Third in a four-part series
Copyright © 2012
|Dear Readers:It used to be pretty simple.Heroin was heroin. Cocaine was cocaine.
Now, federal and local cops have to use the Physician’s Desk Reference — PDR for short — to identify the pills they seize in drug arrests. Or collect at the scene of fatal drug overdoses.
Are the blue pills oxycodone or OxyContin? Is this Valium or hydrocodone? It’s often up to police to identify the pills because the people involved couldn’t tell an aspirin from suppository.
We hear stories of young people raiding the family medicine cabinet, going to parties where they throw the pills into a bowl — antidepressants, sedatives, decongestants, painkillers, muscle relaxers and anything else they found in the medicine cabinet or got from a friend. They play games and take pills from the bowl like candy rewards.
You can dismiss the stories as urban legend, thinking that the behavior is too bizarre to be true.
Then a kid dies at one of these parties and it’s no longer urban legend. It’s the new reality of the drug world.
Harris Silver, M.D., and Tim Gallagher (no relation to the reporter) are both in recovery.
That’s where the similarity starts and ends.
Both have battled the euphoria and warm sense of well-being that addicts describe when taking opioid drugs. Some describe it as a “cocoon” against all troubles.
Silver was a practicing surgeon when he became addicted to painkillers.
He was prescribed the drugs for pain from a bulging disc in his neck.
Like a lot of professional people who become addicted, at some point he started “doctor shopping” to get prescriptions for the drugs.
That was more than 20 years ago.
“I was a dumb doctor shopper. I kept taking the prescriptions to the same pharmacist,” Silver said. “He called my boss, and that began this long road I’ve been on.”
Silver lobbied the Legislature this last session for tougher regulations on prescription painkillers and was the main analyst for the state Drug Policy Task Force.
He does educational programs for doctors on the prescription painkiller addiction problem and is involved in national symposiums on the problem.
And when he needed surgery recently, he had to take painkillers and then come off them with a lot of help from his sponsor, doctor and others.
You don’t stop being an addict or stop being in recovery.
“I am enthusiastic about being in recovery,” Silver said.
That’s something Gallagher is trying to learn.
Gallagher, 32, doesn’t walk the halls of the Roundhouse in Santa Fe. Until recently, he was hustling for his next heroin fix — an addiction that grew from his use of painkillers.
“Started out when I was about 17 with painkillers from my dentist,” he said.
After that, things get a little hazy.
Family members had a history of drug abuse, and he was introduced to injecting heroin by a family member.
“You work but you get fired because you have to score or think about scoring,” Gallagher said. “Once you’re into heroin, you don’t think about anything else.”
At the time of an interview with the Journal, he was at the Bernalillo County Metropolitan Assessment & Treatment Services facility to detox.
He had just graduated from Turquoise Lodge, a Department of Health inpatient rehabilitation program.
“I graduated three days ago,” he said. “I immediately forgot to concentrate on my recovery.
“I started worrying about a job and getting a car. Next thing I know, I wake up facedown in the street and can’t remember how I got there.”
“Tell everyone, this isn’t easy,” he said.
More people in New Mexico are dying of prescription painkiller drug overdoses than from overdosing on heroin and cocaine. A typical victim is middle-aged and female.
The Centers for Disease Control and Prevention called it a national epidemic last November. The New Mexico Drug Policy Task Force, with members appointed by the Legislature and Gov. Susana Martinez, goes one better: “In New Mexico, we have a substance abuse epidemic of monumental proportions.”
The warnings that prescription painkillers were a threat date back to 2001, when federal agencies noted large increases in emergency room visits for people who had overdosed on oxycodone or hydrocodone.
Both narcotics are “controlled substances” under federal law, but oxycodone is a Schedule II drug and hydrocodone is Schedule III. Oxycodone is slightly more powerful and is considered more subject to abuse. As a result, prescriptions for oxycodone cannot be “called in” to a pharmacy like hydrocodone prescriptions.
Add to that the growing current concern that prescription pain medication has become a “gateway” to heroin addiction for young people. In New Mexico, heroin overdose deaths among people 25 and younger doubled from 2009 to 2010.
But that recent concern masks other problems in New Mexico.
⋄ Deaths from prescription opioid drugs tripled from 2000 to 2009.
⋄ The majority of people dying of prescription drug overdoses are between the ages of 44 and 64.
⋄ More women die of prescription drug overdoses than overdoses of illegal drugs.
⋄ Prescriptions for pain medications in New Mexico increased more than 350 percent for oxycodone and more than 150 percent for hydrocodone from 1999 to 2009.
The state Drug Policy Task Force concluded there were several reasons for what it called a “glut” of opioid prescription medication in New Mexico.
⋄ Overprescribing prescription painkillers like Percocet (oxycodone) and Vicodin (hydrocodone) by doctors and dentists.
⋄ The “medicine cabinet” problem, in which unused prescription painkillers are stored unsecured and accessible to others, especially to teenagers.
⋄ Prescription forgeries and doctor shopping by people who are addicted to the pills or who want to sell the pills to other addicts.
Many people addicted to prescription drugs come by it honestly — through medical treatment for cancer, complications from surgery, spinal cord injuries and other medical conditions for which doctors prescribe painkillers.
Because patients taking opioid painkillers build up a physical tolerance to the drugs, the addiction needs to be carefully managed in a way that requires the attention of the doctor and patient.
Patients with a history of substance abuse or mental health problems can be difficult to manage.
“One in 20 patients are at high risk for addiction if they are prescribed opioid painkillers,” said Silver, the physician analyst for the Drug Policy Task Force. “We have to do a better job of identifying those patients at high risk.”
Once treatment begins, other challenges present themselves.
Problems with insurance coverage can interrupt the doctor’s oversight or make it hard for people to legally obtain the drugs. If a patient has to see multiple doctors for different health problems, addiction management can become difficult as the patient receives different drugs for different medical problems.
And doctors can miss signs that a patient’s use of pain medication is spinning out of control.
The state Medical Board wants doctors to do a better job of explaining to all patients receiving prescriptions for painkillers how addictive the drugs are.
Jennifer Weiss of the Heroin Awareness Committee said that is one of her group’s goals.
“I know from personal experience that I never got an explanation of how addictive the painkillers were,” Weiss said.
Her son, Cameron, died of a heroin overdose after he became addicted to painkillers prescribed after he had a series of high school sports injuries.
Looking for abuse
The Heroin Awareness Committee didn’t have much luck with its legislative agenda last session.
New Mexico regulations governing prescription drugs are in line with those of most other states, but some, like Washington, have already tightened regulations in response to opioid drug overdose deaths.
“We ran into opposition from medical societies,” Weiss said. “They opposed limits on prescribing pain medication.”
The group did manage to pass amendments to the Pain Relief Act that require state agencies to create rules on pain management and continuing education for those who prescribe opioid medications.
The committee seems to be having better luck with regulatory agencies.
In June, the State Board of Pharmacy approved changes that will expand the board’s prescription monitoring program.
One change was to make it a “real time” computer program that would allow pharmacists and doctors and others to check on a patient’s prescription history. The board has had a monitoring program since 2005, but it was used primarily by board investigators, who are both pharmacists and trained law enforcement officers, to look for patterns of prescriptions that would indicate forgeries, doctor shopping or other signs of illegal diversion of prescription medications.
The Pharmacy Board investigators are highly regarded by law enforcement.
“They do amazing work,” said DEA Assistant Special Agent in Charge Keith Brown. “They either initiate or aid all our diversion investigations.”
The Legislature didn’t fund the expansion of the program, but the board found grant money to do it.
Responding to the state’s top-in-the-nation ranking for prescription overdose deaths, the state Medical Board last week enacted regulations governing prescription practices for opioid painkillers.
They require doctors prescribing the narcotic painkillers for more than 10 days to use the Board of Pharmacy’s prescription monitoring program to determine if patients are getting painkillers from other doctors.
Physicians also must document the treatment plan for patients receiving painkillers for longer than 10 days and see long-term patients at least every six months.
Some doctors objected to the changes as “heavy-handed,” but board Chairman Dr. Steven Weiner said the board was responding to a statewide “public health crisis.”
The regulations would require ongoing education for doctors on prescription pain medications.
So is Big Pharma pushing pain meds too aggressively?
The U.S. Senate is investigating the role of drug manufacturers in promoting painkillers within the medical community and the public.
Sens. Max Baucus, D-Mont., and Charles Grassley, R-Iowa, sent letters to pharmaceutical firms saying evidence suggests the epidemic of addiction and accidental deaths from narcotic painkillers is due to companies “promoting misleading information about the drugs’ safety and effectiveness.”
The senators are asking for financial information about links between drug companies manufacturing painkillers and what they called the “pain lobby.”
During the 1990s, Congress held numerous hearings on the “undermedicating” of cancer patients and others with painful chronic medical conditions, such as spinal cord injuries.
A major complaint was that the regulations of state medical boards — which license doctors — restricted physicians from prescribing adequate amounts of narcotic painkillers to patients with diseases such as cancer.
One result of the hearings was a liberalization of state regulations on prescribing powerful painkillers for “acute” pain, which covers a much larger universe of patients — from minor surgical procedures to sports injuries.
About the time the changes went into effect, the number of overdose deaths from prescription painkillers and emergency room admissions for overdoses began to increase.
One of the arguments in favor of loosening state regulations was that the new generation of painkillers was not as addictive as older drugs.
Two companies that produced the most widely used painkillers — hydrocodone and oxycodone — were sued by federal prosecutors in 2006 for misleading doctors about how addictive the drugs are.
The lawsuits were settled for almost $1 billion, with the companies promising to market their products using more accurate information saying that today’s painkillers are just as addictive as older medications.
The companies also have taken some steps to modify opioid painkillers to make some of them more difficult to snort or smoke.
— This article appeared on page A1 of the Albuquerque Journal