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Oklahoma Rising?: Part three, Prescription painkillers


Scott Cooper September 18th, 2008

State pride swelled and the nation took notice as Oklahoma celebrated its first 100 years in 2007. After sweeping up the confetti, our state embarks on a new century invigorated with promise and hope....

State pride swelled and the nation took notice as Oklahoma celebrated its first 100 years in 2007. After sweeping up the confetti, our state embarks on a new century invigorated with promise and hope.

PRESCRIPTION PAIN RELIEVERS
SOBERING FACTS
A DEADLY CURE
SEVERAL FACTORS
PRESCRIBING DATA

While the state leads the nation in many respects, Oklahomans face significant hurdles that continue to challenge our spirit and resolve. Believe it or not, our fair city and state still dwell in the basement in several categories nationwide.

A cornerstone of Oklahoma Gazette's mission is to improve the quality of life in Central Oklahoma. Our six-part "Oklahoma Rising?" series examines several categories where our city or state ranks last. We'll examine why we're there, explain some of the root causes and look forward to alternatives for a better tomorrow.

PRESCRIPTION PAIN RELIEVERS
It has the power to heal, but can kill if handled recklessly. It can only be given by a professional, but is passed around like candy at teenage parties. It provides relief for hundreds of thousands of Oklahomans, yet has become the number one abused drug.

When most people hear of a person dying from a drug overdose, the assumption falls to cocaine or heroin. But more Oklahomans are dying from prescription pain relievers than any illegal drug.

"I liken it to a cancer in your body that you really don't know about until it's too late," said Darrell Weaver, director of the Oklahoma Bureau of Narcotics and Dangerous Drugs. "We started capturing data and some of it to me was just absolutely astonishing."

Earlier this year, the National Survey on Drug Use and Health found that Oklahoma had the highest estimated percentage of prescription pain relief abuse. The survey estimated 6.72 percent of Oklahomans age 12 and up abuse prescription painkillers like hydrocodone and oxycodone, ingredients for popular pills like Vicodin and OxyContin.

Oklahoma ranked just above Arkansas in the survey.

In a situation where a cure needs its own answer to prevent further harm, the medical profession and law enforcement are finding the right formula a difficult balancing act. The technology is there, but stereotypes and humanity present dilemmas for databases to compute.

SOBERING FACTS
Oklahoma's prescription problem cuts across nearly every age group. The state ranks first in overall numbers for ages 12 and above. The Substance Abuse & Mental Health Services Administration, which conducted the survey, broke the results into three other age groups. Oklahoma could be found high in the rankings of most of those groups.

For ages 12-17, Oklahoma ranked second with an estimated 9.7 percent abusing prescription pain relievers. Arkansas barely took this age group with 9.8 percent. The state did take first place with the 26 and older crowd. The survey estimated 4.87 percent of the state's adult and older population are abusers.

The age group Oklahoma ranked lower in came with the 18-25 population with an estimated abuse rate of 14.4 percent, keeping the state out of the top 10 for that category " just barely.

But no matter the age group, Oklahoma's percentages were above the national average.

"The medical community is definitely aware of this problem," said Dr. Michael Pondrom with the University of Oklahoma College of Pharmacy.

Oklahoma's statistics are a reflection of a nationwide trend which has law enforcement and medical communities extremely worried.

According to The Associated Press last year, based on figures from the U.S. Drug Enforcement Administration, the sale of painkillers jumped 90 percent between 1997 and 2005. During that time period, Oklahoma's usage soared 145 percent. The investigation found more than 200,000 pounds of the five most prescribed painkillers were sold in 2005 alone, which calculated out is 300 milligrams for each person in the United States.

"Any time you have a source of any type of drug, whether it's a source of meth or a source of marijuana or a source of controlled dangerous substance, i.e., prescription drugs, you always have an element there that will abuse the system," Weaver said. "I really believe that."

A year ago, civil litigation attorney Robert Behlen was accused of robbing one pharmacy in Edmond, entering three times within an 11-minute period. According to AP, Behlen took several bottles of painkillers while holding employees at gunpoint, swallowing pills during one the incidents.

A DEADLY CURE
The rising tide of prescription drug abuse may seem like just another obstacle Oklahoma authorities need to address to make this state a better place. But add to the problem that a growing number of the abusers are ending up in the state's medical examiners office, and the younger population attaching to the trend, and an epidemic emerges.

Autopsy reports reveal accidental drug overdose deaths are no longer about familiar street drugs like cocaine. According to OBNDD, last year more than 80 percent of deaths from overdoses came via prescription pills. The number of those deaths are rapidly climbing.

In 2001, 344 Oklahomans died of a drug overdose. In 2007, that number leaped to 564, a 64 percent increase.

"There is a tendency to think these pills are safe, 'so I took six of these, let me try eight,'" Pondrom said. "There is a point you cross into the toxic range. I think there is a false comfort thinking that it's a medication, it's going to be safe for them to take a little bit more."

The emergence of pain relievers literally becoming pain "killers" practically happened in one year. Statistics show between 2000 and 2001, overdose deaths from oxycodone doubled to 40, outpacing cocaine and methamphetamine. Those numbers continued to increase the following years, with methadone, a treatment of narcotic withdrawal and dependence, surging to the top. By 2004, methadone accounted for one-fourth of all drug overdose deaths.

During the past two years, methadone, followed by pain relievers hydrocodone and oxycodone lead the pack, more than doubling the number of deaths from cocaine.

But what has OBNDD even more concerned is prescription drugs becoming the latest fad with teenagers. For adolescents, the taking and consuming of medication deals more with recreation and fun than fulfilling a need.

Mark Woodward, director of communications for the OBNDD, said in his travels across the state as an educator for drug programs, high school students are bragging about their prescription parties, and that some parties will not allow anyone in without a pill.

"It used to be BYOB, now it's often times 'What pills did you bring?'" Woodward said. "Kids have told me they see kids eating it like candy out of bowls, and assume it's safe because they see their parents take it. Most of these (pills) come out of the house. Mom gets 30 hydrocodone, she is not going to miss three or four. That's what kids mainly do, they don't steal the whole bottle."

These parties are referred to as "pharm" parties or "salad" parties. The bowls of pills are called "trail mix," according to Woodward.

SEVERAL FACTORS
Experts in both law enforcement and the medical community point to several factors spurring the new epidemic.

The starting point comes from the supply. Doctors are prescribing more and higher doses of painkillers, putting more pills in home medicine cabinets.

"In the Nineties, that's when pain control became a big issue," Pondrom said. "I was educated that if someone came in with a chronic pain condition, they should get pain pills.

"Before that period, people were very stingy about prescribing strong pain pills because of the potential for abuse. Then the medical community decided cancer is very painful, and we should try to make people comfortable and give them pain pills."

Pondrom said a new philosophy about the potential for abuse emerged, which deals more with a patient's past.

"We were looking at it from the perspective that everybody who is getting a pain pill had the potential for abuse. We have flipped that around to say if someone has a history of abuse, then the potential is there. Just getting a pain pill doesn't mean you are going to get addicted and fall into that abuse."

Pondrom admits the correlation between more prescriptions and more painkiller drug abuse exists. But it's hard for doctors to go against their professional duties.

"Their (abusers') mind-set is they've got pain, their doctor is helping them to control that pain. The doctor says 'Well, maybe you just need a little bit more' and goes along with it. It's like a therapeutic arrangement between the two. But at some point it needs to be re-evaluated and cut off. That's probably where we are weak."

The growing trend also has to do with simple capitalism. The marketplace for prescription drugs is easier to navigate than that of illegal drugs.

"You do have some of those benefits when it comes to prescription drugs (such as) insurance companies picking it up," Woodward said. "Many have said it's easier to get prescription drugs from a doctor than buy it out on the streets."

An addict can simply go see a doctor, complain of pain, get a prescription and have the insurance company, or in some cases Medicaid, pay the bill. Not only does this make it an easy way to get drugs, but for some a justifiable excuse.

"I think if you have someone who has the idea of getting a drug to abuse, the idea of going to a doctor, maybe telling a few lies, getting a prescription and going to a pharmacy to get a drug sounds more appealing than trying to find some heroin dealer on the street," Pondrom said.

Stereotyping plays a major part as well. People addicted to painkillers do not see themselves as traditional drug addicts.

"I frequently hear they think they can handle it because it's a prescription drug," Woodward said. "They say, 'Don't throw me in there with those street drug addicts.' Many of them despise street drugs and never tried any in their life. But maybe they were in a wreck, or hurt their knee playing basketball. Ninety-nine times out of 100, they leave with a prescription for hydrocodone and before they know it, they don't need it for pain, they just need it."

PRESCRIBING DATA
OBNDD has adopted a three-pronged approach to meeting painkiller abuse head on, referring to the approach as PIE " prevention, intervention and enforcement.

Intervention is the point of emphasis for OBNDD and its key tool is a new program called the Prescription Monitoring Program. PMP is a database listing all prescriptions that patients in Oklahoma are receiving. A doctor or pharmacist, when suspicious of a patient who may be abusing pain pills, can access the database to confirm their concern. If a doctor sees a patient has been given several pain relief prescriptions over a short period of time, and from different physicians, the doctor will have better knowledge of whether or not the patient should get another dose.

"This is a very peculiar enforcement type of situation for us," Weaver said. "You've got a lot of working people out here that are taking a lot of pain medicine. They're productive citizens. So do we want to go and arrest all these people and overload our jails? Probably not. So the 'I' is very important. It's important that this Prescription Monitoring Program, at the point of intervention, that the doctor to say, 'Listen, you are going to three other doctors and that's unacceptable. I'm not going to treat you.'"

From the medical standpoint, PMP is a valuable tool.

"When I worked in community pharmacies, I had situations where I thought somebody might be abusing drugs," Pondrom said. "I wasn't sure, but I got that feeling this person was an abuser but I didn't have any evidence. They've become very good at being deceptive. They learned how to get what they need."

Weaver believes this is a better working model to curb prescription drug abuse than any piece of legislation.

"There (are) too many prescriptions out there and too much good that happens to ever attempt to regulate that."

As with any phenomenon which grips a state or society, the focus not only turns to intervention but prevention as well. However, Jessica Hawkins with the state Department of Mental Health and Substance Abuse said don't expect the tide to turn quickly.

"There's a huge gap between raising awareness and seeing action," Hawkins said. "It may take years. That's how prevention works. It just takes time." "Scott Cooper

 
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