February 4, 2007 - Spokesman-Review (WA) Deadly Prescriptions As The Number Of Deaths Attributed To Legal Painkillers Surpasses Those Of Illicit Drugs, Health Experts Around The Region Are Sounding The Alarm By JoNel Allecia, Staff writer

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Deaths from prescription painkillers have soared in Spokane and across Washington during the past decade, according to new research that warns of danger as close as the bathroom medicine cabinet.

Popular drugs such as hydrocodone and methadone fueled an 800 percent increase in statewide deaths linked to prescription opiates, which jumped from 45 in 1995 to 411 in 2004, state health researchers found.

Spokane, which once saw almost no prescription-related deaths, logged 48 deaths in 2004, posting the highest rate per population of any county in the state. Unintended drug poisonings now account for almost as many deaths in Washington as car crashes -- about 650 a year -- primarily because of the spike in prescription-related fatalities, said Jennifer Sabel, an epidemiologist with the state Department of Health.

"Prescription drug overdose deaths have been climbing through the roof," said Sabel. "Even doctors don't really realize the magnitude of the deaths."

While no detailed research has been conducted in Idaho, health officials there said, in general, accidental deaths caused by drug poisoning rose statewide by 94 percent between 2000 and 2004, jumping from 32 to 62. And Dr. Robert West, the Kootenai County coroner, said there's no doubt the rise is tied to powerful legal prescriptions.

"I'm showing six, just off the top of my head, that are definite prescription drug overdoses apart from alcohol," West said.

In West's exam room, victims last year included an elderly woman who died after failing to remove used patches of time-released Fentanyl, a prescription opiate, before applying the new ones.

"There's usually a 72-hour dose time on the patch, but at the end of 72 hours there's still Fentanyl left in the patch," West said. "She came in with eight or nine patches plastered on her body. It caused a narcotic cessation of breathing."

One addict seeking an extended high took long-acting prescription methadone pills, but didn't wait for the effect to kick in. He added Benadryl, a cold medicine, plus alcohol -- and then died from the effects of the toxic cocktail.

"In this case, the alcohol level was low, below intoxication level, but the methadone was the toxic drug," West said. "It's not likely that someone would die from a Benadryl overdose, but if the Benadryl is there, it adds up."People seeking relief from pain -- or those just looking to get high -- are ingesting potent painkillers in greater variety and increased quantity, often without recognizing the hazard and often with fatal results, experts said.

"Users may be lulled into thinking prescription medications are safe as opposed to 'street drugs,' " said Spokane County Medical Examiner Sally Aiken.

But the most detailed examination ever of opiate-related deaths in Washington reveals that legal opiates are killing more people than illicit substances, such as heroin.

Ann Lima, a state epidemiologist trained to study causes of death, said researchers began noticing a grim trend: more and more death certificates that named drugs prescribed by doctors.

"I've had to manually review all these death certificates and I've just seen it increase," she said. "It's incredible how much it's gone up."

Lima was part of the team of researchers who hand-examined more than 3,500 state death certificates from 1995 to 2004 that listed opiates as a cause. Among their findings:

oOverall opiate deaths -- those linked to prescription drugs, illegal drugs or others that were unspecified -- more than doubled between 1995 and 2004, rising from 260 to 555 a year.

oThe number of deaths definitely caused by prescribed opiates such as methadone and hydrocodone rose tenfold, from 23 to 267, between 1995 and 2004. Deaths definitely or possibly tied to the drugs rose 800 percent, from 45 in 1995 to 411 in 2004.

oThe highest death rates were among men ages 35 to 54.

oDuring the same period, deaths caused by illicit opiates, such as heroin, and those that were unspecified, actually fell by 33 percent, from 215 in 1995 to 144 in 2004. That's a trend that echoed here, said Aiken, Spokane's medical director.

"In Spokane County, it has become much less usual to list heroin, cocaine and methamphetamine as the cause of death, and more common to find a prescription medication," Aiken said.

The huge jumps recorded by state researchers probably underestimate the extent of the problem, Aiken added. Better investigation techniques and a new emphasis on determining the cause of drug-related deaths will yield even more alarming results, predicted Aiken, who expects final tallies soon for 2006.

In Spokane, state researchers found no definite prescription opiate deaths in 1995, and only two possibly linked to the drugs. But by 2004, the numbers had jumped to 36 definite prescription deaths and a dozen more that were possibly tied to the drugs.

That left Spokane with a rate of 8.08 definite deaths per 100,000 people, far above larger population centers. In King County, for instance, with 55 definite deaths, the rate was 2.9 per 100,000 residents.

That only confirms what those who've long worried about the problem believe.

"When our own coroner is telling us that legal drugs are killing more people than illegal drugs, it's time we got a clue," said Troy Anderson, police chief in Chewelah, where citizens have started a grass-roots advocacy group aimed at stopping teenagers from using prescription drugs.

Mark Selle, a Chewelah-area school district superintendent who helped form the group "Prescriptions for Life," (see below) said public awareness needs to catch up with reality.

"I'm familiar with people close to me who have hydrocodone, OxyContin and Percocet," said Selle, citing common painkillers. "They think, 'I can't sleep, I'll just pop one of those.' "

The new Washington data offers the first detailed glimpse into what health advocates say is a growing problem nationwide. Researchers tracking death certificates followed a hunch about what seemed to be a disturbing trend, said Dr. Kim Thorburn, former health director for the Spokane Regional Health District.

"It was that kind of red flag that sparked our early discussion," said Thorburn, who championed injury prevention during her nine-year tenure, including more than a year as the head of the state Board of Health. "We thought, 'We need to look at this.' "

Only a few states have reviewed deaths specifically related to prescription opiates, but those that did found exponential increases. A national study drafted last year for the federal Centers for Disease Control and Prevention showed an increase of more than 91 percent in narcotic painkiller poisonings listed on death certificates between 1999 and 2002.

"This is a national problem," said Dr. Gary Franklin, medical director for Washington's Department of Labor and Industries, who has studied prescription opiate deaths.

Experts familiar with the drugs and their effects said vastly increased supplies of prescription painkillers have combined with growing demand and a cavalier attitude about the potential for toxicity.

"If they take two or three Ambiens and they still have pain, they end up taking 10 or so oxycodone just to see if that works," noted West, the Kootenai County coroner.

"Or someone who's been used to taking eight Percodan will switch over to OxyContin, and it will result in an overdose."

Users fail to recognize the drugs' most dangerous effect: suppressing the respiratory system, doctors said. If too much of the drug is taken, or if a long-acting drug is taken in combination with other potent medications -- or even with less lethal substances such as antidepressants, cold medicines or alcohol -- the combination can override even the most basic bodily function.

"In some of the acute cases, they'll simply stop breathing," West said. "The narcotic depresses the brain stem that causes the breathing."

Statistics don't distinguish between mistakes in drug prescriptions or dosing and intentional misuse of drugs, researchers said. Users seeking a high may induce a euphoric effect by ingesting large quantities of a drug, or by injecting, snorting or smoking it, but the result is the same -- death by overdose.

"You have a kid who comes over after school and starts rummaging through the medicine cabinet," West said. "They will take anything they can to get a buzz."

February 4, 2007 - Spokesman-Review (WA)

Rx Painkiller Supplies, Dosages Soaring

By JoNel Allecia, Staff writer

Supplies of prescription painkillers have increased exponentially since the late 1990s, when regulations governing their use were relaxed.

In Washington, for instance, the volume of methadone distributed from manufacturers to hospitals and pharmacies grew by nearly 975 percent between 1997 and 2004, according to federal Drug Enforcement Administration statistics. Oxycodone supplies surged by nearly 600 percent, state researchers noted.

The methadone figures don't include use of the drug for rehabilitating addicts in places such as the methadone clinic run by the Spokane Regional Health District. The drugs used there come in a liquid form aimed at thwarting illegal distribution.

In the late 1990s, methadone was approved as a prescription painkiller. Since then, it has become the drug cited most often in opiate-related deaths, noted Jennifer Sabel, an epidemiologist with the Washington state Department of Health.

The increase in drug distribution was driven, in part, by advocates for people with chronic pain, who argued that opiates provided safe, humane treatment with low risk of addiction, said Dr. Gary Franklin, medical director for the Washington state Department of Labor and Industries.

Researchers have discovered, however, that people using opiates for chronic, non-cancer pain have developed growing tolerances for the drugs. Equally alarming, some patients have found that very high doses of opiates actually make them hypersensitive to pain.

Franklin conducted a study of workers' compensation patients, showing that the average daily dose of the most potent long-acting opiates had increased by 50 percent between 1996 and 2002, to 132 milligrams a day.

Even that figure has been eclipsed, Franklin said recently. The average daily dose for many clients is now up to about 250 milligrams a day, with some users routinely ingesting 400 to 500 milligrams.

"That is absolutely huge," said Dr. Kim Thorburn, former health officer for the Spokane Regional Health District. "By comparison, in a naïve young woman not used to those drugs, even 10 milligrams can make her really sick."

One remedy may be a pilot effort, led by Franklin, to provide new opiate guidelines for doctors who treat pain patients through state-run programs.

"The vast majority of people who are getting into trouble with prescriptions are getting into the drugs without any guidance," he said.

Under a plan scheduled for release in March, doctors will be urged to think twice when daily doses reach 120 milligrams of morphine or its equivalent, and to seek advice from pain management specialists if that level poses a problem.

A second part of the plan offers guidelines to help taper drug dosages that exceed the 120 milligram mark if patients' pain and function doesn't improve.

Franklin stressed that the guidelines are an educational effort aimed at preventing new patients from becoming too tolerant to drugs, not a mandate to cut doses for existing clients.

"It is the most practical way to get at this rather than causing a ruckus among people who are already on high dosages," he noted.

Slowing the skyrocketing number of prescription drug deaths will depend on a number of other actions targeting doctors, patients and the public, experts said.

A prescription monitoring program would provide electronic tracking of patients, doctors and pharmacies to help prevent users from accessing multiple drugs from several sources.

A pharmaceutical "take-back" program that allows people to return unused or outdated drugs to general locations is now in pilot stages in Washington. Current laws require unwanted drugs to be returned only to law enforcement. That encourages people to keep drugs around, where they pose a danger, or to flush them into the sewer, where they contaminate water supplies.

But the biggest effort must center on raising public awareness about the dangers of prescription painkillers, experts said.

Parents need to lock drugs away from their teenagers as well as their toddlers. Patients need to check and double-check their drugs, their dosages and any potential interactions. And they need to take the instructions and warnings seriously.

"People don't understand the combination with alcohol," Thorburn said.

Even users popping painkillers for the high need a dose of reality. Unintentional drug poisonings are precisely that, she added.

"This is a preventable death."

February 4, 2007 - Spokesman-Review (WA)

Searching For Solutions

By JoNel Allecia, Staff writer

CHEWELAH - A 12-year-old brings hydrocodone tablets to a middle-school slumber party.

A high-schooler steals methadone pills from her parents' medicine cabinet.

A 21-year-old cuts open a 12-hour Fentanyl patch, squeezes the drug onto tinfoil, and smokes the entire contents through a "tooter," the stripped plastic cartridge from a Bic pen.

He's still holding it in his hand when police break down the bathroom door.

He's dead.

If Mark Selle sounds upset, it's because the superintendent of Chewelah's Valley and Orient school districts has seen every one of these things happen in his community.

And it's taking far too long to do anything about them.

"When we're watching these kids die, when we're seeing these addicts, it's frustrating that we can't do it faster," said Selle.

He's part of a small group of parents and community leaders who have formed to combat prescription drug abuse, which they believe is a grave and growing threat to young people in this Eastern Washington town of 2,300 -- and beyond.

"This is a problem at every high school in the country," said Selle, a founding member of the Chewelah-based "Prescriptions for Life."

For four years, the group that includes the police chief, a counselor, a school administrator and two parents whose 20-year-old daughter is an admitted addict have done everything they can think of to warn the world.

They've made presentations and held public forums. They've put out press releases and raised money, though not enough. They've put together a Web site and public telephone line.

Slowly, they say, they're helping raise awareness of a problem that hasn't reached the radar of a society convulsed with anxiety over methamphetamine and other illegal drugs.

"It's becoming generation Rx," said Chewelah Police Chief Troy Anderson.

In this town, organizers can name a half-dozen young people who've died from prescription drug overdoses. That includes Jared C. Scott, a longtime Boy Scout who had a good job, lots of friends, a new fiancé -- and who sliced open and smoked a Fentanyl patch within days of his 21st birthday in September 2004.

The Stevens County coroner listed drug overdose as the cause of death.

Jared's mother, Karen Scott, said her son was not a typical drug user. She'd never heard of Fentanyl when he died, but she knows now that he and his friends may have used the prescription narcotic before.

"Kids are kids. They take chances," she said. "And parents are parents. They want to believe their kids. I don't know how it's going to change, but maybe."

Communities worried about meth, Ecstasy, cocaine and marijuana are ignoring an equally alarming challenge, said Selle, the school superintendent.

"Everywhere we go, when we present people say, 'Well, it's not here,' " he said. "But it is."

National research backs that view. Nearly one in five teenagers -- 19 percent or 4.5 million -- reported abusing prescription medications to get high, according to the Partnership for a Drug-Free America, a nonprofit advocacy group that seeks to lower youth drug use through advertising.

And nearly a third of those young people surveyed believe "there's nothing wrong" with using prescription medications without a prescription, the research showed. Three out of 10 teens believe that prescription pain relievers are not addictive, according to a 2005 study conducted by the group.

Hayley Tilla certainly shared those views as a high school sophomore in Chewelah, when she first tried OxyContin. It made her sick, she said. Then it made her high. Finally, it made her desperate.

"I stole, I lied, anything you can think of, I did it," she said.

Now 20, the blond, brown-eyed young woman has been battling prescription addiction for more than five years.

Today, she's not sure who's winning.

"I am doing good because I'm not using, but I'm not really doing good, you know?" said Hayley, who suffers from severe anxiety and constant, low-level withdrawal symptoms.

"I'm having such a hard time with this whole pain thing. I'm just always in pain, always in pain. And I know what would fix it would be to go get high."

She won't give in, she said, partly because of her family and partly because she's grieving for her 23-year-old boyfriend, who died in a car accident last summer.

"I kind of feel like I'm doing it for him and for me," she said. "But mostly for me."

Hayley's parents, Jim and Sherry Tilla, fervently hope so. They helped start "Prescriptions for Life" as an outlet for the pain, fear and lack of control that come with having a child addicted to medication.

The couple wants parents and others to know that addiction can strike any kid, any family. They want to push for stricter statewide monitoring of prescriptions and for more and better treatment for Hayley Tilla and other young people with chemical cravings for the potent prescription drugs.

"We talked to her about drugs, about pot and alcohol, and she told us she'd never do that," said Sherry Tilla, a fourth-grade teacher. "She thought because the drug came from a doctor it was safe."

Prescription addiction is easy to sustain -- and easy to hide. The drugs are everywhere, and the symptoms are subtle, the parents said.

"I could never tell when she was high," Sherry Tilla said. "I would look into her eyes and look and look and I couldn't tell."

The stealthy drug turned their daughter into a stranger, Sherry Tilla said. Last year on Mother's Day, Jim Tilla gave his wife money to buy flowers. Hayley, in the midst of a relapse, stole the money from Sherry's purse.

Sherry Tilla didn't see Hayley again until midsummer.

"Then she came home and said, 'I need help.' "

Hayley went through a Seattle rehabilitation program last year and is on controlled doses of methadone. She'd prefer to be on buprenorphine, a drug that has been shown to be more effective for some prescription painkiller addicts. She wishes she could find a good addiction counselor.

But few regional doctors, even in Spokane, are certified to provide the drug -- and willing to do so. And counseling is almost nonexistent in the area.

"It seems ridiculous that people who want to get help can't," Hayley said.

In the meantime, Patti Hancock, the Stevens County coroner, said there are specific steps that parents and community members can take to keep prescription drugs away from young people.

First, she said, realize that the drugs are there.

"Everybody in the world has hydrocodone," she said. "Grandma and grandpa who have their little drugs in their medicine cupboard would die if they knew their grandkids, the kid who mows the lawn, are in there, looking for it."

Lock the drugs up or dispose of them properly, she said.

"These kids, they have their little 'pharm parties,' " Hancock said. "It's such a waste of life."

For information: Visit the Prescriptions for Life Web site at www.rx4lifechewelah.org or call (509) 935-4529.

Reach reporter JoNel Aleccia at 509-459-5460 or by e-mail at jonela@spokesman.com

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