How About Taking Responsibility For the Medications You Take

Ruth Marcus seems oblivious to the fact that sedating medications, including Ambien, are frequently abused.

[Kerry] Kennedy may have taken the pill by mistake, they contended, but she ought to have known she was impaired and pulled over.

Excuse me, but maybe they should have tried taking this drug before filing criminal charges. Ambien and other sleeping pills are powerful. You take Ambien, and 15 to 30 minutes later, you begin to zonk out. A toxicologist who testified at Kennedy’s trial — for the prosecution, no less — said that someone under the influence of Ambien could fail to recognize that she was having a problem, or even to remember, later, what happened.

I think we can infer from Marcus's statement that she has taken Ambien, and thus knows how sedating it is. What Marcus probably has not seen is what happens when somebody takes Ambien and deliberately stays awake. The superficial affect is one of significant alcohol intoxication. Why do some people do that? Just as with abuse of common benzodiazepines, ecause they like the way it makes them feel, and some of them use other drugs or alcohol at the same time so that they can enjoy a magnifying effect.

Ambien may be something of an extreme case, given how quickly the sleepiness can come on, but how far would Marcus extend her "Let's assume it was an accident" rationale to other sleep aids? She draws a distinction between "medications with drowsiness as a side effect, [and] the ones whose sole purpose is sedation", but why? Many people take Benadryl to sleep, and sometimes pharmacists recommend it as a non-prescription sleep aid. Many people take opiate and opioid medications for pain, but they can be highly sedating and are commonly abused.

Marcus seems to feel that nobody who drives down a road after taking Ambien should ever face a criminal charge for driving while impaired by drugs, even if they injure or kill somebody. I have no problem working from the perspective that if you are too drugged to drive you shouldn't get behind the wheel, even if you took the wrong medication by accident. When somebody is intoxicated behind the wheel, I don't mind putting the impetus on that person to convince me both that it was a mistake and that they had no reasonable opportunity to recognize the mistake so as to get off the road. Kerry Kennedy was able to convince a jury that she took Ambien by accident, and didn't recognize its effect in time to safely stop her car. Marcus thinks that's too high a price for Kennedy and other Ambien users to pay, but it's not as if either of them are unaware of the dangers of that drug. They are both certainly aware of this case:

U.S. Rep. Patrick Kennedy said Friday that he will enter a rehabilitation program after crashing his car on Capitol Hill a day earlier....

He said in a statement Thursday evening that he was apparently disoriented at the time of the crash after taking the prescribed amounts of a sleep aid and an anti-nausea drug.

"I am deeply concerned about my reaction to the medication and my lack of knowledge of the accident that evening. But I do know enough to know that I need to seek expert help," he said Friday....

In his Thursday evening statement, Kennedy said he had returned home after final votes in the House of Representatives around midnight Wednesday and taken the sleep aid Ambien and an anti-nausea drug....

In his comments Friday, Kennedy said, "The recurrence of an addiction problem can be triggered by things that happen in every day life, such as taking a common treatment for a stomach flu.

Assuming she takes Ambien, Marcus, I expect, is very careful with Ambien due to the stories she recounts, including one that put one of her own children in danger. How many stories do we need, and how close to home do they have to hit, before we can reasonably expect people to look at their pills and read their pill bottles before swallowing a sleeping pill then getting behind the wheel of a car?

I won't argue with Marcus that manufacturers could create pill colors and shapes, or package sleep aids in a different manner, and thereby all-but-eliminate the "I was confused" defense. Perhaps at that point Marcus would accept that people intoxicated by Ambien should be subject to prosecution for driving in that condition. But for now, if people have multiple, similar-looking medications, they owe it to themselves and others not to confuse their pills. If people who have serious health conditions requiring them to juggle dozens of medications can keep their pills straight, I think it's reasonable to ask that people with minor medical conditions and two or three prescriptions to do the same, more so when incidents of carelessness will pose serious risk to themselves and others.

Tough Words To Say....

Our society makes it really hard to admit, but the excuses? Come on. A judge in disciplinary proceedings for being intoxicated on the bench explains,

during the alleged drunken appearances, he was taking the painkiller Vicodin for back and knee injuries from a car accident; an anti-inflammatory medicine; Ambien for sleep apnea; and medication for diabetes and high blood pressure.

Let's get one thing straight. You don't take Ambien (or any other sleep medication) for sleep apnea. You take it to help you sleep if you are having trouble with a CPAP or BiPAP machine, the actual treatment for sleep apnea. After you take it you go to sleep. You do not take Ambien and then go to work unless you are either intending to go to sleep on the bench or you are an addict.

He admitted that he went on the bench on two occasions after taking Vicodin and consuming alcohol.

On Dec. 6, 2006, he took three or four Vicodins before a 9 a.m. session in Bridgewater, and at lunch that day had two to three glasses of Chardonnay.

When you're gulping down a triple or quadruple dose of Vicodin, with a substantial alcohol chaser, you're either being extremely foolish and reckless in the treatment of your physical pain or you've moved well hinto the territory of addiction.

Sasso said he knew he should not take his daily Vicodin dosage all at once but added that he generally needs a large dose because he is 6'3" and weighs 290 pounds.

More likely, because if you take three or four times your prescribed dose you build up a tolerance. If you are taking prescribed pain relievers and they're not helping, here's what you do: You go back to your doctor and say, "These aren't helping at the dose you prescribed. What do you recommend?"

Similarly, if you find yourself taking Ambien and not falling asleep, you go back to your doctor and say "These aren't helping me sleep. Can we try something else?" If you take Abmien and intentionally stay awake, it's unlikely that you're taking it for any purpose other than its intoxicating effects (which, as Patrick Kennedy (and the officer who investigated his accident) can tell you, are a lot like alcohol intoxication).

Let's draw a line here between addiction and dependence. If you take certain medications for a long enough period of time, including opiates, you develop a physical dependence on those medications. You may also develop a tolerance that requires an adjustment of your dose or a change of medication, and may be dependent to the point that you will suffer withdrawal if you suddenly stop taking your medications. That's not addiction. Where you transition from dependence to addiction is when your medications stop improving your ability to lead a normal life, and your focus shifts to clock-watching or drug-seeking. There's also a syndrome called pseudoaddiction, where somebody who is receiving inadequate pain relief may demonstrate obsessive or drug-seeking behaviors that resemble those of an addict, but those symptoms resolve when their pain is adequately treated. But if you're buying shoeboxes of drugs from your maid (in addition to taking the drugs you get from your doctor), or gulping down huge doses of opiate medication with alcohol, it's safe to assume that you're an addict.

The AA/NA model for addiction dictates that the very first step in recovery is admitting your powerlessness over your drug of choice. I'm fortunate enough not to have a history of addiction, but I can say this: When the Rush Limbaughs, Patrick Kennedys, and even lesser known people like Judge Sasso avoid making that direct, honest concession - when they insist that their addictions are somehow more elevated because they claim to have physical pain, or are somehow more pure because they're abusing prescription pharmaceuticals - they're lying to themselves and to anybody who listens to them.

It would be really nice to hear one of these high profile addicts discard all of the excuses and finger pointing and simply admit, even if prefaced with an explanation of how they became addicted, "I did it because I am an addict." (e.g., "Although I didn't seek out this disease, and had no experience with addiction before I received opiate medication for a back injury, I stole drugs from my charity because I am an addict.")

Addendum: To be clear, I believe that if high profile addicts are honest about their addiction, they will help diminish the stigma of addiction. While we sometimes pretend otherwise, addiction strikes at all levels of our society and, while the rich and powerful are often better able to cover for their addiction or avoid street drugs, nobody is immune.