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Death toll drops in drug war

(April 1, 2012) — After a decade of shattered lives and early graves, Ohioans finally might be seeing a glimmer of hope in the battle against prescription-drug overdoses.

Drug-induced deaths inched downward last year for the first time in 10 years. Four fewer people fatally overdosed in 2011 than in 2010.

Between 2010 and 2012, Ohio’s average per-capita dose of prescription opiates decreased by 0.8 percent, according to the Ohio State Board of Pharmacy. While the statewide decline is small, more than half of Ohio’s counties saw a reduction including virtually all of southern Ohio, considered the heart of the problem.

In Scioto County, the number of pills prescribed dropped by more than 15 percent. The two counties just up the Ohio River, Lawrence and Gallia, also recorded double-digit decreases, while Pike and Jackson counties to the north showed just under a 10 percent decline.

The Scioto County total translates into 1.5 million fewer pills prescribed last year than in 2010. And, more important, the persistent correlation between the number of pills handed out and the number of drug-related deaths held true: 17 fewer people lost their lives in Scioto County.

Credit for the possible turnaround is multifaceted: a concentrated effort to close “pill mills” that dispensed prescriptions or drugs in large quantities, a new state law cracking down on pain clinics, an active public-private education campaign and doctors’ newfound awareness about the dangers of overprescribing addictive painkillers.

But no one is holding a victory celebration just yet in this drug epidemic.

“It’s its own animal,” said Lisa Roberts, a public-health nurse at the Portsmouth Health Department in Scioto County. “It’s entrenched in rural communities to the point … that some people call the police and tell them they’ve been shortchanged on pill deals.”

More alarming: Those who can’t get prescription drugs because of the state’s new crackdown are turning to lethal alternatives such as heroin.

What the Ohio Department of Alcohol and Drug Addiction Services calls heroin hot spots are cropping up not only in larger cities such as Columbus, Cleveland, Dayton, Akron and Cincinnati, but also in more rural areas, such as Highland County in southwestern Ohio and Fairfield County just southeast of Columbus.

The death toll from accidental drug overdoses in Ohio had risen steadily since 1999, reaching a record high in 2010 of more than 1,500 deaths, according to the latest data from the state Department of Health.

Of those 1,500 deaths, 45 percent involved prescription opiates, such as Oxycontin, Vicodin and methadone, a synthetic drug commonly used to help heroin addicts through withdrawal.

One difficult aspect of the pill battle is that no single factor created the drug problem plaguing Ohio, which means that a solution must be multipronged, too. Authorities cite four factors, some of which can’t be controlled:

  • Ohio is a geographic crossroads of highways and interstates that serve as major trafficking routes. A new emphasis on detection by the State Highway Patrol led to a 13 percent increase in drug seizures last year, compared with the previous three-year average. A total of 51,723 prescription pills were seized, an increase of more than 10,000 from 2010.
  • “Florida is beginning to work with us, as well as other states, to share information,” said Ohio Attorney General Mike DeWine. “We’ve made this a priority to go after this prescription-drug problem.”
  • Persistent unemployment and high poverty rates, especially in Ohio’s rural areas, lead to drug trafficking and abuse.

“If they’re poor and they don’t really go to school anymore and they don’t have jobs, they hang out on the streets,” said Dr. Robert Masone, president and executive director of the Ohio Society of Interventional Pain Physicians. “And the people that have these pills, they sell these pills and they can get high. That’s what they do almost every day.”

Gov. John Kasich says that’s one reason he is emphasizing jobs: “What we find is, when people don’t have work, when they become hopeless, they turn to things they otherwise wouldn’t turn to.”

Though the drug scourge has been around since the late 1990s, the first legislation to combat prescription-drug abuse didn’t come until 2011.

“The technical issue was, what (pill-mill physicians) were doing was actually legal,” said state Sen. Dave Burke, R-Marysville, a pharmacist who sponsored last year’s pill-mill bill. “How do you stop that?”

The wheels began turning with a task force set up under Gov. Ted Strickland, Burke said.

“The drug task force doesn’t get the credit it deserves … only it didn’t solve the problem of the pain clinic,” he said. “If (the authors of the pill-mill bill) are the lead singers, Strickland’s drug task force was the band.”

  • Treating pain with opiates is a relatively new practice, and the necessary patient-to-doctor communication has been skewed by heavy pharmaceutical advertising and other factors over the past decade.

Orman Hall, director of the Ohio Department of Alcohol and Drug Addiction Services, tells of a staff member taking his son for treatment of a sore throat. He received a prescription for medicine to treat his throat and one for an opiate painkiller.

Treating pain with opiates became the norm in the late 1990s, Hall said. This not only increased the dangers of addiction, but also of opiate-induced hyperalgesia, or an increased sensitivity to pain.

That switch in the 1990s was sparked by a surge in direct-to-consumer prescription advertising. Pharmaceutical companies’ ad spending more than quadrupled from 1995 to 2000, when about $22.5 million was spent, he said.

This marketing effort led to patients seeking certain drugs from their doctors.

“We started down this path where patients joined up with the (pharmaceutical company). That matured significantly in the 2000-to-2010 window, where people developed arts of deception realizing physicians would do as you asked them to do because they’re just trying to help people,” Burke said.

“And until you know you’ve been deceived, you don’t know you’re being deceived. … The physician and the pharmacists no longer acted in collaboration.”

With the dangerously addictive properties in these medications, a need for more open communication between doctors and their patients should have become obvious sooner, added Richard Whitehouse, executive director of the Ohio State Medical Board.

“Despite whatever background or experience, folks may still not appreciate the addictive properties of these medications,” he said.

Kasich said the next step for Ohio should include redefining the treatment of pain.

“Long term, we’re going to need the medical schools to begin to instruct physicians about the way to use these highly addictive drugs,” Kasich said.

Burke agrees.

“If we’re going to treat this as a disease, then we need to treat it as a disease,” he said. “We’ve got to legitimize the art of pain treatment and management.”

Deanna Pan and Pat Holmes are fellows in Ohio University’s E.W. Scripps School of Journalism Statehouse News Bureau.