Look at it This Way: Some Aspects of the Drug Mix-Up Problem among Black, Poor, Aged, and Female Patients Elizabeth F. Johnson, JD Washington, DC
Black, poor, aged, and female patients are more susceptible to having to face problems ofloneliness and stress, feelings offailure, sagging egos, and other psychological and emotional difficulties. Relief of these feelings is often found through artificial supports such as over-the-counter drugs. Because of the easy accessibility of such drugs as sleeping pills, weight control pills, and vitamins, an individual could have a bottle of almost any drug medication advertised in the media without physician supervision. Ignorance of the cumulative impact of mixing medications often leads to habit-forming results and significant side effects. A major step toward prevention of drug abuse is to know that someone cares and will reach out to patients before the problem drives them to seek relief from over-the-counter medications and drugs. A second major step is education about the hazards of mixing medicines without physician supervision. A curious, but misguided, notion abounds that any medication (and this word is used interchangeably with the word drugs) obtainable without a prescription is completely safe. This misconception has figured in the current sale boom of a wide range of drugs such as pain killers, sleeping pills, and tranquilizers, all of them potentially dangerous. These drugs are being bought and consumed as casually as peanuts. But of greater concem is the innocent mixing of drugs and the potentially habit-forming results. Certain medications often make us
Dr. Johnson is Deputy Director, Division of Consumer Education and Awareness, US Consumer Product Safety Commission, Washington, DC. Requests for reprints should be addressed to Dr. Elizabeth F. Johnson, 4529 St. George Ave, Baltimore, MD 21212.
forget our pressures, and often relieve us of stress. They enable us to "cope," oftentimes helping us to temporarily escape reality. On the other hand, we sometimes conclude that the mere fact of a prescribed drug means that all risk is eliminated. That, too, is a misguided notion.
An Example of the Drug Mix-Up Problem Recently, I visited a friend whose husband had left her for a younger, more attractive woman. He had told my friend that he had "outgrown" her. It appeared to be the end of a 31-year marriage. Mary and Ben had married when they were both 18 years old. Each was the oldest of large one-parent families
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 10, 1978
and getting married was a way of being relieved of the responsibilities of being the oldest. Mary encouraged Ben to go to college and work part time. She would work full time and forego college until after Ben got his degree. Working full time and later mothering a set of twins and a third child left Mary little energy to go to college, but Ben went on to complete his undergraduate degree and eventually acquire the master's degree. At 49, in the midst of menopause, Mary was a lonely deserted female. The children were grown and lived in other cities near their jobs. Mary's income was very limited because she had no real skills. Hence, she had to change her living habits since she had to depend on her income to survive. Her's was not an outgoing personality, although she was very warm and friendly. She had few friends. As we sat chatting, I noticed a row of medicine bottles on the counter in the kitchen. "Do you actually take all those medicines at one time?" I asked. To which she replied, "Sure, but they're harmless." She had: * cold tablets for a cold she could not seem to get rid of, * aspirin for frequent headaches (advertised on television), * sleeping pills (advertised on television) to use when she had difficulty sleeping-and that was often, * daily vitamin pills (advertised on television), * pills "to relax her nerves" given her by a friend, and * diet pills for loss of weight 745
What was my friend facing? (1) Loneliness, (2) loss of a spouse during the "change-of-life," (3) approaching the age of 50, (4) feelings of inadequacy, (5) pressure on the job, (6) inability to be competitive on the job because of lack of academic qualifications and racial discrimination, (7) sagging ego, (8) lack of a satisfying concept of self, (9) stress, (10) fat and overweight (due to overeating because of frustration), (11) feeling miserable due to a lingering cold, and (12) lack of pep and energy. She seemed to be drowning her problems in pills, none of which were prescribed by a doctor. Mary was mixing medicines. It never occurred to her that when different drugs meet inside the human body, they can touch off some unusual reactions. Mixing drugs without a physician's advice can produce unexpected and dangerous side effects or it can set off puzzling or misleading symptoms. Mary was so engrossed in being her own physician that she just didn't stop to consider two things: (1) drugs and medicines mean the same thing; and (2) when taking drugs-headache remedies, cold medicines, sleeping pills, and other nonpremedicines-consideration scription must be given to their cumulative impact. When added to the accumulation of drugs within her system, the cocktail or two before dinner "to relax her" just increased an already existing danger. "Go to the doctor and discuss your problems with him or her," I suggested. "He won't do any more than prescribe what I have now," she said. "Besides, I really can't afford to waste money like that." Blacks, the poor, and the aged have feelings, needs, and goals-like others. They, too, seek a certain quality of life. Many times, they never come close to achieving what, for them, is a thing called happiness and satisfaction about who and what they are. Reaction from certain over-thecounter drugs will often help one to escape the reality of failure-if only for a moment!
Some Major Considerations In past generations, black families generally stayed in one place and looked out for each other. Communities were smaller and more stable and blacks had a sense of identity in relation to people and places around 746
them. There was a sense of belonging. Growing old did not mean loneliness because the family made a place for the elderly in the home. One never had to face a problem alone because there was always someone who cared and someone with whom to share your problem. Black families were strong families, generally held together by a strong grandmother. Today's black and poor are by comparison "rootless." An elderly person, especially, often faces loneliness because the family appears uncaring. He is left to a life that is impersonal and anonymous. The turnover in the communities means no one knows anyone else, but worst of all, nobody cares. A tranquilizer (a drug) for nerves -whether prescription or nonprescription-offers him an escape from that feeling of loneliness and depression. Elderly blacks seldom have sufficient funds to seek proper medical advice. They frequently diagnose their own physical problems and decide that they are minor. They are vulnerable to slick Madison Avenue advertising that a pill or a drug which can be purchased without a doctor's prescription will give relief in a short time. This is especially true of drugs advertised to give relief to the pains of arthritis. And if one receives even the minimal relief, the taking of the drug soon becomes habit-forming. Growing up has never been easy for blacks. In many instances, the passage from childhood to maturity is hazardous and stormy. In today's complex society, it is difficult for the 16 to 18year-old to find and keep a job. If he or she doesn't complete senior high school, the teenager is severely handicapped in finding employment. If you are poor, black, and a teenager who can't find a job, it is easy to convince yourself that you will never achieve. Drugs, whether aspirin and coke or over-the-counter, offer a simple escape from a life that is already irrational. The results of experimenting with alcohol and drugs often counteract the feeling of failure. It becomes easy to succumb to the peer pressure for using any drug that will help alleviate the feeling of failure. Tension. Stress. Anxiety. Depression. Any one of these will keep you from sleeping. But you must get some sleep. You have to go to work. You can't afford to miss any time because you need the job. "Take a sleeping
pill," you say to yourself. "One sleeping pill won't hurt." But you can't sleep the next night, or the next, or the next. The sleeping pill by the bed gets you through each night. That's how drug dependency begins. The widespread access to sleeping pills and "mind relaxers" (without medical supervision) makes many blacks and poor vulnerable to drug abuse as they struggle to survive and to find a method of coping. The inability to read labels with understanding continues to create problems for persons with limited education, especially the elderly. Many times the warning information is written in language that is above the average consumer's level of comprehension. Better written warnings are necessary because physicians often fail to warn patients or patients misunderstand or forget the warnings. The issue of patient labelling on medicines is being explored by the Food and Drug Administration. It is important to know and understand, for example, the consequences of drug interaction with foods and alcohol. Being poor means you frequently must depend upon Medicaid and Medicare. Many doctors do not give these patients very much time. Often the average office visit between a medical assistance patient and some doctors is less than 20 minutes. Many such patients are rushed out of the doctor's office clutching a prescription that merely reads, "Take as directed." What directions? The patient was in the office such a short time that they hardly heard any directions. This means the patient must make assumptions about what he or she thought the doctor said. Patients must protect themselves against possible drug reactions and interactions. When a patient is given a prescription, he/she should get complete answers to these questions from the doctor: 1. What is my diagnosis and how did you arrive at it? 2. What is the name of the drug prescribed and what is it supposed to do to help me get well? 3. Are there any foods, drinks, or other medications to avoid? 4. What specific instructions should I follow when taking the medication? 5. Are there any potential side effects? 6. Does the medication require modification of diet or activity? It is the doctor's responsibility to provide sim-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 10, 1978
ple and clear explanations. Women are probably the most medicated of all Americans. Tranquilizers are prescribed for women, particularly those over 35, at almost twice the rate of men. This is because women frequently complain of having bad "nerves," or they try to maintain their youth through pills. Most women have the natural desire to preserve their youth. They want to lessen the symptoms of aging and to treat the unpleasant symptoms of menopause. Hot flashes can be both embarrassing and uncomfortable. Menopause can be, and often is, the cause of some of the emotional problems women experience. To seek relief is a natural desire. The relief often comes from a pill that contains a drug called estrogen, a drug which has the effect of making women feel better, younger, and happier. "Feeling better" is, of course, subjective. The fact is that if you imagine that the pill makes you feel happier and younger, it is not difficult for it to become habit-forming. Many women have found that to stop taking estrogen was so traumatic that they had to go back on the "pill." A large percentage of women past menopause take estrogen as a matter of
CALORIES' 100
course. Currently however, the use of estrogen is under study because of the potential side effects, such as cancer and heart disease. Often physicians are pressured by patients to prescribe medication for the slightest ailment. Many patients are convinced that they do not get their money's worth unless they can leave the physician's office clutching a prescription. Pressure from regular patients for a prescription when none is really necessary can be intense. Often a family physician will prescribe a mild drug to appease his patient for fear that the patient will go and find another doctor who will prescribe a drug. Time pressure is another influential factor because it takes less time to write a prescription than to explain why no medicine is necessary.
Conclusion Out of ignorance and/or the desire to obtain relief from some physical, emotional, or psychological discomfort, we create drug mix-up problems for ourselves. Ten years ago, most discussions about drug problems centered only on
the drugs themselves, their composition, their physiological and psychological effects, their control, and their availability. Today, we must use the humanistic approach to understanding the drug mix-up problem among population groups. It is important to understand their basic needs and what the failure to meet those needs will create. We need to understand feelings, culture, and aspirations. We need to understand coping patterns and/or the lack of coping abilities. Many can live with reality because they know there is someone who cares and will help them through the days ahead. Others are alone, and there is no illness worse than loneliness. Look at it this way. Drug mix-up problems and drug dependency problems can be prevented, in many instances, by helping people work out their problems without turning to artificial supports and experiences. People can help people best if they learn to relate effectively, interact compassionately and honestly, and draw strength from relationships they build with each other. The first step toward drug abuse prevention is a rather simple step. It is the hand of one who cares reaching out to touch another.
Alcohol by itself supplies calories with virtually -no. vitamins. Eventually, too lqor with l-:ittle or no ntk ~~~~~~~~~~~~~Muc f vitamis''in the diet results in Vitamin
deficiencies, particularly thoseofthe
igh-potency vammincomple.x With
PARKEDAVI PARKE, DAVIS & COMPANY
Detrot, Ml 48232
PD-JA2355,-A-P(1-78)
Black, poor, aged, and female patients are more susceptible to having to face problems ofloneliness and stress, feelings offailure, sagging egos, and other psychological and emotional difficulties. Relief of these feelings is often found through artificial supports such as over-the-counter drugs. Because of the easy accessibility of such drugs as sleeping pills, weight control pills, and vitamins, an individual could have a bottle of almost any drug medication advertised in the media without physician supervision. Ignorance of the cumulative impact of mixing medications often leads to habit-forming results and significant side effects. A major step toward prevention of drug abuse is to know that someone cares and will reach out to patients before the problem drives them to seek relief from over-the-counter medications and drugs. A second major step is education about the hazards of mixing medicines without physician supervision. A curious, but misguided, notion abounds that any medication (and this word is used interchangeably with the word drugs) obtainable without a prescription is completely safe. This misconception has figured in the current sale boom of a wide range of drugs such as pain killers, sleeping pills, and tranquilizers, all of them potentially dangerous. These drugs are being bought and consumed as casually as peanuts. But of greater concem is the innocent mixing of drugs and the potentially habit-forming results. Certain medications often make us
Dr. Johnson is Deputy Director, Division of Consumer Education and Awareness, US Consumer Product Safety Commission, Washington, DC. Requests for reprints should be addressed to Dr. Elizabeth F. Johnson, 4529 St. George Ave, Baltimore, MD 21212.
forget our pressures, and often relieve us of stress. They enable us to "cope," oftentimes helping us to temporarily escape reality. On the other hand, we sometimes conclude that the mere fact of a prescribed drug means that all risk is eliminated. That, too, is a misguided notion.
An Example of the Drug Mix-Up Problem Recently, I visited a friend whose husband had left her for a younger, more attractive woman. He had told my friend that he had "outgrown" her. It appeared to be the end of a 31-year marriage. Mary and Ben had married when they were both 18 years old. Each was the oldest of large one-parent families
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 10, 1978
and getting married was a way of being relieved of the responsibilities of being the oldest. Mary encouraged Ben to go to college and work part time. She would work full time and forego college until after Ben got his degree. Working full time and later mothering a set of twins and a third child left Mary little energy to go to college, but Ben went on to complete his undergraduate degree and eventually acquire the master's degree. At 49, in the midst of menopause, Mary was a lonely deserted female. The children were grown and lived in other cities near their jobs. Mary's income was very limited because she had no real skills. Hence, she had to change her living habits since she had to depend on her income to survive. Her's was not an outgoing personality, although she was very warm and friendly. She had few friends. As we sat chatting, I noticed a row of medicine bottles on the counter in the kitchen. "Do you actually take all those medicines at one time?" I asked. To which she replied, "Sure, but they're harmless." She had: * cold tablets for a cold she could not seem to get rid of, * aspirin for frequent headaches (advertised on television), * sleeping pills (advertised on television) to use when she had difficulty sleeping-and that was often, * daily vitamin pills (advertised on television), * pills "to relax her nerves" given her by a friend, and * diet pills for loss of weight 745
What was my friend facing? (1) Loneliness, (2) loss of a spouse during the "change-of-life," (3) approaching the age of 50, (4) feelings of inadequacy, (5) pressure on the job, (6) inability to be competitive on the job because of lack of academic qualifications and racial discrimination, (7) sagging ego, (8) lack of a satisfying concept of self, (9) stress, (10) fat and overweight (due to overeating because of frustration), (11) feeling miserable due to a lingering cold, and (12) lack of pep and energy. She seemed to be drowning her problems in pills, none of which were prescribed by a doctor. Mary was mixing medicines. It never occurred to her that when different drugs meet inside the human body, they can touch off some unusual reactions. Mixing drugs without a physician's advice can produce unexpected and dangerous side effects or it can set off puzzling or misleading symptoms. Mary was so engrossed in being her own physician that she just didn't stop to consider two things: (1) drugs and medicines mean the same thing; and (2) when taking drugs-headache remedies, cold medicines, sleeping pills, and other nonpremedicines-consideration scription must be given to their cumulative impact. When added to the accumulation of drugs within her system, the cocktail or two before dinner "to relax her" just increased an already existing danger. "Go to the doctor and discuss your problems with him or her," I suggested. "He won't do any more than prescribe what I have now," she said. "Besides, I really can't afford to waste money like that." Blacks, the poor, and the aged have feelings, needs, and goals-like others. They, too, seek a certain quality of life. Many times, they never come close to achieving what, for them, is a thing called happiness and satisfaction about who and what they are. Reaction from certain over-thecounter drugs will often help one to escape the reality of failure-if only for a moment!
Some Major Considerations In past generations, black families generally stayed in one place and looked out for each other. Communities were smaller and more stable and blacks had a sense of identity in relation to people and places around 746
them. There was a sense of belonging. Growing old did not mean loneliness because the family made a place for the elderly in the home. One never had to face a problem alone because there was always someone who cared and someone with whom to share your problem. Black families were strong families, generally held together by a strong grandmother. Today's black and poor are by comparison "rootless." An elderly person, especially, often faces loneliness because the family appears uncaring. He is left to a life that is impersonal and anonymous. The turnover in the communities means no one knows anyone else, but worst of all, nobody cares. A tranquilizer (a drug) for nerves -whether prescription or nonprescription-offers him an escape from that feeling of loneliness and depression. Elderly blacks seldom have sufficient funds to seek proper medical advice. They frequently diagnose their own physical problems and decide that they are minor. They are vulnerable to slick Madison Avenue advertising that a pill or a drug which can be purchased without a doctor's prescription will give relief in a short time. This is especially true of drugs advertised to give relief to the pains of arthritis. And if one receives even the minimal relief, the taking of the drug soon becomes habit-forming. Growing up has never been easy for blacks. In many instances, the passage from childhood to maturity is hazardous and stormy. In today's complex society, it is difficult for the 16 to 18year-old to find and keep a job. If he or she doesn't complete senior high school, the teenager is severely handicapped in finding employment. If you are poor, black, and a teenager who can't find a job, it is easy to convince yourself that you will never achieve. Drugs, whether aspirin and coke or over-the-counter, offer a simple escape from a life that is already irrational. The results of experimenting with alcohol and drugs often counteract the feeling of failure. It becomes easy to succumb to the peer pressure for using any drug that will help alleviate the feeling of failure. Tension. Stress. Anxiety. Depression. Any one of these will keep you from sleeping. But you must get some sleep. You have to go to work. You can't afford to miss any time because you need the job. "Take a sleeping
pill," you say to yourself. "One sleeping pill won't hurt." But you can't sleep the next night, or the next, or the next. The sleeping pill by the bed gets you through each night. That's how drug dependency begins. The widespread access to sleeping pills and "mind relaxers" (without medical supervision) makes many blacks and poor vulnerable to drug abuse as they struggle to survive and to find a method of coping. The inability to read labels with understanding continues to create problems for persons with limited education, especially the elderly. Many times the warning information is written in language that is above the average consumer's level of comprehension. Better written warnings are necessary because physicians often fail to warn patients or patients misunderstand or forget the warnings. The issue of patient labelling on medicines is being explored by the Food and Drug Administration. It is important to know and understand, for example, the consequences of drug interaction with foods and alcohol. Being poor means you frequently must depend upon Medicaid and Medicare. Many doctors do not give these patients very much time. Often the average office visit between a medical assistance patient and some doctors is less than 20 minutes. Many such patients are rushed out of the doctor's office clutching a prescription that merely reads, "Take as directed." What directions? The patient was in the office such a short time that they hardly heard any directions. This means the patient must make assumptions about what he or she thought the doctor said. Patients must protect themselves against possible drug reactions and interactions. When a patient is given a prescription, he/she should get complete answers to these questions from the doctor: 1. What is my diagnosis and how did you arrive at it? 2. What is the name of the drug prescribed and what is it supposed to do to help me get well? 3. Are there any foods, drinks, or other medications to avoid? 4. What specific instructions should I follow when taking the medication? 5. Are there any potential side effects? 6. Does the medication require modification of diet or activity? It is the doctor's responsibility to provide sim-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 10, 1978
ple and clear explanations. Women are probably the most medicated of all Americans. Tranquilizers are prescribed for women, particularly those over 35, at almost twice the rate of men. This is because women frequently complain of having bad "nerves," or they try to maintain their youth through pills. Most women have the natural desire to preserve their youth. They want to lessen the symptoms of aging and to treat the unpleasant symptoms of menopause. Hot flashes can be both embarrassing and uncomfortable. Menopause can be, and often is, the cause of some of the emotional problems women experience. To seek relief is a natural desire. The relief often comes from a pill that contains a drug called estrogen, a drug which has the effect of making women feel better, younger, and happier. "Feeling better" is, of course, subjective. The fact is that if you imagine that the pill makes you feel happier and younger, it is not difficult for it to become habit-forming. Many women have found that to stop taking estrogen was so traumatic that they had to go back on the "pill." A large percentage of women past menopause take estrogen as a matter of
CALORIES' 100
course. Currently however, the use of estrogen is under study because of the potential side effects, such as cancer and heart disease. Often physicians are pressured by patients to prescribe medication for the slightest ailment. Many patients are convinced that they do not get their money's worth unless they can leave the physician's office clutching a prescription. Pressure from regular patients for a prescription when none is really necessary can be intense. Often a family physician will prescribe a mild drug to appease his patient for fear that the patient will go and find another doctor who will prescribe a drug. Time pressure is another influential factor because it takes less time to write a prescription than to explain why no medicine is necessary.
Conclusion Out of ignorance and/or the desire to obtain relief from some physical, emotional, or psychological discomfort, we create drug mix-up problems for ourselves. Ten years ago, most discussions about drug problems centered only on
the drugs themselves, their composition, their physiological and psychological effects, their control, and their availability. Today, we must use the humanistic approach to understanding the drug mix-up problem among population groups. It is important to understand their basic needs and what the failure to meet those needs will create. We need to understand feelings, culture, and aspirations. We need to understand coping patterns and/or the lack of coping abilities. Many can live with reality because they know there is someone who cares and will help them through the days ahead. Others are alone, and there is no illness worse than loneliness. Look at it this way. Drug mix-up problems and drug dependency problems can be prevented, in many instances, by helping people work out their problems without turning to artificial supports and experiences. People can help people best if they learn to relate effectively, interact compassionately and honestly, and draw strength from relationships they build with each other. The first step toward drug abuse prevention is a rather simple step. It is the hand of one who cares reaching out to touch another.
Alcohol by itself supplies calories with virtually -no. vitamins. Eventually, too lqor with l-:ittle or no ntk ~~~~~~~~~~~~~Muc f vitamis''in the diet results in Vitamin
deficiencies, particularly thoseofthe
igh-potency vammincomple.x With
PARKEDAVI PARKE, DAVIS & COMPANY
Detrot, Ml 48232
PD-JA2355,-A-P(1-78)
