By Stuart Colburn, Esq., Downs Stanford, P.C.
A November 2011 Centers for Disease Control and Prevention (CDC) report describes prescription painkiller abuse as “a public health epidemic.” The CDC concludes that “improving the way prescription painkillers are prescribed can reduce the number of people who misuse, abuse or overdose from these powerful drugs, while making sure patients have access to safe, effective treatment.”
The following “slideshow” summarizes the report’s findings and data from other CDC reports and non-CDC sources.
One direct cost of the overdoses and other abuse is increased prescription drug costs associated with medical care professionals liberally writing prescriptions within the workers’ compensation system.
Indirect workers’ compensation costs include lost time and subsequent injuries that are attributable to decreased alertness and other ill effects of working while abusing prescription drugs. Other indirect costs are the illnesses and deaths that stem from that abuse.
One CDC-recommended solution is to generally restrict claimants to obtaining prescriptions from one physician and a single pharmacy. The CDC also suggests stronger enforcement of medical care providers being unduly liberal with prescriptions.
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What do these people have in common?
They all died of prescription drug abuse.
The Problem
We are killing our children. We are killing their parents, too. When we are not successful killing them, we destroy their lives and the lives of their families. And for the most part, it is legal.
Hyperbole aside, no one intends such damages on our citizens. America's prescription drug abuse (PDA) problem is not nearly as well known as our War on Drugs. No war has been declared and yet American lives are being lost.
The statistics are well known. American citizens make up 4% of the world's population. Yet, we consume 66% of the world's illegal drugs.
America consumes
7 million Americans abuse prescription drugs
More than the number of Americans abusing cocaine, heroin, hallucinogens, ecstasy, and inhalants COMBINED
CDC Report
The CDC estimated that 12 million Americans, some of whom were only 12 years old, engaged in nonmedical use of prescription painkillers in 2009 and/or 2010. We are fighting the wrong war.
CDC Population Statistics
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Lower income people are more prone to prescription drug overdoses
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A history of mental illness increases the risk of prescription drug overdoses
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The rate of fatal prescription painkiller overdoses is much higher for men than women
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Middle-aged people face a higher risk of prescription painkiller overdoses than other age groups
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Many Americans “doctor shop” to get prescriptions from several medical professionals
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American Indians and Alaska Natives have particularly high rates of nonmedical use of prescription painkillers
According to the CDC, in 2011:
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11,499 died in opiates in 2007
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Quadrupled over last nine years
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Twice as many as cocaine
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Five times as heroin
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Higher dosages associated with overdose (JAMA 2011)
Opioid Growth
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1991: 40 million prescriptions
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2007: 180 million prescriptions
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400% increase in admissions (1998-2008)
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200% increase in deaths (1998-2008)
Highest rates of emergency department visits for non-medical use of selected opioid analgesic by type….United States, 2004-2008
#1 Oxycodone
#2 Hydrocodone
#3 Methadone
#4 Morphine
#5 Fentanyl
#6 Hydromorphone
Total drug deaths now outnumber Motor Vehicle Accidents (MVAs).
Source: LA Times (September 17, 2011)
CDC National Statistics
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Florida leads in per person sales of prescription painkiller sales
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Illinois has the lowest rate for prescription painkiller sales
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The rate of prescription painkiller overdoses is twice as high in rural areas than cities
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Prescription painkiller overdoses are most prevalent in the Southwest and Appalachia
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New Mexico and West Virginia had the highest drug overdose rates in 2008
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Nebraska had the lowest drug overdose rate in 2008
PDA Deaths in 2007
Michigan Deaths
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2008: 409 deaths
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2009: 457 deaths (11% increase)
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2nd leading cause of unintentional deaths
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25% of those seeking medical care were younger than 25
Texas Deaths 2000-2008
Pharm Parties
“They said they will have parties where the kids will throw a bunch of pills in a bowl and the kids take them without knowing what they are.” Lori Smith whose 15 year old son died from 3 different anti-anxiety drugs, morphine and marijuana.
Source: LA Times (September 17, 2011)
Harris County (Houston, Texas)
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1,235: prescription drugs deaths from 2006-09
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247: prescription drugs deaths in 2009.
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42: Average age of those who died from prescription drugs in 2009
Houston Cocktail
"These doctors are using our loved ones as cash cows or ATM machines. They make a lot of money off these drugs."
Esther Scarborough, whose son died of an overdose after his first visit to a Beaumont pain clinic
Houston, Texas
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734 million hydrocodone pills in 2010
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Every man, woman and child in Texas could each consume 30 doses
(Source: Houston Chronicle 2010)
Military Experience
Military
Using Meds 6 Months After Dispense Date Banned
According to the Army News Service by Brandy Gill, reporting out of Fort Hood, Texas, “Soldiers who take their prescription medications six months after dispensation and pop positive on a urinalysis test could see their careers go down the toilet.”
Federal WC Response to Fentanyl
Source: Risk and Insurance – 06/13/2011
Robbing the Pharmacies
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81% increase since 2006
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1.3 million pills stolen
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Some pharmacies are posting signs “they don’t carry oxycontin, oxycodone”
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Long Island: shot pharmacist; teenage store clerk and 2 customers for hydrocodone
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Idaho: man in suit and tie threatened to “light this place up” if he did not get oxycontin
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Virginia: Samurai Sword
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Squeezing into air conditioner shaft
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Electric saw to cut door knob
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Crowbar to Walgreens drive thru window
New Study: “Duh”
“Higher opioid doses were associated with increased risk of opioid overdose death.”
Source: JAMA 2011
Why the Prescription Drug Abuse Problem Is Different Than Illicit Drugs
Prescription drugs are qualitatively and quantitatively different than illegal drugs. First, prescription drugs are more plentiful and their availability, although controlled and regulated by the federal government, is not prohibited. Abusers of prescription drugs have more access to scheduled narcotics than illegal drugs.
Second, abusers have greater access to not only drugs but higher quality drugs. Large companies manufacture prescription drugs in a clean and safe facility with consistent dose and strength monitored by governmental agencies. Prescription drugs are taken orally with no risk of HIV or hepatitis B/C. The quality of illegal drugs, such as cocaine or heroin, is circumspect with no enforcement or regulatory safeguards. Illegal drug makers can dilute their product to expand profits without threat of regulatory sanctions or lawsuits. Deaths occur due to impurities.
Abuse Favorites
Many drugs can be abused. The current favorites are as follows:
Legal Opioids
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OxyContin
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Hydrocodone
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Other oxycodone
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Methadone
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Morphine
Oxycodone
Drug Diversion: Lucrative Secondary Market Exists
The public's appetite for prescription drugs leads to a lucrative secondary market. The typical prescription drug abuser personally uses the drugs for nonmedical purposes. Drug diversion occurs when the prescription holder gives or sells drugs to others. For example, oxycontin has been known to sell for $40 a pill. MScontin fetched as much as $70 per pill. A fetanyl patch was good for $50. Even vicodin was worth $1-$4 per pill. One study revealed 85% of respondents received drugs from someone who had a prescription.
Young adults are generally the buyers and sellers in the secondary market. Kids steal from their parents' medicine cabinets to feed their own habit or sell to others. The relatively easy and free availability provide a seemingly endless supply chain. Peer pressure and addiction creates the demand. PDA moves from outcasts to the "in" kids. Soon it is accepted and cool to get high with prescription drugs.
Top 10 Drugs Prescribed for Workers’ Compensation Claims for 2010
- Oxycontin
- Lidoderm
- Hydrocodone-Acetaminophen
- Lyrica
- Celebrex
- Gabapentin
- Skelaxin
- Cymbalta
- Meloxicam
- Cyclobenzaprine HCL
IAIABC Letter to States
“The abuse of prescription opioids has become a great personal risk to injured employees, a disruptive force in the lives of those close claimants harmed by abuse, and a cost concern to other stakeholders in the United States workers compensation system.“
“One tool is to effectively deploy treatment guidelines with pain management recommendations. Another important element of chronic opioid management is a prescription drug monitoring program. Prescreening for abuse potential and drug screening are also key elements of chronic opioid management.”
Source: IAIABC and ACOEM letter dated 2011
Scheduled Narcotics
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I. Heroin, marijuana
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II. Morphine, Fentanyl, Duragesic, Percocet, Oxycontin
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III. Vicodin, Lortab
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IV. Darvan
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V. Cough medicine with codeine
The White House Takes Measures
On 4/21/11 the White House introduced a policy to fight a “prescription drug epidemic,” calling it “our nation’s fastest growing drug problem.”
White House Plan
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Expand Rx Drug Monitoring Programs
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Educate doctors and patients
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Expand prosecution of pill mills
CDC Workers’ Compensation Oriented Suggestions
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Workers’ compensation claim information can reveal inappropriate prescription painkiller prescriptions
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Establish programs that address claimant abuse of prescription painkillers
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Facilitate using substance abuse programs
© Copyright 2011 Stuart Colburn, Esq. Reprinted with permission.