Under a Rainbow of Drugs

I lived for a while in Brooklyn Heights across the East River and Lower Hudson Bay from Staten Island. I rarely looked at SI and never had a desire to visit, although I frequently reflected on the beauty of the Staten Island Ferry, still free to ride, passing in plain view of my window.

Staten Island is considered the forgotten borough in New York City, perhaps because it’s cut off from the mainland, has little in terms of cultural attractions and can’t keep up with the other boroughs in its display of trendiness. But this borough of almost 500,000 residents has gained some notoriety in its addiction to heroin and prescription pills. According to “The Antidote,” an article by Jan Frazier in The New Yorker (September 8, 2014), “In 2012, thirty-six people on Staten Island overdosed on heroin and thirty-seven on prescription opioid pills, for an average of almost exactly one overdose every five days.”

The New Yorker article, which is mainly about the Narcan nasal-spray antidote to overdoses, also traces the beginnings of the Staten Island opioid problem. In the borough, more people work in health-care than any other industry. Frazier notes that “Health-care workers often know about and have access to pills, and their insurance generally pays for them.” Staten Island seems to have a disproportionate number of police officers, firefighters, and sanitation workers, who likely would be more prone to injury. Getting pills legally is very easy in this borough. In 2012, doctors and hospitals “on Staten Island prescribed painkillers at a rate about twice that of the rest of the city.”

I was in a therapy room after hand surgery in a Manhattan hospital, telling the therapist that the recovery had been uneventful. And I didn’t need any of the oxycodone tablets the doctor prescribed. She joked that I could always sell them. I remembered from the New Yorker article that the asking price for oxycodone on the streets was about $50 a pill. I joked that there was probably a demand right outside the window on Central Park’s Upper East Side. I did the math in my head.

My experience is that doctors are generally too generous with opiates and often prescribe them without much conversation with the patient. After the hand surgery, I was given a prescription for fifty oxycodone/acetaminophen pills with a maximum daily dose of ten tablets. That seemed like a lot of pain-killing during a potential five-day period, especially when I consumed none.

A year earlier, for a more painful sinus operation, I was given thirty oxycodone/acetaminophen tablets with a maximum daily dose of six tablets. In retrospect, that seems like a considerable difference in the two prescriptions of the same strength. I have enormous respect for both doctors but received no cautions about these pills regarding possible liver problems, addiction, and drug interactions. I guess Google is everyone’s default. Neither doctor asked me about my tolerance for pain or history with the medication. Neither asked me if I even wanted the pills. In one instance, I didn’t recognize the name of the doctor on the prescription.

Later, I asked both doctors about the prescription and specifically about the number of pills. The answers were similar and somewhat predictable. The number of pills prescribed was based on reports from previous patients on what it took to lower the pain threshold to an acceptable level. Average as I was, I fit comfortably into a well-defined mean. There was no pharmaceutical salesperson in sight.

In 2012, New York State passed a law requiring most prescribers of pain pills to check the state’s Prescription Monitoring Program, aimed at people who go to multiple doctors for additional prescriptions. Early results suggest that the amount of illegal opiates on the market had declined. The bad news is that the consumption of heroin has increased.

New York Attorney General Eric Schneiderman just announced the arrest of a practical nurse for allegedly stealing three oxycodone tablets from a disabled person in Ulster County and replacing them with a generic form of the Claritin allergy pill. The A.G. wrote that “The allegations in this case serve as a strong reminder of the dangerous and addictive qualities of opioid medicines and why they must be closely monitored.” We could use this gentleman down state.

One of the first magazine articles I wrote decades ago was about the growing use of Valium and Librium, the hot drugs of the day, as if they were candy. It was titled, “Under a Rainbow of Drugs.” America has been living blissfully in this prescription territory for some time.

The New Yorker article, brimming with utility, was a reminder that my family should place our trove of opiates in a plastic bag and drop it off at the local sheriff’s office during Operation Medicine Cabinet without any consideration of street value for these eighty untouched, pure oxycodone pills, an unremarkable testament to my stoicism and restraint.