as a public health issue. It has become clearer to me that there is a vast scope of different cultures and communities which are affected by drug usage and abuse. Prescription drug abuse has negotiated it's way into a whole new market of potential addicts, many of which would be unlikely to become addicted to other illicit drugs. I now have a comprehensive view on addiction and a more compassionate and educated perspective which will allow me, in the future, to have a deeper understanding and empathy for drug addicts I know now, or may know in the future. ====

REFLECTION ONE
http://healthcultureandsociety2013.wikispaces.com/share/view/64711192

REFLECTION TWO
http://healthcultureandsociety2013.wikispaces.com/share/view/64711360

D, Holmes. (2012). Prescription drug addiction: the treatment challenges. The Lancet (British edition), 379 (9810), p.17.

L, Righter, et al. (2005). Non-medical use of prescription opiods among teenagers in the United States: Trends and correlates. Journal of Adolescent Health. Vol. 37, Issue 1, p 44-51.
M, O'Neill, et al. (2010). Understanding the cultures of prescription drug abuse, misuse, addiction, and diversion. // West Virginia medical journal //, 106 (4), p. 64.