Editor’s Note: The Times Record continues its series of reports on prescription drug abuse.
FORT SMITH — Prescription drug prosecutions are now more frequent than prosecutions for methamphetamine and marijuana in both Crawford and Sebastian counties, according to prosecutors.
"There’s always a flux. One comes in, one disappears; another comes in, one disappears. But right now that would be the No. 1 issue with regard to narcotics," said Sebastian County Prosecutor Dan Shue. "And in my perspective, they’re (prescription drugs) every bit as dangerous, and maybe more dangerous (than illicit drugs) because it’s like there’s almost a social acceptance because ‘it was prescribed.’"
Crawford County Prosecutor Marc McCune said the danger of prescription drugs is also magnified because "pills are so easy to get" whether someone is doctor shopping or, in the case of juveniles, taking them from their parents’ or grandparents’ medicine cabinets.
McCune said youths who take drugs prescribed for someone else will still rationalize they’re not as bad as illicit drugs because they were prescribed by a doctor.
Minors in the juvenile system who abuse prescription drugs almost always get them from a relative, said Shue and Erin Mata, Crawford County juvenile intake officer.
From minors in the juvenile system, Shue said, it’s common to learn a parent was prescribed a month supply of painkillers — more than they needed — and after the parent put the drugs away and forgot them, the juvenile took them.
Mata said it’s also not unusual for young people to steal prescription drugs from the medicine cabinet of a friend’s parents or grandparents, and she’s aware of a case where a juvenile stole a prescription pad from a parent who was a physician.
While juveniles primarily rely on a secondary market — stealing them or purchasing them from a friend or acquaintance — for prescription drugs, McCune said, adults usually only resort to the secondary market after they can’t get them anymore from a physician.
Deputy Prosecutor Aaron Jennen, the prosecutor’s representative on the Sebastian County Drug Court team, said it’s common for prescription drug addicts to get hooked after they were initially prescribed for a legitimate purpose.
Once they’re hooked, addicts commonly engage in doctor shopping — obtaining multiple prescriptions from multiple doctors, while hiding that information from each physician. It can include visiting multiple emergency rooms, where an addict fakes or exaggerates symptoms to obtain prescriptions.
Dealers who supply the secondary or black market also will engage in doctor shopping, and sell drugs like OxyContin — which comes in doses from 10 mg to 80 mg — for $1 per milligram, Jennen said.
Whether addicts are purchasing through legitimate prescriptions or the secondary market, the cost often leads them to commit crimes to support their habit, said Jennen.
Although a methamphetamine addict and prescription addict who end up in the criminal justice system share common characteristics, in general their crimes differ.
Where prescription addicts primarily commit offenses like fraudulent use of a credit/debit card, theft of property — often checks or credit/debit cards from family or friends — and forgery by cashing a stolen check or attempting to get drugs from a pharmacy using a phony or altered prescription, methamphetamine addicts will more often move on to breaking and entering, burglary and robbery, said McCune and Jennen.
When addicts come into the criminal justice system in Crawford or Sebastian counties, they are likely facing three possibilities: probation, prison or drug court.
Users or addicts convicted of simple possession are rarely sentenced to prison unless they have a significant criminal history.
Jennen said the hope is imprisonment or probation will result in rehabilitation or at least deterrence, but the courtroom any Wednesday afternoon shows "it doesn’t always work."
For addicts who end up in the criminal justice system, drug court is the best option if they qualify for it, said Jennen.
Currently, prescription addicts make up about 75 percent of the 145 drug court participants in Sebastian County Drug Court, said Shirl Page, drug court coordinator.
When she was hired as coordinator in 2003, Page said, it was "meth, meth, meth" until a few years ago when prescription drugs became the majority drug of choice among drug court participants. McCune said the same trend is present in Crawford County Drug Court.
Page said it can be a significant challenge changing the prescription addicts’ mindset that what they’re doing is OK because the drugs were prescribed by a doctor.
"Just because a doctor prescribed it doesn’t mean you need it or it’s right for you," Page said.
The longer a person has abused prescription drugs, the more difficult it is to combat his or her rationalization, said Page.
Rationalization and cross-addiction
Rationalization is one form of manipulation all addicts use, but sometimes the denial is stronger in prescription drug abusers, who often fail in their attempts to maintain sobriety three or four times before they can stay clean, said Leanne Alexander, an Arkansas Department of Community Correction adviser and drug court counselor.
Rationalization can also lead to cross-addiction, where addicts will substitute another drug for their drug of choice when it’s no longer an option.
"One of the worst problems we have in Phase IV or (the yearlong) supervised aftercare is cross-addiction. If you have addictive thinking or an addictive personality, you’ll find something else," said Alexander.
Alexander said methamphetamine addicts are much more likely to become cross-addicted to prescription pills than a prescription addict is to become cross-addicted to methamphetamine. However, Alexander said it’s not uncommon for narcotic painkiller addicts to become cross-addicted to Tramadol.
Tramadol is a non-narcotic painkiller, and not considered a controlled substance under federal law, although Arkansas is one of 12 states that designates the drug a controlled substance, according to the Drug Enforcement Administration.
Tramadol is most commonly abused by narcotic addicts, chronic pain patients and health professionals, according to a DEA memo released in March.
Although state laws in Oklahoma and Arkansas limiting the availability of chemicals needed to manufacture methamphetamine have helped diminish its use, Shue said legislative and regulatory remedies are limited in combating prescription drug abuse.
Shue said from a prosecutor’s perspective, he really sees only two areas where he can be proactive on prescription abuse: juvenile courts and drug courts.
Sebastian County Juvenile Court Judge Mark Hewett said while he’s seeing an increase in prescription abuse in juvenile delinquency cases, he’s seeing a more significant increase in abuse among parents in dependency/neglect cases — which has risen significantly in recent years.
Hewett’s experience with parents in juvenile court is similar to that in criminal court — doctor shopping, hopping from emergency room to emergency room, and the "excuse I get all the time" that users get the drugs from the doctor, so it’s not so bad.
The judge recalled the specific rationalization of one mother who told him, "I’m only dependent, not addicted."
Hewett said unfortunately parental rights have to be terminated for some who ultimately can’t overcome their denial and addiction.
Next: Fighting abuse a passion for Fort Smith detective.