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Prescription painkillers dominate Maine drug scene

 

This is  news>?  not to anyone that has lived it themselves or through someone they love!  And addicts certainly aren’t “emotionless and souless” as one particularly ignorant contributer to this story put it!  If anything, many of us feel things too deeply and that is why we turn to drugs.

By Daniel Dunkle | Jun 24, 2010

Rockland — This is the first article in a three-part series on prescription drug use and methadone treatment in the Midcoast. Part two will offer an in-depth look at Rockland’s Turning Tide methadone clinic.

Over the past three years, more Mainers have died from overdoses than from car crashes, according to state officials, and in the overwhelming majority of cases, the drugs being abused have been prescription medications.

Data from the Maine Office of the Chief Medical Examiner show that the number of drug-related deaths in the state rose from 34 in 1997 to 164 in 2008. The number of deaths increased steadily from the late 1990s and reached a peak of 176 in 2005.

Maine Department of Public Safety Commissioner Anne Jordan said that looking at the most recent data, 92 percent of the drug-related deaths have involved prescription medications rather than street drugs. About 8 percent have been attributed to street drugs including heroin, cocaine and crack, she said.

The drugs most commonly linked to drug-related deaths and addiction are opiate or opioid painkillers that come in pill form. Opiates and opioids refer to any painkillers derived from the poppy or to similar synthetic drugs, including methadone, OxyContin, oxycodone, hydrocodone, Vicodin, Percocet and morphine. The street drug heroin is also an opioid.

“In Maine, we are facing a tidal wave of opioids, both prescription and heroin,” said Roy McKinney, director of the Maine Drug Enforcement Agency.

Opiates are extremely addictive and can bring on painful withdrawals when people try to stop using them.

Dr. Chris Michalakes, medical director of the emergency department at Penobscot Bay Medical Center in Rockport, said his staff deals with issues related to substance abuse multiple times each day. In some cases, the emergency department has to deal with overdoses. In many cases, people come to the emergency department with fictitious complaints of pain in hopes of obtaining drugs.

He said this puts doctors in a difficult position, because they often have no way of knowing if a complaint of pain is legitimate or false.

“The line you’re on, the tightrope, is pretty tight,” he said.

Michalakes said in most cases he is seeing prescription drugs that have been diverted for sale on the street as recreational drugs.

He added that the Midcoast and Down East areas of the state have been identified by the Centers for Disease Control as having a rampant prescription opiate problem.

Clinical Director Mike Franklin of the Turning Tide methadone clinic in Rockland said very few of the clinic’s patients are being admitted for heroin use. Most of the clinic’s patients are seeking treatment for abuse of prescription drugs.

Methadone

Opiates account for 72 percent of the overdose deaths in Maine, according to University of Maine Associate Professor Marcella Sorg, who serves as director of the Rural Drug and Alcohol Research Program. Sorg also works closely with the Maine Medical Examiner’s Office.

She said methadone is the largest single type of opiate involved.

Sorg, Michalakes, and the Maine Office of Substance Abuse and Turning Tide administrators all agree, however, that in most deaths involving methadone, the methadone pill prescribed for chronic pain was used rather than the methadone liquid administered at methadone clinics.

Sorg said that in methadone overdose cases, the Medical Examiner’s Office and law enforcement investigate and are often able to determine whether the drug came from a prescription pill or the liquid dispensed at clinics. The investigators look at whether the person was a patient at a clinic and check whether the person had a prescription for the pills.

In cases where methadone is a cause of death either alone or in combination with other drugs, 60 percent of the cases involve the pill rather than the liquid, according to Sorg. “That’s the number for the cases where we know,” she said. “Frequently we don’t know.”

Driving the rise of prescription drug abuse

Sorg said two key changes some years back paved the way for the rise in prescription drug abuse. The first was when the medical community decided it needed to treat pain more effectively. Hospitals now ask every patient to rate their level of pain.

Michalakes said there has been a real thrust in the last decade to treat pain appropriately.

“For many, many patients, we under treat their pain,” he said.

He said that when in doubt, a doctor is likely to err on the side of treating the pain.

In addition, in the late 1990s, direct-to-consumer advertising of prescription medications became legal in the United States. Sorg said this has led to a culture of “get a drug for everything that’s wrong with you.”

“This has put the consumer in the driver’s seat rather than the doctor,” she said.

More people ask their doctors about medications advertised, and more prescriptions are being written. The result has been an increase in the availability of prescription drugs.

Jordan said about 2.3 million prescriptions were written in Maine last year. The state’s population is 1.3 million.

To combat this problem, the state has started a mail-back program so that people with prescriptions left over from an illness, surgery or loved one who has passed away can get these medications out of their homes, according to Jordan. Once mailed in to the state, the drugs are destroyed.

The state has been collecting 100 pounds of medications per week through this program, according to Jordan.

“Diverted, abused and misused prescription drugs are a major cause of accidental poisonings and arrests in the state,” according to a report on the citizen mail-back program in Maine. “The state ranks number one in the country in terms of the perceived relationship of pharmaceuticals to violent crime and property crime, and second in terms of the availability of pharmaceuticals for abuse. Forty percent of Maine law enforcement agencies perceive prescription drug misuse as the state’s most serious drug threat.”

The report also notes that Maine has the oldest population by median age in the country. The mail-back project started as a pilot program in 2007 through the University of Maine Center on Aging with funding through the U.S. Environmental Protection Agency.

“The mail-back program, during its first two phases of EPA-funded operation, has disposed of more than 2,300 pounds of drugs,” the report states. “Over 380,000 pills were cataloged via the drug inventory process … 250 pounds of controlled drugs have been destroyed. … Approximately 17 percent of the drugs were schedules II, III, and IV — controlled drugs. These included narcotic pain relievers, tranquilizers and sedatives, as well as stimulants.”

Many people, however, are not getting rid of unwanted or unused drugs appropriately. There is a tremendous financial motive to sell these medications.

One OxyContin pill can net between $40 and $80 on the street, Jordan said, depending on whether it is a 40-milligram pill or 80 milligrams. The drug is worth about $1 per milligram.

The pills to meet the demand are not all coming from local doctors or pharmacies. Jordan said some people fly as far as Florida to fill prescriptions at pain clinics. They then fly the drugs back to Maine and sell them on the street. The profit margin for this kind of business is extremely high.

Franklin said the fastest growing segment of the population for any type of substance dependence ranges in age from 12 to 17.

Jordan said a recent national survey of high school students found that one in four had experimented with prescription medication. She said teens raid their family medicine cabinets for pills.

Drug use drives crime

The Maine Department of Public Safety recently released its annual crime rate report. While the overall crime rate decreased slightly in Maine during 2009, Jordan said robbery, burglary and arson have increased.

“The increases in robbery and burglary are a result of the increasing demand for money to feed the state’s drug habits,” Jordan said in a press release.

Robberies increased by nearly 20 percent in 2009 (398 cases, up from 332), reversing two years of decrease. Burglaries were up 3 percent to 6,711 cases.

McKinney said drug addicts resort to stealing from family and friends, writing bad checks, fraud, holding up pharmacies, and burglary.

In some cases, thieves watch the obituaries in newspapers and break into homes while the owners are out at the funeral, according to Jordan. In other cases, the burglars target a home because they know the person who recently died had cancer and probably left behind painkillers that had been prescribed for the illness.

“These people have no decency and no souls,” Jordan said of those committing this type of crime.

There were 154 burglaries in Knox County in 2008, according to the Maine Department of Public Safety. That was up from 126 the year before. Robbery, however, was down. No robberies were listed for the county in 2008, but there were three robberies in 2007.

Deaths in the Midcoast

The human cost of drug addiction can be counted in lost lives, broken families and a deterioration of the quality of life for the addict.

According to reports from the Drug Abuse Warning Network, Knox County has seen between four and seven drug-related deaths each year from 2004 to 2007, not including drug-related suicides. Experts note that it is sometimes difficult to draw the line between a suicide and an accidental overdose.

The county reached a high (among the years looked at) with seven deaths in 2004 and saw six deaths in 2007.

The problem is less severe in neighboring Lincoln County, which has seen no deaths in some years and a high of four in 2006. Waldo County has seen between two and four deaths each year from 2004 to 2007.

Opiates and opioids make up only a portion of the state’s substance abuse problem. Alcohol remains the number one drug cited by people seeking treatment in the state of Maine, according to Guy Cousins, director of the Maine Office of Substance Abuse.

Out of 12,000 people who sought treatment in Maine from July 1, 2008, to June 30, 2009, 45 percent cited alcohol use as the reason they needed treatment. Another 30 percent were seeking help for use of prescription opiates; 10 percent cited marijuana; 9 percent cited heroin; and 5 percent cited cocaine and/or crack.

Getting help

Jordan said the drug problem in Maine is worsening. While the problem is understood, there are no easy solutions.

Opiate addicts face a difficult battle with a drug that changes brain chemistry and creates a strong physical dependence. For many, fighting their addiction is a lifelong effort.

However, substance abuse experts and recovering addicts say that for those who have decided they want to change, help is available and addicts have been able to rebuild their lives.

To seek help, call the Maine Office of Substance Abuse resource center at 1-800-499-0027 or visit the Maine Office of Substance Abuse online.

Residents can also access health information and substance abuse resources by dialing 211.

For more information, see sidebar, “Treatment options in Midcoast Maine.”

Envelopes for the prescription drug mail-back program are available at Penobscot Bay Medical Center in Rockport, Rite Aid in Camden and Kennebec Pharmacy in Rockport. For more information, visit safemeddisposal.com or call 1-866-637-9743.

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