Dr. Robert Oelhaf, Jr. became interested in addiction medicine for several reasons. His ER practice was filled with patients with acute or chronic complications of substance use, both legal and illegal. These patients often seemed very intent on leaving behind the chemical that brought them such illness and injury, but were completely unable to stop the unending cycle of damage to their bodies, families and jobs.

Dr. Robert Oelhaf, Jr. became interested in addiction medicine for several reasons. His ER practice was filled with patients with acute or chronic complications of substance use, both legal and illegal. These patients often seemed very intent on leaving behind the chemical that brought them such illness and injury, but were completely unable to stop the unending cycle of damage to their bodies, families and jobs.

There were concepts of medical care involved in rehabilitating such people, but much of what was offered seemed to be life coaching. It seemed as if the mentally strong would succeed and the mentally weak would be destined to fail and fall back into use over and over again. Finally, the substance or its complications would be expected to take everything they had-including their lives.

Dr. Oelhaf then realized one of his friends had a substance problem and found a fascinating answer to that problem. His friend was once a finance executive in a major healthcare organization in California. This friend had a severe back injury in a car accident and now suffered from chronic pain and evolved addiction to narcotic pain killers. An operation could not help him.

Dr. Oelhaf's friend began a regimen of carefully designed exercises and went to a chronic pain medicine doctor and the spine pain became less and less of an issue. Yet the withdrawal from the narcotics still intruded into his life whenever he tried to stop the pills. The friend found a doctor that prescribed him buprenorphine, known more commonly by the brand names Suboxone and Subutex.

Columbus Parent: Dr. Oelhaf, most parents know that drugs and other substances are a major issue for children in this country, but some don't realize how big of a problem it is. Can you explain?

Dr. Robert Oelhaf: Well, it's a huge problem and unfortunately it seems like it's getting worse instead of better. There are very few areas where we are actually gaining ground. We have seen a huge jump in opiate use in rural areas, over 200% over the past 5 years. This includes heroin. But the biggest jump has been the use of legal pain killers like oxycontin/oxycodone, hydrocodone and similar substances.

CP: That's amazing. Where do all these legal pain killers come from? Are doctors overprescribing?

RO: In every shift in my ER practice I write prescriptions for pain killers. Most of my colleagues do the same thing. Pain killers like oxycodone (Percocet), hydrocodone (Vicodin), propoxyphene (Darvocet) and codeine and are prescribed for people who are either in pain or acting like it. Sometimes it's really hard to tell the difference. And the consensus at this point is generally that a doctor should err on the side of overtreating pain rather than undertreating. Research has shown time and again that doctors generally undertreat pain. So that's the first problem.

The second problem is when people get better, they leave the pill bottles with the pills in the medicine cabinet "just in case". Except then your teen's friend comes over and uses the bathroom, and grabs the pills off the shelf and nobody knows they are gone. Or a preteen is trained by an older sibling to look for pill bottles with certain words on them and hands them over to the teen when they get some. Then the pills are transported into the illegal drug supply system to be sold on the street. This is also a problem with anxiety medication.

I think people need to be much more careful about discarding unused medications than they currently are. I also encourage people who are chronic users of pain medication to get a medication safe. I know that Walmart sells them for around $50. A third problem is that is that people who are addicted to drugs do things to get them that seem bizarre to people like us. One addict was visiting a nursing home patient, and when they got there they ripped off the patient's fentanyl (Duragesic) patch and chewed it to get the drugs out. The bottom line is if you have pain medication in your home, assume that someone visiting your home is likely to steal it.

CP: How old should a child be for a parent to start focusing on the problem of drug use with them?

RO: It is becoming more and more obvious to doctors who treat addictions that children in grade school, specifically between the ages of 8 and 12, are at the greatest risk of making the initial bad decision that can lead to a life of abuse and addiction.

CP: Wow. Are you suggesting that parents talk to their 8-year-olds about cocaine, heroin and IV drug use? My gut feeling, as a parent of young kids, is that seems a little age-inappropriate.

RO: To a certain extent it's a matter of access to the substance. At age 8, I think the focus should be on tobacco and alcohol.

CP: Is it fair to label tobacco and alcohol as drugs? I suppose someone with multiple DUIs has a problem, but there are lots of parents that smoke and seem to be perfectly ordinary people.

RO: Both alcohol and tobacco are legal, but we know that both are addictive. We also know that every day in this country there are children that become addicted to one or the other. I think the label is appropriate. Let's take this a step further with tobacco. I have interviewed many patients who use tobacco, and they are usually unable to tell me how tobacco use makes them feel better than they felt in the first place. The major feeling they get with tobacco use, either smoking or chewing, is that it suppresses the symptoms of craving for tobacco! I have to admit there does not seem to be much of an intoxication that one gets from tobacco use, unlike alcohol, but I think the logical conclusion is that tobacco has many drug-like features.

CP: What are the risk factors for a child starting a smoking habit?

RO: The more peers a child has who smoke or chew, and the earlier in life the child uses tobacco for the first time, the more likely they are to become chronic tobacco users.

CP: Is there anything that is proven to work to keep kids from smoking?

RO: The current data suggest that the longer a child delays the first cigarette, the less likely they will be to become a chronic tobacco user. Children also seem to become less at-risk if they participate in certain anti-smoking curriculums in school. One that stands out as a success in outcome studies is when children design anti-smoking ads for magazines. Scaring children about the dangers of smoking actually has been a great deal less successful when it has been studied for effectiveness.

Dr. Oelhaf practices addiction medicine and emergency medicine in the Pittsburgh area. He can be reached at doctoroelhaf@yahoo.com. Questions or comments sent to this email address may be seen in future articles. Your questions can be kept confidential.