Ed. Note: This is the second of a two-part series.

What started off as a disturbing trend in now being regarded by public health and law enforcement officials across the United States as an epidemic.

According to the Medicine Abuse Project, one in four teens has abused prescription drugs as of 2008, a number that has continued to increase each year.

According to a Burlington Free Press article, in 2010 the Vermont court system was dominated by prosecution of individuals accused of illicit trafficking of prescription drugs–drugs responsible for over 50 percent of drug overdose fatalities each year in Vermont and in the United States as a whole since 2005.

A disheartening realization is that the youth are gaining access to these drugs in their own homes or that of a friend.

Dad broke his ankle but stopped half-way through his prescription and the left the remaining pain killers in the bathroom medicine cabinet above the sink.

Grandma’s sleeping pills are on the second shelf in her bathroom.

An older sister’s buprenorphine is unsecured.

This is called home diversion, and it has contributed significantly to the drug crisis not only in Vermont, but everywhere.

Franklin County anesthesiologist Dr. William Roberts, an interventional pain management specialist, is highly versed in many areas of prescription drug diversion.

As a professional he has taken every measure possible to ensure his patients are not diverting the prescriptions he fills. However, according to him it is up to those who hold the prescriptions to properly secure them.

“It’s well understood that the first step in opiate addiction is access to an opiate that has been diverted from a member of the family or the family of a peer. Fifth and sixth grades are entry point dates. The really tragic part is that it’s completely preventable,” he said. “The reality is that the first step is recognizing that you are a risk to your own children and grandchildren. [People] are failing to secure medications. If you’re not going to dispose of them, then lock them up. It’s a deadly thing that’s dangerous and people play with it and then get hurt.”

Medications are not to be flushed or thrown away, so local police departments or pharmacies have tried to make it easy for individuals to dispose of unwanted medications. Locking the medicine cabinet seems simple, but according to Roberts far too many prescriptions are left unattended.

Although failing to secure or properly dispose of medications is a leading cause of dangerous exposure to opiates and narcotics, there are other levels of diversion that are concerning according to Roberts.

“Diversion is nothing more than someone practicing medicine that hasn’t been trained. So quite often they can make a case which is philosophically correct about wanting to advance the best interest of someone else,” he said. “But what it boils down to if it was all [altruistic] they wouldn’t be exchanging dollars. We have a huge problem with people not coming to treatment for narcotic addiction because other people are allowing them to receive a portion of the treatment that is given to someone else and that interferes with care. That care is never associated with any counseling or appropriate content.”

This means that individuals are self-medicating and fueling their addiction problems by purchasing diverted medication on the streets.

By doing this they are not obtaining the proper counseling or building the skills needed for narcotic addiction management that otherwise would be provided through outpatient specialists.

“This idea that one person should just willy-nilly take it on their own initiative to share medications with other people when they aren’t licensed, educated, or capable of really understanding the consequences is just wrong,” Roberts said. “People who exchange medications with each other for profit or even when it’s well-intended don’t know to say, ‘Where are you going to keep the medication locked up?’ So children access the medication and overdose because no one instructed the parent not to leave it out. No one talks about the consequences of precipitated withdrawal. When you’re using some of these medications if you’re all hopped up on one opiate and take another medication that is not operating by the same mechanism, you can cause withdrawal.”

It is the withdrawal that fuels the cycle of opiate and narcotic abuse. Instead of then seeking the proper care, individuals, including children, become reliant on diversion.

But what happens when the medicine cabinet in the home is empty?

In his professional experience, Roberts has found that many addicts then attempt to obtain their own prescriptions through doctors like him.

“This behavior is undesirable and they will lie right to your face,” he said. “I don’t get much of that because I’m really straightforward and make it really clear that if I find out they’re diverting their medicine I will call the state police. Once you cross over the line from being my patent to being a drug dealer, you’re no longer my patient: You’re just a drug dealer.”

Roberts has created a system within his office to weed out potential drug abusers.

Using a program called Vermont Prescription Monitoring System, by simply typing in the patient’s date of birth online he can obtain information on each prescription this individual has ever had filled in the state of Vermont, which pharmacy filled it, who wrote it, and where the individual lived at that time.

“Fundamentally it’s a tool that should be used by every doctor who has a prescription pad. If you’re going to write for sedatives, hypnotics, or opiates you should be knowing what somebody else already gave the patient,” he said. “You won’t find a chart there that doesn’t have that in it. When I talk to the patient it’s right there and I don’t share it with the patient unless they give me information that doesn’t line up with it.”

Although the program is only limited to the state of Vermont, Roberts has found it extremely helpful in judging the intentions of his patients. While Roberts is scrupulously attentive to the potential for prescription abuse, not all doctors maintain the same level of vigilance.

“Are doctors too responsive to the subjective expressed needs of the patients? I think that in general the real problem is about the educational system not being honest with physicians in the training process,” he said. “Narcotic addiction and drug use in general is, at a societal level, perceived incorrectly as being partly okay, and it’s not. We are a society that uses substances routinely. We drink alcohol, we smoke a lot of dope, and we all think that it’s just fine.

“Recreational use of inebriants including opiates is a behavior of 14 percent of the American population. If you include alcohol it’s closer to 30 percent. The real problem is not the doctors; it’s that as a society we are not honest with ourselves about our own behavior. We condone them and think of it as okay. Inebriation and modifying your level of consciousness for recreation is incredibly pervasive in our society. The medical training is not really honest with the providers.”

So what’s the solution?

According to Roberts, that lies within the training of physicians. Doctors should be taught to ask specific questions, develop a level of honesty, increase highly supervised urine tests, and to be free of any judgment with patients.

“For the amount of substance abuse that goes on in our society you’d think it’d be one of the first questions that physicians would begin with when taking a general history,” he said. “You’d think it’d be the third for the fourth question; instead it only happens if there’s a behavior problem.”

As for the community, Roberts stresses the importance of locking up prescription drugs or disposing of those that are not being used.

For anyone with a prescription drug problem or a family member with that problem, he advises them to seek proper professional help because self-medicating illegally is not the answer.

“As a society in addition to having to be more honest with ourselves about these very pervasive habits that we have for abusing substances, we have to get out of the habit of reinforcing people’s lack of get-up-and-go by providing them with inordinate amounts of empathy. It’s very appropriate to be clear with people that you understand that their behavior, their narcotic addiction, is interfering with their life and that is sad, but that’s where the empathy should end.”