Ten or so years ago, a doctor prescribed me a drug combo of codeine and Flexeril, a muscle relaxant, for a bout of severe arthritis pain. I took it once, collapsed into a boozy burrow and was completely out of my head for two days.
The pain went right away, but I never took the drugs again, vowing instead to find a suitable alternative. Contrary to one of my favorite Ramones’ songs, I didn’t really want to be sedated.
Why? It turned out that, whatever its challenges, I liked my here and now, and avoiding it in a groggy, happy daze wasn’t anything I was interested in. Whether by biology or personality, I’m not likely to ever be an opiate abuser.
The latest drug abuse data show New Mexico still leading the nation in deaths due to drug overdoses as we have for all but two of the past 20 years. We now die of drug ODs at a rate twice the national average. And fatal overdoses from prescription drugs have eclipsed those from more traditionally abused drugs, cocaine and heroin.
The personal tragedies of the 500 New Mexicans who died of overdoses last year tell us the “who” of the problem.
And the statistics tell us the what, when and where: The highest drug-induced death rate is among Hispanic males; Rio Arriba County leads the state in drug-induced deaths per capita; 80 percent of drug-induced deaths are unintentional; and during the period of 2005 to 2009, the most common drugs that caused unintentional ODs were, in order, prescription opioids (methadone, oxycodone and morphine), heroin, cocaine, tranquilizers and muscle relaxants and antidepressants.
I’m curious about the why. What is it about New Mexico that causes us to use, abuse and die from it at a greater rate than others?
Michael Bogenschutz is a psychiatrist, a professor at the University of New Mexico’s School of Medicine and an addiction specialist.
When I posed the question to him, he pointed first to New Mexico’s unique and long-standing position in the heroin pipeline, which has created a black tar heroin supply that is plentiful and inexpensive and, along with that, a long history of heroin abuse that spans generations.
Next, he mentioned the spike in the availability of prescription drugs – mostly powerful opiate-based pain killers – that has occurred all over the country, and especially in New Mexico in the last decade. According to DEA figures, oxycodone and hydrocodone sales in New Mexico rose at one of the highest rates in the country between 2000 and 2010.
Most people who are prescribed an opiate-based pain killer don’t go on to use the drug recreationally or to become dependent on it, Bogenschutz pointed out. But, he said, “The more exposure there is, the more people get into trouble.”
He also said people tend to abuse the drug they have access to. The more prescription pills – millions and millions of them – that are obtained with legal and forged prescriptions, the greater the opportunity for addiction and the bigger the street market for hydrocodone and oxycodone, which leads to a surge in abuse use of the drugs, which leads to unintentional overdoses.
A host of intertwining factors have been considered over the years to help explain New Mexico’s perennially high rates of drug and alcohol abuse: poverty, low levels of education, rural isolation, high rates of mental illness and depression and an acceptance of drug abuse that has seeped into our cultural makeup.
As Bogenschutz pointed out when I asked him about those possibilities, those explanations are plausible, but scientists can’t run randomized studies to test those factors.
Obviously, drug addiction and overdose deaths are not confined to the poor, and most poor people are not addicts. But Michael Landen, the state’s deputy epidemiologist, said self-reporting research shows poverty is a frequent theme behind many of our poor health outcomes and risky behaviors. You grow up poor, poverty breeds stress, you look for ways to feel better, and you start getting high.
The explosion of hydrocodone and oxycodone prescriptions has opened the doors of drug abuse to a whole new population. Landen said people mistakenly think prescription drugs are safer than illegal drugs because they come with a doctor’s stamp of approval – even when they are being abused outside of their intended use. Women, especially, are more likely to abuse prescription opioids than other illicit drugs, Landen said, which explains why the percentage of women who die of drug overdoses in New Mexico is going up.
William Harvey, executive director of the state’s Board of Pharmacy, told me opioid abuse often starts with a prescription for a narcotic pain killer and grows from there. “The demographics for people who abuse opiates is the full spectrum,” he said.
The good news about prescription opioids now being our most dangerous drug of choice is that they are controlled substances (or at least they’re supposed to be controlled) and so there are mechanisms available to regulate them – through doctors, pharmacies and the Medical Board – that aren’t available for street drugs.
A recent amendment to the state’s Pain Control Act tries to balance the legitimate use of opioid pain killers against abuse by spelling out accepted prescription guidelines. And New Mexico now has a mandatory computerized prescription monitoring program that requires pharmacies to report who is prescribing controlled substances, in what amounts and to whom.
One of the benefits of that system is that regulators can now spotlight where the most controlled substances are being handed out.
Last year’s data show us that one doctor in Las Cruces, neurologist Pawan Kumar Jain, prescribed nearly 3 million pills of the types the Board of Pharmacy monitors to fewer than 4,000 patients. That’s about a half a million more pills than the entire staff of medical residents at the University of New Mexico Hospital for more than 23,000 patients.
Jain was put on the spot about his record levels of pain killer prescriptions by a KOB-TV reporter earlier this year and what he said on camera was telling. “Here in America,” he said, “people love pain medicine.”
Here in New Mexico, we love it too much. I still don’t know why, but I do know it’s killing us.
UpFront is a daily front-page news and opinion column. Comment directly to Leslie at 823-3914 or email@example.com. Go to www.abqjournal.com/letters/new to submit a letter to the editor.
— This article appeared on page A1 of the Albuquerque Journal