There’s a Little Yellow Pill

And though she’s not really ill, there’s a little yellow pill.

She goes running for the shelter of her mother’s little helper…

The Rolling Stones

That little yellow pill in the classic Stones hit was Valium, a benzodiazepine. Other “benzos”include Ativan, Klonopin, Librium and Xanax. Benzos are commonly prescribed for anxiety, depression and insomnia. The side effects range from headaches and dizziness to confusion, aggression and memory impairment. But what’s really scary is the list of withdrawal symptoms, among which are ANXIETY, DEPRESSION and INSOMNIA, the very conditions the pills were supposed to treat! I once watched someone I loved trying to come off of Klonopin, which had been prescribed to treat his depression, and the crippling depression that resulted nearly killed him.

We are a prescription nation. If it’s broke, there’s a pill that can fix it. If it ain’t broke, fix it anyway. And the pandemic has led to a vast increase in substance use as people seek to relieve stress, isolation and boredom. In the U.S. over 4.5 billion prescriptions were filled in 2020. More and more people are seeking relief from pain, be it psychic or physical, which brings us to the opiate epidemic. The number one prescribed drug in the U.S. is hydrocodone, a powerful and highly addictive opioid (opioids are synthetically manufactured opiates) which is widely abused. This abuse often leads to overdose and sometimes death. Death from drug overdoses soared last year to 93,000, up nearly 30% from 2019. Another culprit in this deadly epidemic is the opioid fentanyl. It is more and more common for dealers to lace other drugs like marijuana and cocaine with fentanyl. This creates a much more powerful dependence upon the “original” drug of choice, and the users have no idea what they’re actually addicted to…until it’s too late. Even a minute amount of fentanyl can halt breathing in an instant.

I’m in recovery and for me personally, total abstinence is what works. But as a recovery coach, I embrace multiple pathways of healing. Harm reduction is one of them. I work with someone (remember Lexi from my previous posts?) who was addicted to intravenous cocaine. She’s been clean for months but has an occasional glass of wine. Alcohol was not her drug of choice and it doesn’t seem to lead her back to her primary addiction. But here’s where it gets tricky. Let’s say a guy kicked heroin but wants to smoke a little weed from time to time. When that benign, harmless and now legal joint contains even trace amounts of an opioid, he’s screwed. Craving the high that the doctored weed gives him, he might resort back to heroin, or overdose on the fentanyl he doesn’t even know he’s ingesting.

Many people begin taking opioids “as prescribed” for a painful medical condition or a surgery. But while the pain is initially dulled, so is the realization that the pain is lessening. And if you’re trying to “stay ahead of the pain” you can very quickly find yourself needing the drug just to feel “normal”. And then needing more. And more. The source of the pain is now the lack of the drug. You’re addicted.

My friend Allison was prescribed OxyContin after back surgery. When she found herself craving more than the doctor would prescribe, she resorted to the internet and ordered pills from Canada. Turns out that when a controlled substance is shipped across a border…it’s drug trafficking. While her 18 month sentence was suspended, she spent 30 days in jail and was on house arrest for 2 years, unable to leave the state. She now has a criminal record for a felony conviction.

The pharmaceutical industry rapidly develops and markets new drugs to treat mental illness, yet the rate of mental illness continues to skyrocket. A study into why doctors over-prescribe showed reasons ranging from fear of malpractice to attractive incentives from the drug companies to this, quoted from a recent study: “The appeal of writing a prescription outweighs the time and effort required to explain why it is not needed.” It is also difficult for doctors to “deprescribe”, or take patients off medication. And consumer advertising reinforces…or creates…the belief that there’s something out there that will make us feel better. While the addiction crisis rages, we are self-diagnosing ourselves and finding doctors who’ll give us whatever we think will solve whatever we think is wrong with us. As a friend of mine says “If you go into a broom store, you’re going to come out with a broom”.

You don’t need to be a rocket scientist to realize that Big Pharma is all about maximizing profits. In addition to the over six billion spent in consumer advertising last year, drug companies spent over TWENTY billion marketing to doctors. Incentives like free samples, lavish meals and other perks from sales reps, “informational conferences” and sponsorships are all common practices. And payback’s a bitch.

I went to the emergency room a few months ago with a broken foot and the doctor started to write me a prescription for pain. I told him it wasn’t that bad and he suggested I have it filled “just in case”. When I told him I was in recovery and didn’t take narcotics he offered to prescribe a 600 milligram NSAID. “It’s like taking 3 Motrin” he explained. When I asked him why I wouldn’t I just take 3 Motrin he replied “some people really like the yellow bottle.”