By Lisa Girion, Scott Glover and Doug Smith, Los Angeles Times
September 17, 2011
Fueling the surge are prescription pain and anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol.
Lori Smith of Aliso Viejo with photographs of her son Nolan, who died of a drug overdose in January 2009, six months shy of his 16th birthday. A toxicology test turned up Zoloft, which had been prescribed for anxiety, and a host of other drugs that had not been prescribed, including two additional anti-anxiety drugs, as well as morphine and marijuana. (Liz O. Baylen / Los Angeles Times / September 18, 2011)
Propelled by an increase in prescription narcotic overdoses, drug deaths now outnumber traffic fatalities in the United States, a Times analysis of government data has found.
Drugs exceeded motor vehicle accidents as a cause of death in 2009, killing at least 37,485 people nationwide, according to preliminary data from the U.S. Centers for Disease Control and Prevention.
While most major causes of preventable death are declining, drugs are an exception. The death toll has doubled in the last decade, now claiming a life every 14 minutes. By contrast, traffic accidents have been dropping for decades because of huge investments in auto safety.
Public health experts have used the comparison to draw attention to the nation's growing prescription drug problem, which they characterize as an epidemic. This is the first time that drugs have accounted for more fatalities than traffic accidents since the government started tracking drug-induced deaths in 1979.
Fueling the surge in deaths are prescription pain and anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol. Among the most commonly abused are OxyContin, Vicodin, Xanax and Soma. One relative newcomer to the scene is Fentanyl, a painkiller that comes in the form of patches and lollipops and is 100 times more powerful than morphine.
Such drugs now cause more deaths than heroin and cocaine combined.
"The problem is right here under our noses in our medicine cabinets," said Laz Salinas, a sheriff's commander in Santa Barbara, which has seen a dramatic rise in prescription drug deaths in recent years.
Overdose victims range in age and circumstance from teenagers who pop pills to get a heroin-like high to middle-aged working men and women who take medications prescribed for strained backs and bum knees and become addicted.
A review of hundreds of autopsy reports in Southern California reveals one tragic demise after another: A 19-year-old Army recruit, who had just passed his military physical, took a handful of Xanax and painkillers while partying with friends. A groom, anxious over his upcoming wedding, overdosed on a cocktail of prescription drugs. A teenage honors student overdosed on painkillers her father left in his medicine cabinet from a surgery years earlier. A toddler was orphaned after both parents overdosed on prescription drugs months apart. A grandmother suffering from chronic back pain apparently forgot she'd already taken her daily regimen of pills and ended up double dosing.
Many died after failed attempts at rehab — or after using one too many times while contemplating quitting. That's apparently what happened to a San Diego woman found dead with a Fentanyl patch on her body, one of five she'd applied in the 24 hours before her death. Next to her on the couch was a notebook with information about rehab.
The seeds of the problem were planted more than a decade ago by well-meaning efforts by doctors to mitigate suffering, as well as aggressive sales campaigns by pharmaceutical manufacturers. In hindsight, the liberalized prescription of pain drugs "may in fact be the cause of the epidemic we're now facing," said Linda Rosenstock, dean of the UCLA School of Public Health.
In some ways, prescription drugs are more dangerous than illicit ones because users don't have their guard up, said Los Angeles County Sheriff's Sgt. Steve Opferman, head of a county task force on prescription drug-related crimes. "People feel they are safer with prescription drugs because you get them from a pharmacy and they are prescribed by a doctor," Opferman said. "Younger people believe they are safer because they see their parents taking them. It doesn't have the same stigma as using street narcotics."
Lori Smith said she believes that's what her son might have been thinking the night he died six months shy of his 16th birthday. Nolan Smith, of Aliso Viejo, loved to surf, sail and fish with his brother and father. He suffered from migraines and anxiety but showed no signs of drug abuse, his mother said.
The night before he died in January 2009, Nolan called his mother at work, asking for a ride to the girls basketball game at Aliso Niguel High School. Lori told him she couldn't get away.
When Nolan didn't come home that evening, his parents called police and his friends. His body was found the next morning on a stranger's front porch.
A toxicology test turned up Zoloft, which had been prescribed for anxiety, and a host of other drugs that had not been prescribed, including two additional anti-anxiety drugs, as well as morphine and marijuana.
All investigators could give the family were theories.
"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 said. "We called all of his friends, but no one would say they were with him. But he must have been with someone. You just don't do that by yourself."
The triumph of public health policies that have improved traffic safety over the years through the use of seat belts, air bags and other measures stands in stark contrast to the nation's record on prescription drugs. Even though more people are driving more miles, traffic fatalities have dropped by more than a third since the early 1970s to 36,284 in 2009. Drug-induced deaths had equaled or surpassed traffic fatalities in California, 22 other states and the District of Columbia even before the 2009 figures revealed the shift at the national level, according to the Times analysis.
The Centers for Disease Control collects data on all causes of death each year and analyzes them to identify health problems. Drug-induced deaths are mostly accidental overdoses but also include suicides and fatal diseases caused by drugs.
The CDC's 2009 statistics are the agency's most current. They are considered preliminary because they reflect 96% of death certificates filed. The remaining are deaths for which the causes were not immediately clear.
Drug fatalities more than doubled among teens and young adults between 2000 and 2008, years for which more detailed data are available. Deaths more than tripled among people aged 50 to 69, the Times analysis found. In terms of sheer numbers, the death toll is highest among people in their 40s.
Overdose deaths involving prescription painkillers, including OxyContin and Vicodin, and anti-anxiety drugs such as Valium and Xanax more than tripled between 2000 and 2008.
The rise in deaths corresponds with doctors prescribing more painkillers and anti-anxiety medications. The number of prescriptions for the strongest pain pills filled at California pharmacies, for instance, increased more than 43% since 2007 — and the doses grew by even more, nearly 50%, according to a review of prescribing data collected by the state.
Those prescriptions provide relief to pain sufferers but also fuel a thriving black market. Prescription drugs are traded on Internet chat rooms that buzz with offers of "vikes," "percs" and "oxys" for $10 to $80 a pill. They are sold on street corners along with heroin, marijuana and crack. An addiction to prescription drugs can be costly; a heavy OxyContin habit can run twice as much as a heroin addiction, authorities say.
On a recent weekday morning, Los Angeles County undercover sheriff's deputies posing as drug buyers easily purchased enough pills to fill a medicine cabinet on a sidewalk a few blocks south of Los Angeles City Hall.
The most commonly abused prescription drug, hydrocodone, also is the most widely prescribed drug in America, according to the U.S. Drug Enforcement Agency. Better known as Vicodin, the pain reliever is prescribed more often than the top cholesterol drug and the top antibiotic.
"We have an insatiable appetite for this drug — insatiable," Joseph T. Rannazzisi, a top DEA administrator, told a group of pharmacists at a regulatory meeting in Sacramento.
In April, the White House Office of National Drug Control Policy announced initiatives aimed at stanching prescription drug abuse. The plans include a series of drug take-back days, modeled after similar programs involving weapons, in which consumers are encouraged to turn leftover prescription drugs in to authorities. Another initiative would develop voluntary courses to train physicians on how to safely prescribe pain drugs, a curriculum that is not widely taught in medical schools.
Initial attempts to reverse the trend in drug deaths — such as state-run prescription drug-monitoring programs aimed at thwarting "doctor-shopping" addicts — don't appear to be having much effect, experts say.
"What's really scary is we don't know a lot about how to reduce prescription deaths," said Amy S.B. Bohnert, a researcher at the University of Michigan Medical School who is studying ways to lower the risk of prescription drugs.
"It's a wonderful medical advancement that we can treat pain," Bohnert said. "But we haven't figured out the safety belt yet."