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Abuse of opioid drugs hits all-time high
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The headlines are startling:
• Some 210 million prescriptions were written last year for opioid medications, Nora Volkow, head of the National Institute on Drug Abuse, told CBS "60 Minutes."
• In 2009, there were more than 13,000 babies born with neonatal abstinence syndrome after being exposed to opioids in utero, a three-fold increase since 2000, according to an article just published online by The Journal of the American Medical Association.
• Locally, the number of drug overdose deaths in Allegheny County has doubled over the last 10 years, with opioids involved in the vast majority of them.
• Similarly, about 4 percent of the people who went to Greenbriar Treatment Center for help 10 years ago were involved with opioids. So far this year, it's 52 percent, Greenbriar COO Holly Martin said.
"It's beyond a jump. It's an epidemic," she added.
Opioids include heroin and a number of prescribed pain medications, among them hydrocodone (Vicodin), oxycodone (OxyContin), propoxyphene (Darvon) and hydromorphone (Dilaudid and others).
Though other families of prescription drugs also are involved in drug abuse, opioids are the biggest problem, both here and nationally.
"Right now there's more people than at any time in history in our region addicted to prescription medications and heroin," said Neil Capretto, medical director of Gateway Rehabilitation Center. "There's more heroin out there, but 95 percent or more got that way because of prescription medications first. Somebody starts with OxyContin. It becomes too expensive." The user switches over to the cheaper heroin, starts snorting it, eventually starts taking it intraveneously and then rarely goes back.
So what is the reason for this epidemic?
The obvious answer is overprescription of the addictive drugs.
Ms. Martin tells the story of a Greenbriar patient who suffers from chronic pain and who told his counselor his doctor regularly prescribed 200 opioids at a time but had never referred him to a pain clinic.
Similarly, forensic pathologist and former county medical examiner Cyril Wecht said he recently was called to do an autopsy on a man in his 20s for whom a doctor had written a prescription for 180 Vicodins. When his body was found the next day, there were only 18 pills left, indicating he had both taken and sold the pills.
"The doctor treats our symptoms so we get prescriptions of pain medications," Ms. Martin said. "If you wanted pain medication you could have it." All you'd have to do is go to a doctor, orthopedic specialist, emergency room or UrgiCare Center and report pain.
Dr. Capretto said the history of the use and marketing of these painkilling drugs played a role in their overuse today.
"In the late '90s, the medical profession was criticized for undertreating pain," he said, recalling a news magazine cover that shouted, "No Excuse for Pain." At the time, they were used mostly for terminal patients who needed to be made comfortable. The message behind the criticism was that the drugs were safe medicines for everyone except people with addiction problems.
"Pain became the fifth vital sign. People with pain got better treatment," he added.
"At the same time, drugs like OxyContin were coming on the scene. The drug makers really marketed them hard, and that really pushed the doctors. ...
"The marketing of it probably didn't warn of the risk of abuse and addiction, and I know they ended up having to pay a fine, but they made millions."
Meanwhile, some people who use prescription medications often don't think of themselves as doing anything dangerous or wrong.
"A lot of times they don't see it as illegal - it's prescription drugs," Ms. Martin said.
"These are everyday folks nobody thinks about as being a drug addict, getting drugs legally," Dr. Wecht said.
Or it's their kids, taking the parents' drugs out of medicine cabinets. "[Parents] are always going to doctors, and the medicine cabinets are full of drugs for different things. It gives the message it's OK," Ms. Martin said.
So what can be done about the problem?
"More and more education. Isn't that always the answer?" Dr. Wecht said. "Education, that's No. 1. No 2, education for physicians. ...
"Law enforcement has to be tightened up," he added. Doctors who overprescribed out of naivete rather than greed could be sentenced to mandatory education programs rather than jail, he suggested.
Dr. Capretto said he sees a need to organize and use drug take-back programs like the one recently held by the county police. "Get [the drugs] if you need them, but view it like having a loaded gun. Don't just lay it on a night stand. Keep it in a lock box, and I'm very serious about that. ... Return them to a pharmacy." (For toxic reasons, they should not be flushed down toilets, he noted.)
The medical profession could use databases to track prescriptions given patients by various doctors and alert one of them to multiples, both Dr. Wecht and Ms. Martin said.
Pharmacists also can play a major role, the forensic pathologist said. "They know drugs better than doctors really," he said. "If they see Susie or Tommy has gotten two or three drugs from different doctors, call the doctor.
"So if you do all of these things, it's not going to happen overnight, but there will be a significant drop off in drug abuse deaths."
First Published May 17, 2012 4:22 pm
