His life ended that day, and life as we knew it (also) ended that day. —Phil Bauer
The May 2004 morning that Pennsylvania residents Phil and Cookie Bauer will never forget began like so many others. It normally took everything and then some to get their 18-year-old son, Mark Bauer, out of bed in the morning. His mother, Cookie, would often resort to sprinkling water on her son's face just to get the athletic 5-foot-9 teenager up and moving.
This morning was different.
Phil was getting ready for work downstairs as usual when he heard his wife's screams. He raced upstairs where Cookie told him she could not wake their son.
"He was lying on his bed looking very peaceful," Phil Bauer said. "There was no pulse and he wasn't breathing. It was frankly quite an out-of-body experience. I can't describe what that feeling is like."
Phil began CPR on his son as Cookie called the police, who rushed over to take Mark to the hospital. Despite their efforts, Mark was pronounced dead.
"His life ended that day, and life as we knew it (also) ended that day," Phil Bauer said. "A week before his high-school graduation he never woke up."
In their son's room, the Bauers found a sandwich bag full of oxycodone and acetaminophen pills, both prescription drugs.
"I had no clue he was abusing this," Bauer said. "We learned the hard way."
Bauer now tours the country and lectures parents and kids about the dangers of abusing legal drugs. He is on the parent advisory board at The Partnership at Drugfree.org and is a national advocate for prescription drug safety. Unfortunately, what happened to the Bauer family is even more common today than it was eight years ago.
Studies have found that prescription painkillers and stimulants are becoming the nation's biggest drug problem. Reports indicate painkiller abuse is on the rise and that painkillers pose a bigger threat today than some illegal drugs like cocaine. The problem is now more deadly than car crashes, and 2,100 kids daily engage in the behavior for the first time, according to one expert. Recent legislation was introduced by Pennsylvania and Alaska senators to try and curtail the abuse of cough medicine among teens, but that addresses only one facet of a larger issue. Experts say it might be necessary to reexamine which drugs are legal and how easily they are prescribed and accessible to patients.
"We have a very laissez-faire attitude toward our medicines," said Steve Pasierb, CEO and president of The Partnership at Drugfree.org. "People often keep medicine in the kitchen next to the cereal, but everybody says 'it's not me.' This is a problem uniquely of our own making."
Recognition of a problem
A central concern for experts is that parents and people in general do not recognize prescription drug abuse as the pressing problem that it is.
"I find it amazing that parents still underestimate the dangers of these drugs when they're misused and abused," Bauer said. "Many parents have no point of reference because these drugs weren't around when they were growing up. This ain't your daddy's medicine."
Prescription drug abuse has been declared a true epidemic by the Center for Disease Control and Prevention, Pasierb said.
"The No. 1 cause of accidental death in America is prescription drug overdoes," Pasierb said. "It's really become the lead front of the drug issue in America. In eight years it has gone from a fringe behavior that was typified by one or two pain relievers to a broad consumer behavior and has really spun out of control in many different ways."
Much of the responsibility lies on the parents to become educated and safe with their medicine and to talk to their children about the potential hazards of these medicines, Bauer said.
"If parents don't get it, how can we expect kids to get it?" Bauer said. "Sometimes we need to shock parents. They need to wake up and realize that sometimes they are the drug dealers."
If a teen is prescribed a prescription such as Ritalin or even a sleep aid, the parents must monitor the use of the drug closely, said Leonard Paulozzi, a medical epidemiologist in the Division of Unintentional Injury Prevention of the National Center for Injury Prevention and Control and a Center for Disease Control expert on drug overdoses.
"Know how many pills are in the vial and make sure they take it on schedule," he said. "Don't get prescriptions and fill them just in case. Minimize the amount of drugs used in the home in the first place."
Doctors who over-prescribe patients with larger quantities than necessary is a central concern for experts like Pasierb. He described the ease of accessibility and relatively lax attitude about prescription medications as gateways to abuse.
"Someone who goes to the dentist for a tooth extraction might need two or three hydrocodone tablets to get them through the next 24 hours, but instead they go home with 30," Pasierb said. "Well you know where the other 27 go, on the shelf in the bathroom. So we still have prescribers putting a huge volume of these products into American homes."
Pasierb agrees that parents must recognize the dangers of leaving medicines unsecured as well as working to dispose of medications that are no longer needed.
"The one key word is responsibility," he said. "Parents need to safeguard their medicines by locking them up and educating their family about the risks."
In terms of laws regulating prescription drugs, most of the control is at the state level, Paulozzi said.
"There has been an explosion in legislation on state levels in recent years," he said. "These are intuitive approaches that make sense, but there is no quantitative evidence yet of what works."
Recent legislation was introduced by Sen. Bob Casey of Pennsylvania and Sen. Lisa Murkowski of Alaska aimed at stopping the abuse of prescription cough medicine. The legislation would prohibit the sale of over-the-counter cough medicines containing dextromethorphan to teens under 18. Despite this progress, more needs to be done, Pasierb said.
"Doctors need to make sure their patient understands exactly what the prescription is and that the patients gets the appropriate prescription in the appropriate quantity," Pasierb said. "It begins with prescribers and it begins with patients."
Prescription monitoring is something that has been implemented in states like Kentucky, but in many states it is not fully funded or implemented, Pasierb said. Prescription monitoring allows doctors to keep an accurate database of patients and their prescriptions so that patients can no longer "doctor shop" or go around to various doctors looking for more and more prescription drugs.
Most states now have laws against doctor shopping, but they are not enforced uniformly, according to the CDC. For-profit clinics that distribute controlled substances with minimal medical evaluation, often called "pill mills," have few state laws regulating their activity. According to the National Alliance for Model State Drug Laws and the CDC, only 15 states required or permitted pharmacists to request identification from persons obtaining controlled substances as of March 2009.
"There are states, such as Utah and North Carolina, that have shown some progress," Paulozzi said. "But I wouldn't want to declare victory prematurely. Mortality rates have risen steadily for a decade, and we still have millions of people who are physically dependent on these drugs."
The Drug Enforcement Administration is also drafting rules to provide easier access to drug disposal, according to the CDC. The official recommendation is to flush them down the toilet, Paulozzi said, but he also recommends removing the drug from packaging and mixing it with a substance such as kitty litter. The problem comes when people don't do anything at all and keep the drugs at home, he said.
The FDA recommends not flushing drugs down the toilet unless the information specifically instructs doing so. Otherwise, bring them to a drug take-back location or throw them in the household trash after mixing them in something undesirable and putting them in a sealable baggie or empty can or other container.
In support of medication disposal efforts, the DEA held national Prescription Drug Take-Back Events in 2010 and 2011. During the first two such events, approximately 309 tons of drugs were collected at more than 5,000 sites across the country.
Still, Pasierb said more education is not only crucial for patients, but also for doctors.
"Every three years there should be mandatory education for doctors," he said. "Older doctors need to be educated about the new trends."
Bauer agreed that many times doctors do not receive the proper training about addiction.
"We need physician education and we need to continue to watch how drugs are being manufactured and marketed," Bauer said.
Whether it is mandating physician and patient education or locking down prescription monitoring practices nationwide, solutions need to be implemented soon, Pasierb said.
"We make incremental progress where we could be make big gains," he said. "What we need here are urgent solutions. As we talk here today, someone is going to die from prescription drug abuse."
It will be a challenge for policy makers to change the current lax attitudes and expectations that most Americans have with regard to drug access, experts say.
"We have created a large cohort of individuals who are going to want to continue practices as usual," Paulozzi said. "The problem is not going to turn on a dime."
A different pain
Phil Bauer recalls how he and son Mark would play basketball together in the driveway. The games were very competitive and Bauer would often walk away with injuries such as a sprained ankle or broken finger. That pain, however, was welcome as it defined the close connection of father and son.
"I miss that pain so much," Bauer said. "Because that's how we touched each other when he was a teenager. That was our way of hugging I think."
The pain Bauer feels now is much different.