The paradox of painkillers

From the Salem Statesman Journal, May 9, 2012

Salem Hospital takes steps to reduce excessive prescriptions as overdose deaths rise

READ – Reducing prescription painkillers in the Salem Health emergency

For Matt Harp, it all started with a baseball injury.

He was a sophomore in college when he separated his shoulder. After surgery, his doctor prescribed him oxycodone, a narcotic painkiller.

He took them as prescribed: three 40 milligram doses per day. Looking back, he said, he was hooked by the eighth day of using the medication.

Harp was able to refill his prescription twice. By his 90th day of using oxycodone, the formerly strong athlete was too weak to roll over in his bed and reach for the pills on his nightstand.

Harp told his story Tuesday at a Salem Hospital news conference, where emergency department doctors announced new policies they’re using to reduce excessive prescription of narcotic painkillers.

Although Harp’s story has a happy ending — he is completing his education to become a certified drug and alcohol counselor and is married with an 8-year-old son — many others throughout Oregon and the U.S. haven’t been as fortunate.

As the number of prescriptions for narcotic painkillers has risen in the past decade, so too, have deaths resulting from overdoses of those drugs.

Deaths involving prescription painkiller overdoses more than tripled from 1999, reaching almost 15,000 in 2008, according to Centers for Disease Control and Prevention.

In Oregon, 193 people died from prescription drug overdoses in 2011, according to the Oregon State Medical Examiner. That’s more than the deaths caused by heroin and cocaine overdose combined.

The quantity of prescription painkillers sold to pharmacies, hospitals and doctors’ offices was four times larger in 2010 than in 1999, according to CDC.

Local officials in law enforcement, the justice system and addiction treatment communities say addiction commonly begins the way Harp’s did.

“So many young kids are being prescribed OxyContin (an oxycodone brand name) for minor pains, and what that does to them is that gets them addicted to OxyContin and the withdrawals from OxyContin causes severe muscle aches and pain, and it makes them go back to the doctor,” a Marion County sheriff’s drug detective said.

By the time providers catch on that their patient is addicted, it’s often too late, the detective said. People then start looking for other ways to get their fix, including the streets.

“The (nonmedical) prescription drug use right now in Marion County is rampant,” he said.

The Statesman Journal has agreed not to name the detective because he works undercover.

Salem Hospital’s emergency department has implemented protocols to reverse the trend of overprescription of painkillers, officials said.

Starting in September, the department reduced its distribution of narcotic painkillers by 70 percent in an effort to clear the streets of excess pills that could be diverted or misused.

A big part of the strategy is the Oregon Prescription Drug Monitoring Program, which was signed into law in 2009 and began operating in June 2011.

Pharmacies populate the database when they dispense controlled substances. The database tracks schedule II, III and IV controlled substances, which have varying potential for abuse.

If doctors don’t find objective reasons behind complaints of pain or if a patient specifically asks for narcotic medications, they can look up the patients in the database to see who their providers are, what other prescriptions they have filled and when.

The database can raise the red flags that nonmedical users of the drugs try to hide, said Dr. Rumm Morag, an emergency medicine physician at Salem Hospital.

Oregon Health Authority spokeswoman Christine Stone said that although Oregon pharmacies are required to participate in the program, not all have an updated computer system that enables them to participate.

About 96 percent of the state’s pharmacies are uploading data into the system.

As of October, 37 states have operational prescription drug monitoring programs.

Another focus in Salem Hospital’s efforts is to refer patients back to their primary care or pain management doctors to help prevent doctor shopping.

It also is no longer prescribing long-acting opiates, such as OxyContin, for noncancer patients. Use of non-narcotic medications will be prioritized and Schedule III narcotics may be prescribed for up to three days.

On May 1, a woman who obtained oxycodone by committing identity theft at the Salem Hospital emergency department was sentenced to more than three years in prison.

Sarah Flom, 25, was arrested June 13, 2011, while she was admitted in the hospital under a false name. It was the second of two consecutive days she used the false name and was taken to the emergency room by ambulance, according to Salem police reports.

In November 2010, Flom went to the hospital on three occasions using her sister’s identity, the investigation found.

On Nov. 15, 2010, Flom was admitted to the hospital for five days under her sister’s name, and her family, including the sister, actively covered for her, according to police reports.

When Flom was arrested in June, she eventually told police that she was addicted to narcotic pain medications and heroin.

Police estimated a monetary loss of more than $37,000 in Salem Hospital and Marion County Fire Department services.

Morag said the hospital’s new safeguards might not prevent such cases.

“Addiction is a powerful thing,” he said.

The hospital’s goal is to reduce the amount of narcotics that are out in the community, he said, but people still will fall through the cracks.

A major concern for people in the law enforcement, justice system and addiction treatment communities is that prescription drug addiction often leads people to heroin.

Salem police Lt. Dave Okada said that almost all suspects that detectives interview in heroin-related charges have a history of prescription drug abuse. Often, when users start seeking narcotic painkillers on the street, they find that heroin, which also is an opiate, is cheaper and easier to obtain, he said.

In 2011, Salem police had 201 heroin-related arrests, more than double the number from 2007, Okada said. Statewide, 143 people died because of heroin in 2011, a 59 percent increase from the year before.

The Marion County sheriff’s detective told a similar tale as Salem police.

“It’s a gateway to heroin abuse,” he said.