November 10th, 2008
By David Gutierrez | A report by the Florida Medical Examiners Commission has concluded that prescription drugs have outstripped illegal drugs as a cause of death.
An analysis of 168,900 autopsies conducted in Florida in 2007 found that three times as many people were killed by legal drugs as by cocaine, heroin and all methamphetamines put together. According to state law enforcement officials, this is a sign of a burgeoning prescription drug abuse problem.
"The abuse has reached epidemic proportions," said Lisa McElhaney, a sergeant in the pharmaceutical drug diversion unit of the Broward County Sheriff's Office. "It's just explosive."
In 2007, cocaine was responsible for 843 deaths, heroin for 121, methamphetamines for 25 and marijuana for zero, for a total of 989 deaths. In contrast, 2,328 people were killed by opioid painkillers, including Vicodin and Oxycontin, and 743 were killed by drugs containing benzodiazepine, including the depressants Valium and Xanax.
Alcohol directly caused 466 deaths, but was found in the bodies of 4,179 cadavers in all.
While the number of dead bodies containing heroin jumped 14 percent from the prior year, to a total of 110, the number of deaths influenced by the painkiller oxycodone increased by 36 percent, to a total of 1,253.
Across the country, prescription drugs have become an increasingly popular alternative to the more difficult to acquire illegal drugs. Even as illegal drug use among teenagers have fallen, prescription drug abuse has increased. For example, while 4 percent of U.S. 12th graders were using Oxycontin in 2002, by 2005 that number had increased to 5.5 percent.
It's not hard for teens to come by prescription drugs, according to Sgt. Tracy Busby, supervisor of the Calaveras County, Calif., Sheriff's Office narcotics unit.
"You go to every medicine cabinet in the county, and I bet you're going to find some sort of prescription medicine in 95 percent of them," he said.
Adults can acquire prescriptions by faking injuries, or by visiting multiple doctors and pharmacies for the same health complaint. Some people get more drugs than they expect to need, then sell the extras.
"You have health care providers involved, you have doctor shoppers, and then there are crimes like robbing drug shipments," said Jeff Beasley of the Florida Department of Law Enforcement. "There is a multitude of ways to get these drugs, and that's what makes things complicated."
And while some people may believe that the medicines' legality makes them less dangerous than illegal drugs, Tuolumne County, Calif., Sheriff's Office Deputy Dan Crow warns that this is not the case. Because everybody reacts differently to foreign chemicals, there is no way of predicting the exact response anyone will have to a given dosage. That is why prescription drugs are supposed to be taken under a doctor's supervision.
"All this stuff is poison," Crow said. "Your body will fight all of this stuff." Tuolumne County Health Officer Todd Stolp agreed. A prescription drug taken recreationally is "much like a firearm in the hands of someone who's not trained to use them," he said.
While anyone taking a prescription medicine runs a risk of negative effects, the drugs are even more dangerous when abused. For example, many painkillers are designed to have a delayed effect that fades out over time. This can lead recreational users to take more drugs before the old ones are out of their system, placing them at risk of an overdose. Likewise, the common practice of grinding pills up causes a large dose of drugs to hit the body all at once, with potentially dangerous consequences.
"A medication that was meant to be distributed over 24 hours has immediate effect," Stolp said.
Even more dangerous is the trend of mixing drugs with alcohol, which, like most popularly abused drugs, is a depressant.
"In the case of alcohol and drugs, one plus one equals more than two," said Tuolumne County Sheriff's Office spokesperson Lt. Dan Bressler.
Florida pays careful attention to drug-related deaths, and as such has significantly better data on the problem than any other state. But a recent study conducted by the U.S. Drug Enforcement Agency (DEA) suggests that the problem is indeed national. According to the DEA, the number of people abusing prescription drugs in the United States has jumped 80 percent in six years to seven million, or more than those abusing cocaine, Ecstasy, heroin, hallucinogens an inhalants put together.
Not surprisingly, there has been a corresponding increase in deaths. According to the Drug Abuse Warning Network, the number of emergency room visits related to painkillers has increased by 153 percent since 1995. And a 2007 report by the Justice Department National Intelligence Drug Center found that deaths related to the opioid methadone jumped from 786 in 1999 to 3,849 in 2004 - an increase of 390 percent.
Many experts attribute the trend to the increasing popularity among doctors of prescribing painkillers, combined with a leap in direct-to-consumer marketing by drug companies. For example, promotional spending on Oxycontin increased threefold between 1996 and 2001, to $30 million per year.
Sonora, Calif., pharmacist Eddie Howard reports that he's seen painkiller prescriptions jump dramatically in the last five years.
"I don't know that there is that much pain out there to demand such an increase," he said.
The trend concerns Howard, and he tries to keep an eye out for patients who are coming in too frequently. But he admits that there is little he can do about the problem.
"When you have a lot of people waiting for prescriptions, it's hard to find time to play detective," he said.
Still, the situation makes Howard uncomfortable.
"It almost makes me a legalized drug dealer, and that's not a good position to be in," he said.
Sources for this story include: www.nytimes.com; www.uniondemocrat.com