Jill: We did a whole month and there’s still more to talk about. We did a whole month on opiates and for those of you who are listening and listened in on Paul’s story, who wrote his story about his journey through opiate addiction and how difficult it was. It took a huge toll on his life. And wonderfully, now he is clean, he’s doing well, he is continuing prescription drug prescription drug addiction prescription drug abuse treatment and he actually called me last week and this story that we told you over the air when we were talking to him that he was desperate to have his pain medicine, so he decided to go online and start ordering. And remember he said once he stopped ordering, all of a sudden they started to email him and say it’s time for your next 90 pills, and $400 a pop for 90 pills to be sent to him with like FedEx, and then he stopped getting the emails to him and they started calling him. They called him up to 4 or 5 times a day, triggering him each time they called. This online ordering, it’s not even a business – I don’t even want to call it that.

Now, the latest thing that happened last week, he found out his bank called him and they tried to debit the $400 from his account so they could automatically ship.

Brian: Without his authorization?

Jill: Yes, without his authorization.

Brian: That’s unconscionable.

Jill: Ladies and gentlemen, if you’re listening, never ever order online medication that are something like this that you can become dependent on because they know they have you for life if they do that, and if you do that.

Brian: That’s unscrupulous.

Jill: Yes it is, and I think that legislation has to come down the pipeline right now. It is getting so out of control. People are not only ordering the pain pills, and that 90-day prescription Brian, only would have lasted him 2 days because of the amount he was using. He was having to a lot more than just order online. He said he had 2 online companies going at the same time and he was able to do it.

Brian: If this is peaking an interest, give us a call here, 770-226-0920, or 1-888-920-2665.

Well, tell us something then. We’re looking here at these meds that are going on and that were being found . . .

Jill: Well let’s talk about what they are, first of all. Oxycontin, Vicadin, of course they’re pain medicines, and some people may be taking them, they just had knee surgery and it’s their best friend.

Brian: Keeping them comfortable.

Jill: That’s right. And Valium, Xanax, and Restoril are all in the Xanax family, and the Xanaxs are actually very well used medication when they’re under the care of a doctor or psychiatrist.

Brian: Those are things that are used to help people with anxiety, or maybe also to help them get some rest. I’ve heard that they’re used to help them sleep well.

Jill: Exactly. And they are what we call the anxiolytics, or the anti-anxiety medication. They’re also given to people if they can’t sleep, or they’re prone to panic attack. Then you have Unisom which you can go into a drugstore and buy right now, and antihistamines such as a Benadryl or Vistaril, yes they can kind of get you to calm down a little bit, but they don’t work specifically on the same sites as the Xanaxs would work or they would be prescription.

Anyways, those are the drugs. They found six separate medications. When he took these medications, it would be very, very difficult to say, but they probably had the numbers of, and they would be able to go back because of half-lives of these medications and know exactly when he took them.

Brian: And typically . . . oh, we’ve got a call here. Robbie in Atlanta. Welcome to the show, how can we help you today?

Robbie: Actually I had a couple of questions really. I listen to you guys every week and the guy whose struggle is ongoing with opiate problems and benzo problems, I’m just wondering how a conscientious doctor would prescribe these things and not know there was a possibility of major problems like that, because that comes from that.

Jill: And Robbie, that is a great question and something that really does need to be covered, because then people start to cast that eye at the doctor like what’s wrong with you? Let me just tell you in my experience as an internal medicine PA, I’ve had people come in and they have been on a pain medication from their orthopedist and the Xanax from the primary care physician, and never told each physician they were taking it because it didn’t seem important. Or they didn’t even think about it when they went in. So that’s a real common occurrence. A good doctor will continuously ask that medical history: what are you taking? But a lot of doctors don’t do urine tests, so can’t specify exactly what’s in their system.

Robbie: I see, okay. That answers my question. I just was kind of struggling with that. All of a sudden he turns up dead, it was very shocking to a lot of people I think.

Jill: It was, it was. And Robbie, I hope that you have continued success in your fight against these medications and how they can just get into your life and they are very difficult to bring under control.

Robbie: I’ve been struggling with this for a long time, and I still use them every single day. And to hear something like this with Heath Ledger, and it puts your life in perspective. I’m almost the same age as this guy and it just kind of begins to wake me up that I have this problem. It’s pretty sad that it takes the death of someone like that to do that, but it does sometimes.

Brian: Well Robbie, we appreciate your call. We’re coming to the break right now, and hope you continue to listen and if you have any other questions, give us a call back.

Robbie: Thanks a lot.

Brian: Alright. Well we’ll be right back in a few minutes. Stay with us and give us a call here at 770-226-0920. We’ll be right back.

Jill: Welcome back to the Breakthrough Addiction Recovery Hour. What a great song. I picked that out special for today because . . .

Brian: “When You Think You’re in Control”.

Jill: Yeah, “When You Think You’re in Control” you really do think you’re in control when you are taking these medications or using some of these drugs off label, where you’re not supposed to be using, and the drug is in control.

Brian: I love the way you say that, Jill, the drug is talking, as they say.

Jill: And what did you think about that call from Robbie? That was a great call.

Brian: Fantastic. Robbie, thanks again for that call. And you know, one of the things I’d like to share, thinking back off of that, is so many times people are only dealing with the symptoms – only the symptoms – so that feeling that anxiety, or they’re feeling the depression, or they’re feeling that emotional pain. You know one of the things that we talk about pain, especially like the opiates, where the more a person takes those pain killers or pain medications, instead of becoming less sensitive to the pain, you become more sensitive to the pain, both the emotional pain especially, and also the physical pain. So I like to really encourage people, if you are struggling with your drugs of choice or your drink of choice, it’s not usually because it’s just the alcohol pr the drugs, you’re struggling with something else. And we have a great program where we can help you address the underlying issues to help you really take a look at what is producing the anxiety, what is producing the depression? Is it life issues? Are you having a problem in dealing with communications? We see this happening a lot and this is the reason why we see people moving from the appropriate us of both alcohol and drugs to the addiction, where now they’re becoming more and more difficulty with their family, the law, their friends . . .

Jill: I just want to encourage people, if something is becoming a necessity for you in order to get through your day or to fall asleep at night, if these things are becoming a necessity then instead of just leaning heavily on these substances, have a physician or someone at a prescription drug prescription drug addiction prescription drug abuse treatment facility such as Breakthrough check you out because there could be underlying health issues that are happening too. There could be thyroid issues, there could be hypoglycemia, there could be a million different things that could be causing you to have to lean on these and when I listen to the Heath Ledger information, one of the friends of Heath Ledger would say things like, “He just struggled with getting to sleep, with getting enough sleep.” And then they blamed his last role in Batman in which he played the young Joker, and they said that role was so devastating to him because he became that kind of . . .

Brian: He wasn’t just playing the role, he actually felt he was absorbing the role . . .

Jill: Jack Nicholson said to him, be careful when you play this role. And so maybe it brought up nightmares, maybe it brought up things from his youth that he hadn’t dealt with, and he was having trouble with anxiety and not being able to sleep.

Brian: I’m so glad you bring that up Jill, because so many times, again . . . let me throw this number back out there . . . 770-226-0920. This is something I’m sure our listening audience needs to jump in here. Many times, you brought a thought back to me here, is that we have clients that come in and they may have had a severe history of addiction, physical addiction, emotional addiction, and they’re trying to numb the pain of that event by either using alcohol or using drugs. And we know that that really is a trigger, and for those who aren’t clear, a trigger is anything that causes you to want to either drink or drug. And so many times they’re past history of addiction can also be the thing they’re trying to bury and dump those feelings. So they’ve got to talk that one through.

Jill: Let’s talk a little bit more about, you know these are anti-anxiety medications and sleep aids, and he had a combination of that with the pain medications in his blood stream when he was tested, unfortunately.

Brian: I got a couple of questions for you. Want to handle those?

Jill: That’s why I’m here.

Brian: Alright. Jill, how can anti-anxiety drugs and sleep aids, or a combination of them, really become lethal?

Jill: One of the things that people don’t understand is that there are drugs that have different names but they actually act on the same type of function. Even if they’re acting in different sites of the brain, they can have an additive effect for one function and that is to depress the respiration. That’s why we call them depressants. So what happens is we add them all together, they have additive effect, and they start to depress the respiration and then all of these medications that were found in him, were centrally acting respiratory depressants and that could have an additive or synergistic effect when you take them.

Brian: Okay, so again, using these medications and not real clear about them, they can have this combination situation that could even make them more potent, more powerful.

Second one . . . so they can actually affect the breathing. You said something about it . . .

Jill: Yeah, the respiratory center.

Brian: The breathing.

Jill: Yeah, if you’re taking them in combination then they add together. Now that doesn’t mean you take one and then half-hour, then you take another one, and then an hour, well if you’re taking them all together or too close together, they can have an additive effect. And that can cause what we call respiratory arrest – that is the cessation of breathing. Then you have 6 minutes to try to resuscitate them and after 10 minutes usually, that’s when brain death is occurring and probably the heart will stop. Usually once the breathing stops, that causes the heart to go into fibrillation and it stops. You have a heart attack. You stop breathing, the heart will stop. That is respiratory arrest and cardiac arrest.

Brian: It looks like we have a call from Pamela in Atlanta. Welcome Pamela, to the Breakthrough Addiction Recovery Hour.

Pamela: Hi there.

Brian: Hey, how can we help you?

Pamela: You know, I heard you say something and I must have misheard you. You couldn’t possibly have said that. You must have said something different. You were talking about this one particular man who was taking these drugs that he was filling a prescription, a 90-day prescription, it cost him $400, and it only lasted him 2 days? He was taking 45 pills in one day?

Jill: Well, most of the people that come into prescription drug prescription drug addiction prescription drug abuse treatment for opiate addiction are taking at least 25-30 pills.

Pamela: How can they even do that?

Jill: Well, they’re taking handfuls 3-4 times a day, and sometimes . . . you know 3 times a day and then in the middle of the night also. Understanding how they become tolerant to these medications. But one of the wisest addictionologists told me once, no one knows where the ceiling of tolerance is. And once you take enough to depress your respiratory system, that’s it – you just don’t wake up.

Yes, it can be 2-3 days. If he was taking 30 pills a day, he could easily have those taken up in 3 days . . . easily.

Pamela: I thought for sure that I misheard. It’s impossible to swallow that many pills in one day. Actually it isn’t!

Jill: Exactly. It is shocking. There are people listening to me that understand exactly, are like, “Oh yeah, that’s about right.” And then there are people like you who are saying, “Oh come on, they’re only prescribed 1-2 every 6-8 hours, how can that be?”

So it’s all in the tolerance of the person. But unfortunately they could stop taking them, prescription pain pill detox off of them for a while and one of the things that happens, they relapse and they start back at that level and that is when we find the overdose, because they’re tolerance has changed. But Pamela, I hope that answers your question.

Pamela: It does. It’s baffling. It’s absolutely mind-blowing.

Jill: Yes it is.

Pamela: Well thank you very much.

Brian: Well you’re welcome, and thanks for calling.

Pamela: You bet. Bye.

Jill: And it looks like we’re coming down to the break, and Pamela, thank you for that call once again, and we’re going to continue talking about this deadly combination when we come back. Stay with us.

Jill: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Jill Mattingly . . .

Brian: And I’m Brian Fujii.

Jill: That’s right, and 770-226-0920. We’ve got a lot of people that are getting in on the conversation today, and if you have a question or a comment, or want to clarify something that we have said, please call us, 770-226-0920.

So Brain, Heath Ledger’s accidental overdose, we’re talking about the deadly combination.

Brian: And I’d like to ask, is there a threshold dose at which these drugs actually become deadly?

Jill: Right. The drugs like, if you’re just tuning in, were pain medications and Xanaxs or sleep aids, and actually you can’t really put a number on it. When you take these medications together, but it’s not like you just take 2, take an Oxycontin and Xanax, and then never wake up. But it would be harder to overdose with these particular drugs than with other classes, such as heroine. And also, if you add alcohol into the mix, it doesn’t take as many pills to cause an accidental overdose either because remember, alcohol is a depressant also.

Brian: Okay, well obviously this seems to be an easy thing to do, but how easy would it be to accidentally take too many.

Jill: Well, it’s probably really not too difficult at all because a lot of times people will take a medication . . . they got to get up in the morning, they’re stressed out, they just had an argument, they take one of these Xanaxs such as a Xanax or a Valium or something like that, and it doesn’t work right away. So they are getting more stressed and more anxious, and it hasn’t worked. It’s 15 minutes. I’m not sleepy. I’m going to take more.

Brian: So they get impatient.

Jill: Yeah, they’re impatient. But then again, sometimes a person doesn’t remember that they took . . . Oh, I took my Lortab just 30 minutes ago, and then I took my Xanax to calm down because I was in such pain, and then they’re so groggy from that combination that they get up and decide they need more of their Lortab or Oxycontin, and before you know it, they have taken way over the line of what they should have actually taken.

Brian: Of course too, you mentioned that they’re also taking alcohol together with this, and that could certainly impair their thinking process.

Jill: Well Ambien, Ambien is kind of a fake Xanax. Ambien, Lunesta, Sonata, all of those have a lot of the same traits that Xanaxs that are given as sleep aids, and I think who made something about Ambien famous was the congressman Patrick Kennedy got up in the middle of the night and drove to the Capitol and crashed into a barricade. When a field sobriety test was done on him, he said I hadn’t had anything but I took Ambien. And they now know that Ambien can cause an amnesia-type effect, almost to the place where you could get up and eat in the middle of the night, it’s called sleep-eating . . .

Brian: Sleep-eating. I’ve heard of sleep-walking, but sleep-eating.

Jill: And now we have sleep-voting because Patrick Kennedy thought he was supposed to be at the Capitol voting. So these combinations, once you take one, who knows how you’re memory is going to work. So yes, it would be easy to accidentally overdose and that’s why our voice is going out to the listening public. You may have these in your medicine cabinet and you don’t understand that if you are in an impaired state, there could be an accidental overdose that occurs because of these medications being in your home.

Brian: And again, you just need to help these family members to go back to those medicine cabinets, check those out. If there is anything in there that could possibly be addictiond by family members or friends, remove them.

Jill: Right.

Brian: Let me ask you this one. How quickly do they actually take effect?

Jill: Well, in most case, there are half-lives, and what’s the definition of half-life Brian?

Brian: Half-life is the time it takes for one half of the drug to get out of the body.

Jill: You are such a good student.

Brian: I’m such a good straight man.

Jill: There you go. So what happens is these medications have different half-lives, and they start to work at different times, so people will be taking these and not realizing on an empty stomach they may react faster or on a full stomach they react slower. So actually when they take affect really has to do with their metabolism and what they eat.

Brian: And muscle too. And how that actually stays in the body longer because some gets into the fatty tissues in the body, right?

Jill: Right. And Xanaxs are actually what they call lipo-filling, the metabolites will stay in the fat and that is why it’s hard to get clean from a Xanax if you do a urine drug screen within a couple of days. It usually takes 3-4 days for you to test clean. Also, the liver has to break down Xanaxs.

Brian: And if you’ve got problems with your liver . . .

Jill: Then the active metabolites could be there longer in your bloodstream and you’re putting one on top of another, not realizing it. So it’s very scary.

It looks like we’re coming to another break. And this is just flying by Brian. Let’s really try to get through a few more things when we come back. How’s that?

Brian: We sure will. Stay with us.

Brian: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Brian Fujii and . . .

Jill: I’m Jill Mattingly.

Brian: Alright. And we’ve been talking today about some deadly combinations. We’re having a great conversation here, we appreciate all the callers and today we’re going to be looking at again, these deadly combinations of the Heath Ledger death and especially how these medications, how they got into people’s bodies. In fact we do know that sometimes patients don’t always tell the doctors everything they’re on, and it’s so easy at times for these medications to have that deadly combo. I’m just wondering here Jill, how quickly would they be able to become lethal if these were taken in the wrong quantities.

Jill: Okay like if you took Xanaxs, Xanax, Valium, even Restoril along with the pain medications like he on, the Oxycontin, the Vicadin, there’s no way you can put your finger on, okay, here’s where it’s going to be lethal. It’s the situation we just talked about, they’re too groggy to remember what they’ve taken or they’re panicked and they keep taking it because they’re not getting the effect that they want, and basically they will get the effect if they take too many, they will fall asleep unfortunately, as in his case they won’t wake up. And it’s because of the depression of the respiratory center in the brain and once you stop breathing, and it’s not even that you stop breathing, you’re breathing becomes so slow that it almost, you’re body can’t even get the oomph to actually continue breathing. And once the oxygen stops going in, the heart will fibrillate and you go into cardiac arrest. So it’s very quick and unfortunately it’s extremely lethal. And a lot of people that are found with pills around them such as someone like Heath, didn’t mean to do this. I’m convinced he didn’t mean to. He had a lot to be here for.

Brian: Maybe some people are just joining in with us Jill, and we had this wonderful call, Robbie I believe, that had asked the question how does someone actually get prescribed that many kinds of medication. So again, 770-226-0920, if you’re outside the listening area, 1-888-920-2665. So how does a person who like we said, he probably didn’t do it intentionally and as result got all these different combinations of medications really pretty much of the same class, and yet he . . .

Jill: It’s exactly what was said to Robbie. A lot of people go to their primary care physician and they’re complaining of not being able to sleep and a lot of anxiety, however they forgot that a month ago they had their hip arthritis was flaring up, or they had a problem playing a sport or something and they were given Lortabs, or Vicadins, Oxycontins, and that was controlling their pain really well. That wasn’t on their mind. Their hip wasn’t on their mind.

Brian: There was no pain.

Jill: Right, and so they hadn’t taken it for awhile. So they go in, the doctor gives them Xanax or Klonopin or Valium, and decides let’s just do this for a couple of weeks.

They sleep great, they go out and play their sport again and hurt their hip, and then they’re taking both their pain medication and their anti-anxiety medication the next night. That’s a long and drawn out way to explain how this can happen, and it’s not something that we need to throw that glance at the physician and say, “How can you do this?”

And let’s just be honest, many people get their medications from friends and relatives too.

Brian: We see that a lot.

Jill: With no explanation of how to use these medications.

Brian: And they’re trying to be helpful so many times, “Well just let me borrow one. Let me be able to use one.” And that’s one of the things we have to again, caution. And we know we hear this a lot, but we still realize people say, “Well, it worked for me. Let me let you try one of mine.” And again, they’re not prescribed this medication.

Jill: And this is where it would be a good time for us to say, at Breakthrough Addiction Recovery we’re a prescription drug prescription drug addiction prescription drug abuse treatment facility, and we’re in Norcross, and we see people that are struggling with dependencies on these medications all the time, and part of our program is to help people prescription pain pill detox safely off of these medications and also bring in the prescription drug prescription drug addiction prescription drug abuse treatment . . .

Brian: That counseling component, the ability to understand how the brain really changes.

Jill: Right, and prescription drug prescription drug addiction prescription drug abuse treatment for the underlying reason that they’re depending on these medications in the first place. It is so crucial that there is no magic bullet to help you walk away from a dependency on these medications, especially Xanaxs.

Brian: I’m so glad you said that too Jill, because I know that I do prescription drug prescription drug addiction prescription drug abuse treatment each day, I hear people saying, “If I had known this earlier, I would be so much further along.”

And the fact that we actually see people learning how to make good decisions, just even recently and maybe having a crisis, maybe they had an accident, or maybe they lost a job, or maybe they’re struggling with a relationship. And while they’re in prescription drug prescription drug addiction prescription drug abuse treatment, while they’re in prescription drug prescription drug addiction prescription drug abuse treatment, and because they now learn how to cope, with more coping skills, they’re saying, “I could have chosen to get a drink or get high, but I’m choosing to be here. I’m choosing to go ahead and get that individual therapy or be in that group session.”

I’m telling you that is a significant and powerful move a person can make. When they make that decision.

Jill: There is more to just getting the medications so you can get by.

Brian: Right, you got to understand what’s causing it.

Brian: In fact, we got one right here, right now. Michelle from Decatur. Welcome to the Breakthrough Addiction Recovery Hour. How can we help you?

Michelle: Well, how you guys doing?

Brian: Fine, how are you?

Michelle: I am doing okay. I have a kind of different problem. I’m not addicted to any kind of illegal drug or anything, but I have a very stressful job, and lately I’ve just had trouble getting to sleep, so I started taking sleeping pills. And I don’t take the full pill, usually cut it in half and take half, but this is something that has started in the last couple of months and I’m kind of concerned that I don’t even know if I can get to sleep without them.

Jill: If you would like to share with us, can you tell us the name of the medication?

Michelle: Oh gosh, it’s an over-the-counter . . .

Jill: Okay, so it is an over-the-counter one? Okay so this is not a prescribed medication.

Michelle: No, no, no, no.

Jill: Okay, well one thing you can be assured of, this is not a Xanax which really creates a lot of dependency very quickly, and the over-the-counter ones usually are the things like more antihistamine-based like Tylenol PM or something else that is encouraging like, ‘This is going to help you sleep.’ And the one we mentioned was found in Heath Ledger was Unisom, which is a very common over-the-counter sleep aid.

What’s happening is, is that you are addressing the stress problem and the anxiety with the medication to slow thinking down, and get you relaxed. And that’s a very quick way to do it, other than a hammer to get you to fall asleep. But people, especially as we age, we really do have struggles getting to sleep. But let’s look at what are some other things you could do as a part of trying to get to sleep. And Brian . . .

Brian: I was just going to ask, do you do any exercising or any other type of stress relieving? Do you do any type of meditation or perhaps actually going out and doing something that’s really fun? Have you done any of those types of things to try to de-stress? I know that for example, exercise is one of the keys. If you can continue to have a good exercise regimen it really helps build up those natural endorphins in your brain, really make you feel more relaxed, also doing some form of thought-stopping when you really begin having that anxiety moment, stop yourself and say, ‘Hey how can I deal with this?’ Do some positive self-talk, even some good affirmations. Have you tried any of those type of things?

Michelle: I exercise on the weekends when I have time, but during the week it’s just kind of hard. I have school part time and I work full time, and so I just have a very packed schedule during the week and I just haven’t had time to go to the gym.

Jill: Well Michelle, sorry, you’re just not going to sleep for a while, okay? No, actually, this is unfortunately what the situation is in most people’s lives. Too many things going on and not enough time to actually do the things you know will help you, and let me just say this – in taking an over-the-counter medication, try to do this. I know you’re chopping them in half and that’s good, but try to do it like every other night and see if that works for you, or try not to do it on the weekend and really try to get that 30-minute walk, drinking lots of water, doing things non-stressful before bed, all of those things can help. But try not going toward the prescription drugs.

Brian: And you don’t have to really go over to the gym. You could do it right in your living room. Just walk in place. Anything to help.

Michelle: She just mentioned the water, drinking water. If I drink a lot of water I wind up waking up in the middle of the night.

Jill: Okay Michelle, you got me. Don’t drink the water. But you know, hydrating your body, sometimes when you’re dehydrated it can cause stress to the body also. But Michelle, we have another caller on the line and we’re going to take her call, and we wanted to thank you so much for calling in. Keep listening, okay?

Michelle: Okay, bye-bye.

Brian: Thanks for your call.

Jill: And it looks like we have Sandra in Atlanta. We got one minute Sandra, can you say it quick?

Sandra: Yeah, I hope so. I have diabetes, Crones, and I have severe narrowing of the spine. And then I take Ambien every night and my husband – I know I have been sleep-eating and I also have to take Phenergan for nausea, and I can’t get through the night, through the pain with all this, do I need to make a . . . plus I’m worried about taking . . .

Jill: Well Sandra, let me say this. I want to talk to you. We’re about to go to a hard break. So I’m going to get you on the line. I know exactly what the medications are you’re taking. Let me talk to you off the air, okay? Will you hold for us?

Sandra: Alright. Yeah.

Jill: Thank you so much Sandra, I’ll come right back to you.

Hey everyone, thank you for listening. Tune in next week. We’re going to continue talking about this issue a little bit more.

Brian: Oh I think is fantastic and we appreciate all the callers and we will look forward to next week. Join us.