 Emergency department and mortality data provided by the Drug Abuse Warning Network (DAWN) and reporting from law enforcement agencies indicate that methadone abuse is increasing. In addition, state-level public health agency data reveal increasing methadone abuse.
According to DAWN, the number of emergency department mentions for methadone increased overall from 3,832 in 1997 to 10,725 in 2001. Moreover, DAWN reports that 65 percent of methadone-related emergency department episodes also involved other drugs or alcohol in 2001. In that year alcohol was the substance most frequently used in combination with methadone, followed by cocaine and heroin.
DAWN mortality data for 2001 show that in most methadone-related deaths the drug was used in combination with other substances; however, those substances were not identified. Nevertheless, the data show that methadone ranked among the top 10 drugs mentioned in drug-related deaths in 24 of 33 DAWN reporting cities including Baltimore, Chicago, Detroit, Newark, and Phoenix.
According to the National Drug Intelligence Center National Drug Threat Survey 2003--a statistically representative nationwide survey of state and local law enforcement agencies--nearly 33 percent of all state and local law enforcement agencies indicate that methadone was commonly diverted or illicitly abused in their areas. Survey data further show that a higher percentage of agencies (42.7%) in southeastern states reported methadone abuse.
According to the Florida Department of Law Enforcement and the Florida Office of Drug Control, increased methadone abuse in Florida has resulted in an increase in overdose deaths involving the drug. The 2002 Report of Drugs Identified in Deceased Persons by Florida Medical Examiners indicates that methadone was found in 556 of the 5,816 decedents whose deaths were drug-related. Of these, methadone was determined to have contributed to the cause of death of 308 decedents. Furthermore, the number of drug-related deaths involving methadone increased 56 percent from 357 in 2001 to 556 in 2002, more than any other drug included in the report.
In North Carolina the number of single-drug deaths involving methadone--where methadone was determined to cause the death but was not necessarily the only drug found in the decedent--increased overall from 7 in 1997 to 58 in 2001. For all methadone-related deaths from 1997 to 2001, the source of the methadone was identified in 46 percent (92 deaths) of the medical examiner's reports. Of these deaths, 73 decedents were found to have a prescription for methadone that had been written for them by a physician; 11 had methadone from a prescription that had been written for another person; 3 were known to have obtained their methadone illegally, and 5 were reported as having a combination of prescription methadone and methadone obtained illegally.
Methadone abuse also is a problem in other parts of the United States. Medical examiner data from Maine indicate that methadone increasingly is involved in overdose deaths. According to the report Maine Drug-Related Mortality Patterns: 1997-2002, methadone was the prescription drug most commonly identified in toxicology reports. The report shows that the number of cases in which methadone was listed as the cause of death or as a contributing factor fluctuated but increased overall from 4 in 1997 to 14 in 2001. In the first 6 months of 2002, 18 deaths were reported in which methadone was a cause of death or contributing factor. The report further indicates that in 2001 fewer than half of decedents whose deaths were caused by methadone or in which methadone was a contributing factor had a documented prescription for the drug. Most of them had not been enrolled in a methadone maintenance program. In 2001 an analysis of 14 cases in which methadone was a cause of death or contributing factor statewide indicated that only three individuals had been receiving treatment from a methadone maintenance clinic.
METHADONE DEATHS INCREASING Sunday, 04/01/07
Prescription-drug deaths soar in state
Medicine fatalities rival murder numbers
By MELVIN CLAXTON
and BRAD SCHRADE
Staff Writers
Prescription-drug misuse is a quickly growing, silent epidemic that claims the lives of hundreds of Tennesseans each year.
Prescription drugs now outstrip illegal narcotics — such as cocaine, methamphetamine and heroin — as a cause of death across the state, a Tennessean review of the state's medical examiner's records show.
Deaths from prescription drugs now roughly equal murders in the state. Officially, there were just 31 fewer prescription-drug deaths than murders in 2005, the most recent year for which statistics are available.
The troubling figures illustrate far-reaching problems in the pharmaceutical trade where mistakes, missteps or criminal behavior by doctors, pharmacists, patients, or regulatory agencies can result in death.
The victims range from a newborn baby, whose death was blamed on the mother's methadone use, to an 82-year-old woman who overdosed on a combination of prescription and over-the-counter drugs. The collateral damage is often the children, spouses and other relatives left behind.
A prime example is Jerry Dillingham. He is still trying to come to grips with the death of his 16-year-old daughter, who accidentally overdosed on painkillers 17 months ago in Donelson.
"This stuff is killing people," Dillingham said. "It's killed my daughter."
Nowhere is the problem more acute than in Davidson County , where prescription drugs were linked to the deaths of at least 67 people in 2005. Statewide, there were 401 such deaths.
The numbers are constantly climbing.
From 2002 to 2005, at least 1,240 Tennessee deaths were linked to prescription drugs. During those four years, the number of prescription-related deaths jumped 62 percent.
The numbers are probably really even higher. The medical examiner only tracks drug deaths when an autopsy is performed, which is not always the case in some counties across Tennessee .
"Prescription-drug abuse and accidental overdose is clearly a huge and escalating problem," said State Medical Examiner Bruce Levy. "The cases are coming from all across the state." The deaths, says Levy, "are only the tip of the iceberg."
"Medical examiners only see cases where people are dying," Levy said. "But most people who repeatedly abuse prescription drugs don't die. Many live with the devastating consequences of their abuse."
Tennessee's experience is part of a larger national trend. A recently released report by the Substance and Mental Health Services Administration showed that the number of emergency room visits nationwide for prescription-drug overdose — 598,542 in 2005 — has almost caught up with those for illicit drugs.
Levy said his office has been sounding the alarm for years, but the issue has remained below the public's radar. The rising death toll, coupled with Tennessee 's identification as the state with the highest per capita prescription-drug use in the nation, adds a sense of urgency to the problem.
But there is little in the public records to indicate that federal, state and local agencies charged with monitoring the prescription-drug industry have had much success on this new front in the war on drugs.
Painkillers hit streets
While deaths from illegal narcotics such as cocaine and heroin have grabbed the headlines and are often dramatized in television shows and movies, it is powerful prescription painkillers such as methadone, oxycodone and hydrocodone that play a greater role in overdose deaths in Tennessee , autopsy records show.
Methadone, once primarily used to help heroin addicts kick the habit, has proved especially deadly. Now often prescribed for chronic pain, methadone has become a popular street drug linked to 231 deaths statewide from 2002 to 2005.
Dillingham's 16-year-old daughter, Bridgette, died of a methadone overdose on Oct. 6, 2005. He keeps her ashes in a cream-colored urn on an end table in his West Nashville home.
Dillingham said Bridgette, who died in her sleep, had been partying the day before with friends and took a lethal dose of methadone.
The medical examiner "said she went into such a deep sleep she forgot to breathe," Dillingham said.
Like Bridgette, many of the them had no legitimate prescriptions for the drugs that killed them. But they were likely to have had little trouble obtaining the drugs from friends and relatives or on the streets, say law-enforcement officials and others.
Doctors willing to write repeated prescriptions for powerful painkillers and other narcotics, and pharmacists and pharmacy technicians willing to skirt the law by selling drugs without the required prescriptions, have also helped ensure a steady supply of drugs for abusers.
"You get a different answer on how prescription drugs are diverted based on who you speak to," said James Inciardi, director of the Center for Drug and Alcohol Studies at the University of Delaware in Coral Gables, Fla. "We have seen that people obtain these drugs from a range of sources." The sources Inciardi and colleagues have identified include: "Physicians and pharmacists; parents and relatives; leftover supplies following an illness or injury; personal visits to Mexico, South America and the Caribbean; prescriptions intended for the treatment of mental illness; direct sales on the street and in nightclubs; pharmacy and hospital theft; through friends or acquaintances; under-the-door apartment fliers advertising telephone numbers to call; and 'stealing from grandma's medicine cabinet.' "
It wasn't supposed to be this way.
Under federal and state law, legal drugs deemed too potent, too addictive or too easily abused can only be obtained by prescription. Doctors sign the prescriptions and licensed pharmacists — whose records are subject to scrutiny by state and federal regulators — dispense the drugs.
But with black market prices significantly higher than standard retail prices, there is tremendous financial incentive for the illegal sale of prescription drugs. From January 2005 to Feb. 21 this year, police in Nashville investigated 408 drug cases — 114 involved prescription drugs.
Ten of the prescription-drug investigations involved a doctor, pharmacist or pharmacy technician, said Capt. Todd Henry, head of the Metro Police Department's special investigations division. He said eight of the cases resulted in people being charged and the other two were dropped.
The most recent case involved Brooks Pharmacy in south Nashville , where tens of thousands of pills were missing. Five people were arrested in that case, including Williamson County Sheriff Ricky Headley.
The number of known cases may understate the extent of the problem.
The pharmacy board, charged with regulating pharmacies and their employees, has just five investigators for the state's roughly 2,000 pharmacies, 8,000 pharmacists and 10,000 technicians. The board, by its own admission, rarely identifies pharmacists who break the law and is heavily dependent on the public and law enforcement to ferret out wrongdoing.
Most ODs accidental
More than half of Tennessee drug deaths resulted from a toxic combination of two or more prescription drugs — typically powerful painkillers, tranquilizers or stimulants. In addition, prescription drugs were increasingly mixed with illegal narcotics to create more deadly narcotic cocktails.
The majority of prescription deaths were from accidental overdoses; less than 11 percent were suicides. As deaths mount, so does the circle of people affected.
Not every death was from the intentional misuse of prescription drugs. Some resulted from toxic interactions between prescribed drugs that were legally taken for genuine illnesses. There are no statistics on how many deaths fall into this category.
Experts say the key to preventing such deaths is education.
"A number of people have different doctors for different conditions," said medical examiner Levy, whose office is a depository for drug-death reports from other medical examiners across the state. "The key is to tell your doctors every prescribed or over-the-counter medication you are on. I can't overstate the importance of this because there are some drugs that should never be taken together."
For many, legitimate prescriptions have led to fatal addictions.
When nurse Victoria Olivier severely damaged two vertebrae in her back while helping a patient, a doctor prescribed mild painkillers, according to Olivier's parents, Harry and Marian Sir of Brentwood . They say the drugs didn't work.
The prescriptions were increased in number and dosage, but the pain never seemed to go away. At the same time, Olivier's addiction to painkillers and muscle relaxants increased dramatically. It was a devil's choice: Suffer in severe pain or take the addictive drugs that would eventually wreck her life.
The Sirs watched the drugs transform their daughter from a productive, independent adult into a dependent child, who moved back home and could not support herself or even cook a meal. Harry Sir said he couldn't believe some of the drugs prescribed to his daughter.
"When I saw methadone, I said, 'You might as well be giving her heroin,' " he said.
In May 2004, Olivier fatally overdosed on methadone, the antidepressant citalopram and two other potent prescription drugs. She was 42.
The Sirs blame a medical system that they say did little to prevent their daughter's addiction or help her kick the problem once she became hooked.
And like so many survivors, they second-guess how they responded to their daughter's addiction. Harry Sir wishes he had sought a court order to have his daughter forced into a treatment program — a dramatic step that might have saved her life.
"We should have taken more decisive action as soon as we saw a problem," he said. "Like everyone else, we thought it would get better."
Some distraught relatives have sought to fight back by trying to identify the source of the prescription drugs that killed their loved ones. They have not always succeeded.
Jerry Dillingham said that when he gave police the name and phone number of the person he believes sold his daughter Bridgette a fatal dose of methadone on the street, he got sympathy from the detective but little else.
"He said he was sorry for my loss," Dillingham said. "He said, 'You need to take a deep breath and when you leave this office you need to let it go.' "
Cases such as Olivier's and Dillingham's highlight the human cost of the escalating prescription-drug problem in Tennessee . It is a problem for which many — including doctors, pharmacists, patients and regulators — share the blame.
The federal Drug Enforcement Administration, charged with enforcing the nation's drug laws, beefed up the staff of its unit that combats the illegal sale of prescription drugs in Tennessee . DEA officials, who won't say how many investigators or agents are in the unit, say that the staff was increased by a third within the past year and a half.
But DEA officials and other law-enforcement agencies readily admit that combating prescription drugs poses unique challenges.
"One of the major problems with investigating prescription-drug cases is the commingling of legal and illegal activity," said Assistant Special Agent Harry Sommers, head of the DEA's Nashville district office. "The pharmacist who might be selling drugs without prescriptions is also selling drugs legally. This makes it harder to discern illegal activity."
http://www.dicksonherald.com/apps/pbcs.dll/article?AID=/20070401/NEWS03/704010405/1297/MTCN02
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