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Prescription Painkillers Take Their Toll

Society struggles to handle the uptick in crime and addiction

This is the last part in a four-part series on America’s prescription painkiller epidemic. Read part one, part two, and part three.

By Elaine Meyer

Published August 20, 2013

Many of the areas hardest hit by the prescription painkiller epidemic are struggling to deal with the toll of addiction. From limited resources for addicts trying to get treatment to new law enforcement efforts to crackdown on rising illegal drug sales and criminal activity, prescription opioids have created a significant health and legal burden in many of the hardest hit pockets of the country.

In Appalachia, there is a one to two year waiting list for treatment, according to Dr. Jennifer Havens, an epidemiologist at the Center on Drug and Alcohol Research at the University of Kentucky College of Medicine.

In New York City, there has been a “huge explosion,” of people seeking treatment for opioid analgesic addiction, which has put great pressure on drug rehabilitation facilities, says Dr. Katherine Keyes, an assistant professor of epidemiology at Columbia University’s Mailman School of Public Health. “It’s hard to get a detox bed in New York City as it is.”

“It is a minority of people who need treatment who actually get into treatment for a number of reasons: reluctance, lack of availability,” says Dr. Leonard Paulozzi, a medical epidemiologist in the division of unintentional injury prevention at the CDC’s National Center for Injury Prevention and Control.

Meanwhile, law enforcement is increasingly stepping in as criminal activity around prescription drugs increases.

“The system, even though it’s controlled through prescriptions and tracking, is extremely porous,” says Bridget Brennan, New York City’s special narcotics prosecutor. “There are all kinds of places where someone with criminal intent can intervene in the system and obtain the drugs, whether by theft or stealing or buying a prescription—a paper prescription—and then fraudulently filling it out,” she says.

Since 2009, federal prosecutors have brought charges against 59 doctors related to the illegal prescribing of painkillers, according to the New York Times. Often, these doctors have prescribed drugs not only to addicts but to drug dealers, as was alleged by the Federal Bureau of Investigation in 2011 when it sued a doctor in Las Vegas whose “patients” were known drug dealers, according to the agency.

Staten Island—New York City’s “ground zero” of the painkiller epidemic— has become a hotbed for prescription drug-related crime, according to Brennan.

One of the biggest arrests took place in March of 2011 when authorities charged 31 people with dealing painkillers out of a Lickety Split ice cream truck that cruised around the borough targeting addicts as customers.

The ring originated out of an alliance between a member of a Long Island mafia family and his surgeon’s office manager, who allegedly sold him prescription pads that could be used to fill out fake prescriptions for painkillers, according to the New York City special narcotic prosecutor’s office.

It is a classic example that highlights how porous the system of tracking doctors’ prescribing practices currently is, says Brennan. Additionally, because of patient-doctor confidentiality laws and a “big push to accept what a patient would tell a doctor without a whole lot of scrutiny,” cases against doctors like the one filed against alleged pill mill operator Stan Li are “extraordinarily complex and time-consuming” Brennan says.

The pressure has also been on pharmacies to be more vigilant about prescribing practices. Some have even stopped stocking prescription opioids in reaction to the uptick in armed robberies for painkillers. The Drug Enforcement Agency recently fined The Walgreen Company for failing to monitor suspicious drug sales in some of the drugstore giant’s Florida pharmacies and has gone after pharmaceutical distributors that have ignored signs of illegal pill sales at some of their pharmacy customers.

Meanwhile, health authorities and people affected by opioid addiction have exerted pressure on drug manufacturers to make it harder to get a high from their products. Leading the way just as it did back in the late 1990s, Purdue released a reformulated version of OxyContin in 2010 that turns into jelly when a user tries to break it into powder for snorting or injecting. And the Food and Drug Administration in April put the kibosh on generic versions of the old form of OxyContin.

This is good news, say some. Others, particularly patients who say their pain is legitimate, have complained that some of the new measures have made it harder for them to get needed pain relief drugs.

The measures also may be too little too late for many addicts. Increasingly because it is harder to get opioid analgesics, addicts are turning to heroin, which is a cheaper alternative that provides the same intense high. A 2012 study in the New England Journal of Medicine of over 2,500 people seeking treatment for prescription opioid addiction found that 66 percent had begun using other drugs because of the OxyContin reformulation. For most, that drug was heroin. It is ironic considering the great effort opioid analgesic manufacturers have taken to differentiate their products from past opium-related pain treatments, especially heroin, which retains negative connotations from street epidemics of earlier eras.

Patrick Daly, the brother of Erin Daly of Oxy Watchdog, died of a heroin overdose at age 20 after becoming addicted to OxyContin and Vicodin. He began taking heroin when the prescription drugs became too expensive, according to Daly.

“He wasn’t able to get out of the spiral that he was in. This was a horrible, painful thing for him,” says Daly. “It’s very easy for people to write off drug addicts, especially when they are kids who are from good backgrounds or good families, and they are hooked up on pills. People say, ‘Why don’t you just stop?’ They want to stop, and they can’t stop because these drugs are so powerful. If they progress to the point of doing heroin, then it’s even harder.”

Meanwhile, the number of drug overdose deaths that involve opioid analgesics has continued to rise. The most recent numbers, for 2010, had risen to 16,651 from 15,597 in 2009 and 4,030 in 1999, according to the CDC.

“The sales of the drugs went up in 2011, and the sales are a pretty good predictor of health outcomes and death,” says Dr. Paulozzi. “I can’t say we’ve turned the corner in terms of death and I can’t say we’ve turned the corner in terms of emergency room visit rates either,”

Reformulations and more prescription drug monitoring programs could cut down on availability, says Dr. Keyes, but she is not terribly optimistic.

“I don’t see any reason that it would go down. There are not any programs in place to reduce,” she says. “The best way to reduce drug use, what we’ve seen over and over again is strict policies and laws.”

Of all people who can speak about the ravages of the prescription opioids, David Laffer, the man who was convicted of shooting up a Long Island pharmacy for Vicodin and murdering four people, is perhaps one of the best. In November, 2011, his closing remarks after being sentenced to life in prison for first-degree murder, were a chilling reminder of the distance the nation still has to travel to curb this epidemic:

“I know that it doesn’t begin to explain or excuse my horrific actions that day. However, if a discussion and recognition of prescription pill abuse and doctor shopping has been generated among the public, then maybe something beneficial can come from this.”

This is the conclusion of a four-part series on the prescription opioid epidemic. Go back and read part onepart two, and part three of this series.

Edited by Jordan Lite and Dana March

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The views and opinions expressed on this website are solely those of the authors and do not represent those of the Department of Epidemiology, the Mailman School of Public Health, or Columbia University.