In 2009, 83 percent of drug overdose deaths in Oklahoma were attributed to prescription drugs as compared to 17 percent of the overdoses related to street drugs. The U.S. Centers for Disease Control and Prevention reports that 1.2 million emergency room visits in Oklahoma that year were related to the misuse or abuse of prescription drugs, an increase of 98 percent since 2004.
“This is not surprising,” said Terri White, commissioner for the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS). “Oklahoma consistently ranks near the bottom on health issues and healthy behaviors and near the top in disease-related surveys. We are an unhealthy state.”
While the report made headlines, White said she suspects the news likely didn’t resonate with many Oklahomans, either because of denial or a refusal to accept the problem.
“At least it’s not heroin,” said Carolyn, a former addict to prescription painkillers, who asked that Oklahoma Gazette not use her real name. “That’s what I used to tell myself: ‘At least it’s not heroin.’ Most people hear reports like that and think it’s not them. It’s not their friends or family. They think it’s ‘those people,’ not us.”
Dr. Hal Vorse, medical director of A Chance to Change Foundation, an alcoholism and drug addiction treatment center, said you don’t have to look far to find “those people.”
“Go to a mall on a Saturday afternoon and watch people walk by — that’s our patient load,” Vorse said. “It’s moms and dads in SUVs, athletes, teachers, doctors, construction workers, lawyers, and accountants. It could be, and it is, someone you know.”
And the problem is likely to grow. According to the ODMHSAS, funded treatment facilities saw a 67.5 percent increase in the misuse of prescription medications from 2005 to 2010.
Opioid drugs, such as hydrocodone (sold under the brand names Lortab and Vicodin), oxycodone (OxyContin) and codeine are widely prescribed. In 2009, the last year for which statistics are available, doctors nationwide wrote 132 million prescriptions for hydrocodone and 32 million for OxyContin, which gained notoriety in the late 1990s and early 2000s after highly publicized overdoses led to a public outcry. Drug manufacturer Purdue pleaded guilty to downplaying the risk of addiction and paid $635 million in penalties.
Consequently, OxyContin was moved onto the controlled substance list, meaning patients must show identification and sign for the prescription.
Oklahoma State Medical Association Executive Director Kenneth King said doctors walk a difficult line, measuring the painrelief needs of a patient while avoiding the circumstances that could lead to addiction.
“It’s a delicate balancing act,” he said. “When we saw the rankings come out, I’ve got to say we were not surprised. Even before the report, we had brought together all the stakeholders to look at the issue of how to treat pain and how to deal with addiction.”
Vorse recalled seeing an increase in the number of people seeking treatment for opioid addiction in the 1990s.
“There was more pressure on physicians at that time to treat pain,” he said. “They began writing a lot more prescriptions for pain relievers.”
Even without a prescription, such medications are readily available in Oklahoma, either through a friend or family member who is willing to share their pain medicine or through a thriving black market.
“At least 52 percent of opioid recreational users say the first time they used the drugs, they got it from other people’s prescriptions,” Vorse said. “People are willing to share and try these drugs because there’s an implication that some of these painkillers are safer than they are. Drugs like morphine and OxyContin are consid- ered to be unsafe. But hydrocodone — Vicodin, Lortab and others — are just as dangerous.”
Drug shar- ing might start innocently enough, said Vorse. A friend or family member complains about a pain, and someone remembers the bottle of unused pain pills sitting in the medicine cabinet.
Although parents of teens in Oklahoma often lock up or hide alcohol at home, their prescription drugs are often readily and easily available.
“I used to look through my friends’ medicine cabinets,” Carolyn said. “It was an easy place to get drugs. No one throws away their medicine.”
On the street, one pill is worth $5. The drugs sold on the street
almost always come from someone’s unused prescription, said Vorse. Drug dealers either steal the drugs, get prescriptions themselves or have others “doctor shop” to find a phy- sician willing to write a painkiller prescription.
Vorse said law enforcement should explore alter native ways to deal with addicts instead of sentencing them to prison. Effective alternatives include drug court pro grams and treatment with counseling and buprenorphine (brand name Subutex), a prescription medication designed to ease withdrawal from painkillers. Vorse uses Subutex and counseling to treat patients in his private practice.
Carolyn was able to kick her addiction through counseling and drug therapy.
“Treatment can work,” she said.
“You can get your life back. I know that I’m an addict every day of my life. But it feels good to be able to feel and have my work and family back.”
But Vorse said Oklahoma does not sufficiently support drug treatment programs that could help people overcome addiction.
“Instead we send people to jail,” he said. “We incarcerate twice as many women as any other state. Most of these women are in prison because of drug issues. They sell drugs to get money to buy more drugs, or because their drug addiction keeps them out of a job. The real drug dealers don’t use drugs.”
Another strategy to rein in prescription drug abuse is the Prescription Monitoring Program, or PMP, Operated by the Oklahoma Bureau of Narcotics and Dangerous Drugs, the website was created to reduce prescription fraud and doctor shop ping. Pharmacies are required to submit controlled-substance pre scription information to the site every 24 hours.
But it has a limited impact.
Physicians are supposed to enter prescription and patient information, but they are not required to actually check the PMP to learn whether a patient has a history with painkillers.
About 3,500 of Oklahoma’s 10,000 physicians are registered to use the PMP. Of that figure, 76 percent say they use it regularly.
“This increases a doctor’s workload,” King said. “In Oklahoma, we have a shortage of physicians that’s likely to get worse. Already a doctor sees about 30 to 35 patients a day. Add an additional five minutes to each patient’s time to allow the doctor to enter data into the program, and it becomes an onerous situation. They simply don’t have enough time.”
But Vorse said the benefits of the PMP are worth the inconvenience.
“Physicians are busy and shorthanded, but this is a user-friendly site and it does not take long to make a report,” he said. “A minute or two can save a life.”
State Rep. Richard Morrissette, D-Oklahoma City, introduced legislation last year to bolster physicians’ participation in the program. He wasn’t successful but has vowed to keep trying.
“Our bill got slammed last year and we had intense opposition from both the pharmaceutical and medical groups,” Morrissette said. “We’re looking now at how we can increase reporting and put more enforcement responsibility on the Oklahoma Bureau of Narcotics. The idea is to save lives. We’re not trying to burden the medical profession.”
Along those lines, Morrissette said House members earlier this fall conducted an interim study on the number of people who drive under the influence of prescription painkillers.
Indeed, he and others favor more stringent guidelines on DUIs caused by prescription drugs. Of 521 fatal auto accidents in Oklahoma last year, only 50 of the drivers involved were tested for opioids by the state Department of Public Safety.
Seventeen other states have laws limiting the amount of prescription drugs that can be taken before getting behind the wheel.
Recently, Oklahoma law enforcement has begun prosecuting doctors writing prescriptions. Dr. Mickey Tyrrell was charged in July with second-degree manslaughter in connection with the 2009 death of a Vinita woman who overdosed on prescription painkillers. Prosecutors allege Tyrrell prescribed more than 630 meperidine (Demerol) pain pills to Tammy Dawn Daniels during a two-month period.
“We need to make sure that our physicians are properly trained on this issue,” King said. “Pain treatment and addiction — this is an issue that we’re struggling with right now. By coming together and bringing our top experts and all the stakeholders together, we’ll find solutions.”