AMERICA'S AFFAIR WITH PRESCRIPTION DRUGS

The biggest killer drugs in the States right now are legal and have been prescribed. Here's how easy it is to score and to get hooked .

Kate Spicer


I went to my appointment with “Dr C’ Los Angeles with a shopping list of the most commonly abused types of drug: pain relievers, tranquillisers, stimulants and sedatives. Beforehand, a local addiction specialist, Bernadine Fried, had briefed me on how to approach your doctor like an addict and still come away with fistfuls of pills.

The script went like this: “Say, ‘I just went to my first NA meeting, I’m struggling with my addiction. I’m super anxious, but I also have these pain issues from an old injury.’” Fried stops to think. “Right, what do we have there? He should have given you an opiate [painkiller], Xanax [benzodiazepine tranquilliser, a new-generation Valium] and maybe an antidepressant. Now we just need a stimulant, such as Adderall, and a sleeping pill. Say, ‘I’m having a hard time focusing and my work is so important to me and it’s all that’s keeping me going at this difficult time.’ Oh, and then say, ‘I can’t sleep.’”

The appointment with Dr C, a psychiatrist on Wilshire Boulevard in Beverly Hills, costs about £230, but if I had health insurance, that would cover the fee. I go in and act normal, apart from jiggling my foot around (to denote anxiety) and staring out of the window (to suggest a poor attention span). Dr C asks if I am depressed. “No,” I say. “Are you sure?” he says. I forget to talk about the painful old injury, but towards the end of the appointment, he asks, “Any pain?” That’s my invitation to the highly addictive opiate party.

An hour later, I’ve paid £110 to a nearby pharmacist and my handbag is rattling like a maraca. I’ve been prescribed two Adderall a day, Klonopin (another new-generation Valium) to take “as required, when anxious”, and sleeping pills. The next morning, I take a quarter of the prescribed dose of Adderall. I focus better, but I’m buzzing. I chain-smoke — at 8am — and I’ve lost my appetite. As highs go, it definitely isn’t fun, and the drug has made me feel anxious. I take another quarter after lunch.

Within a few hours, I decide to have half a dose of the Klonopin, to take the edge off my tooth-gnashing, rubbish-talking, Adderalled personality. Then I go for a drink, but after one glass of wine I’m grappling to control myself. Messy is the technical term. Yet I am still legal to drive. I go home and take a sleeping pill. I watch television and through the sludgy fog I get tunnel vision. Famished, I eat a big bag of crisps and pass out. In the morning, I feel thick-headed and slow. An Adderall will sort that out...

Prescription-drug abuse is widespread in the States. Plenty of recent high-profile deaths have been linked to prescription drugs: Corey Haim, Brittany Murphy, Casey Johnson, Michael Jackson, Heath Ledger, Chris Penn, Anna Nicole Smith, Kevyn Aucoin. When Britney Spears was rushed to hospital after a public meltdown in January 2008, reports said she had taken more than 100 prescription pills and washed them down with a “purple monster”: vodka, Nyquil (an over-the-counter flu remedy) and Red Bull. Her condition owed little to illegal drug use.

America is in the grip of what emergency doctors describe as an epidemic. The National Institute of Drug Abuse has watched the use of all illicit drugs and cigarettes drop steadily over the past five years, while prescription and over-the-counter drug abuse has risen. Oxycontin, the brand name of the strongest opiate on the market, has been called hillbilly heroin because of its abuse among the working classes, but Courtney Love, Winona Ryder and, ironically, the right-wing, antidrug shock jock Rush Limbaugh have had well-publicised problems with the drug. Then there is Adderall, and the new-generation “benzos”, such as Klonopin and Xanax. Adderall’s name crops up around fashionable thinness; when the size-zero debate first flared, it was rumoured to be a significant agent to that alarming skin’n’bone’n’suntan Hollywood look. “Adderall is really a treatment for ADHD, but it’s handed out like candy,” Fried says. “Its abuse usually indicates eating disorders.”

Amanda de Cadenet, the British one-time It girl, hasn’t touched drugs in 15 years. She left London in 1992, and actually cleaned up in LA. “People say to me, ‘I don’t do drugs, either,’ and I’m like, ‘You do, you take Adderall, that’s speed.’ God,” she says, pausing, “the Adderall people — I can spot them a mile off: they’re really skinny, but their skin is flabby because they lose weight so fast.” She has held the hands of many young women messy from taking a combination of legal drugs. “The worst kind of insanity comes from mixing prescription drugs. It’s desperate. Why can’t people see? This is not normal.”

In America, if one doctor stops prescribing, start “doctor shopping” and make an appointment somewhere else. Or there’s the internet: some web-based chemists, notably those in Canada and India, are only loosely engaged in the traditional prescribing process. Fried despairs of the internet. “I was sitting yesterday with a patient who recently got sober. While we were in session, his phone rang. It was someone from India asking him if he needed his prescription filled. He says, ‘I’m in a sanatorium. I nearly died of drug addiction. There’s a guard in front of me.’ And the call-centre person goes, ‘Well, is there an address there where we can get them out to you?’”

In Britain, we tend to think of prescription drugs as a marginal problem, but a recent study, A Pill for Every Ill, by Professor Joan Busfield of Essex University, found that, since 1989, “the average number of prescriptions dispensed in the UK per person has doubled from eight a year to more than 16”. She adds: “Here, anti­depressants are overprescribed.”

In a short time, I found several people in the UK who had been prescribed similar combinations to Dr C’s disorientating cocktail, by NHS and private doctors alike. None of them were happy about it. One, a PR, told me: “I went to work and was completely out of it. It was as if I had taken speed: jaw gurning, mouth indescribably dry, pupils huge. I was useless and intoxicated for a week. I nearly lost my job.” “Doctor shopping” is not unheard of in Britain, though it might cost.

Dr Reef Karim, associate director of the UCLA Addiction Medicine Clinic, says legal drugs are “super-accessible, shared and, with a doctor’s signature, they’re seen as okay, even kind of fun. So you get ‘pharming’ at parties, where everyone puts their pills in a bowl, which is passed around, you pick some up and, hey, who knows?” He says young doctors spend much of their twenties in training and go into their profession heavily in debt and naive — and ripe for manipulation. “As a doctor, you have to be street smart or patients will take you for a ride. Most doctors are not bad, but they’re being sidelined by the consumer marketing around drugs. We used to be the gatekeepers of knowledge. Now patients go into the doctor’s office saying, ‘I’ve had a skiing accident, I need Vicodin,’ or, ‘I’ve got ADHD, I need Adderall.’ What once doctors recognised as obvious drug-seeking behaviour is not as clear now. Patients have too much information about what symptoms to talk about.”

Karim never believes what patients say. “You can see their disappointment when I say, ‘And by the way, I am not giving you Adderall.’ These drugs are used by a fast-paced, instant-gratification society that doesn’t want to do things the long way, the right way. We’ve had the age of the speakeasy, cocaine, ecstasy — we like to be altered. Right now, pills are the flavour of the month. It’s not right, but this time it’s not illegal.”