US aims at its deadliest drug problem: painkillers

Associated Press
In this April 15, 2011 photo, a protester carries a sign protesting against a pain clinic in Fort Lauderdale, Fla.  Florida is the epicenter of the deadly rise in abuse of oxycodone and similar addictive painkillers, with doctors in the Sunshine State prescribing far more of the drugs than all other states combined, according to the Drug Enforcement Administration. And Florida’s pill mills are the supplier of choice for much of the eastern U.S., causing a ripple effect of drug overdoses and addiction to the  north _ a phenomenon dubbed the “OxyContin Express.” (AP Photo/Alan Diaz)
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The White House drug czar wants doctors, states and law enforcement working harder to stop America's deadliest drug-abuse problem: highly addictive prescription painkillers. They are killing more people than heroin and cocaine combined as they foster a slew of illegal "pill mill" clinics centered in Florida.

The federal government on Tuesday announced its first-ever comprehensive strategy to combat the abuse of oxycodone and other opioids, aiming to cut misuse by 15 percent in five years. That goal may sound modest, but it would represent a dramatic turnaround: Emergency room visits from prescription drug overdoses doubled from 2004 to 2009, when they topped 1.2 million, according to federal health officials.

"To say we are going to do away with the problem in five years, we cannot do that," said Dr. Roland Gray, medical director of the Nashville-based Tennessee Medical Foundation and a Food and Drug Administration adviser on addiction issues. "I think they are headed in the right direction."

The new approach will depend on education, stepped-up law enforcement and pill-tracking databases, with particular emphasis on Florida, where 85 percent of all oxycodone pills in the nation are prescribed. Many of those end up along the East Coast and in Appalachia, where people take buses to Florida just to get pills in phenomenon dubbed the "OxyContin Express."

"The key is that everyone realizes there is no magic answer to this," Gil Kerlikowske, President Barack Obama's national drug policy director, said in an interview with The Associated Press. "It's a really complex problem."

Danny Webb, the sheriff of Kentucky's rural Letcher County, said he would welcome a 15 percent drop in misuse of prescription drugs.

"Anything would help, because we're drowning in it up here in eastern Kentucky," Webb said, adding that he is skeptical any government plan will ultimately work. "I don't know if there's ever going to be a winning to this war on drugs."

When used properly, OxyContin and similar medications help people deal with chronic pain, slowly releasing key ingredients over many hours. Abusers crush the pills and sniff or inject them, resulting in a euphoric heroin-like high.

According to the federal Centers for Disease Control and Prevention, overdose deaths from painkillers have risen from less than 4,000 in 2000 to more than 11,000 in 2007, the most recent statistics available. Cocaine deaths went from about 3,000 in 2000 to more than 5,000 in 2007; for heroin, the numbers have remained steady at around 2,000 each year.

The agency also reported last year that drug-induced deaths, led by these painkiller drugs, are now second only to car crashes in accidental fatalities nationwide.

Renee Doyle, a Fort Lauderdale mother whose son Blayne was in an oxycodone haze when he was struck and killed by a car in 2009, said he was able to get 240 pills on each monthly visit to a local pain clinic by doing little more than asking for them.

"I think people were just not paying attention and then greed took over," she said. "They are legal drug dealers and they should be outlawed."

There are plenty of legitimate pain clinics. Those that cross the line dispense hundreds of pills per patient based on questionable diagnoses — or none at all. They often accept only cash and direct people to get prescriptions filled at specific pharmacies sometimes owned by the same operators.

Although the DEA and local police recently arrested more than 20 people, including five doctors, in a crackdown on South Florida pill mills, Kerlikowske said it's not strictly a law enforcement issue.

"It's a real collaboration. It's not just a prosecutor and DEA. It isn't just the medical profession. It's everybody," he said.

The strategy announced by Kerlikowske's office calls for additional training on responsible prescription practices for the more than 1 million doctors authorized to prescribe certain controlled substances. Such a change would require congressional approval.

"There has been a flood of new medicines and many of the physicians out there weren't trained in using them, so there's a big gap in understanding how to manage these drugs," said Dr. Janet Woodcock, who directs the agency's Center for Drug Evaluation and Research.

Another element of the strategy is a national education campaign featuring ads like the famous frying-egg "this is your brain on drugs" ad used in past anti-drug efforts. Key to that is making sure parents keep prescription drugs out of the hands of their children, who are now abusing them more than any illegal drug except marijuana. Drug companies will be asked to contribute money to the effort.

The plan also calls for continued aggressive law enforcement efforts and better training, as well as modest increases of $123 million for drug prevention and $99 million more for treatment programs.

In Florida, Miami DEA chief Mark R. Trouville said he expects some physicians to be indicted based on a recent undercover probe involving 340 pill purchases.

"We're trying to make a statement that if you think you're sliding by in a gray area, you're not, and we're coming," Trouville said.

The plan also calls for all 50 states to adopt prescription drug monitoring programs to track what physicians are prescribing and what pharmacies are dispensing. Currently, 35 states have such programs up and running. They are authorized but not yet operational in eight more states, including Florida.

Kentucky Attorney General Jack Conway said every state needs to track drug purchases, adding that Florida accounts for 60 percent of the black-market painkillers in his state.

"When one state doesn't have it, it can have terrible ramifications for other states," Conway said.

Many experts and law enforcement officials say the lack of a Florida database is a key reason so many painkillers are prescribed in the state, which is home to more than 850 registered pain clinics.

Florida Gov. Rick Scott, a conservative Republican elected last year on a pro-business platform, initially objected to the database as an invasion of privacy and vowed to kill it. But an increasing number of lawmakers, along with Republican state Attorney General Pam Bondi and governors from other states, have lined up to support the tracking system and it now appears safe.

The medical director of Covidien, which makes some of the drugs the federal effort targets, expressed support for the government's strategy. Dr. Herb Neuman said an alliance of medical and patient safety groups has been working to educate patients and help physicians with responsible prescription methods.

"Access to these medications must be limited to patients suffering from chronic pain and possessing a valid prescription," Neuman said.

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Associated Press writers Matthew Perrone in Washington and Roger Alford in Frankfort, Ky., contributed to this story.

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Online:

http://www.whitehousedrugpolicy.gov/news/press11/041911.html

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