Pain medicine use has nearly doubled

[Guest guest]

By FRANK BASS, Associated Press Writer 18 minutes ago

 

 

MYRTLE BEACH, S.C. - People in the United States are living in a world of pain

and they are popping pills at an alarming rate to cope with it.

if(window.yzq_d==null)window.yzq_d=new Object();

window.yzq_d['nADmKkLEYrk-']=' & U=13bgu9mq6%2fN%3dnADmKkLEYrk-%2fC%3d609795.11177\

677.11819334.1442997%2fD%3dLREC%2fB%3d4834103';

The amount of five major painkillers sold at retail establishments rose 90

percent between 1997 and 2005, according to an Associated Press analysis of

statistics from the Drug Enforcement Administration.

 

More than 200,000 pounds of codeine, morphine, oxycodone, hydrocodone and

meperidine were purchased at retail stores during the most recent year

represented in the data. That total is enough to give more than 300 milligrams

of painkillers to every person in the country. Oxycodone, the chemical used in

OxyContin, is responsible for most of the increase. Oxycodone use jumped nearly

six-fold between 1997 and 2005. The drug gained notoriety as " hillbilly heroin, "

often bought and sold illegally in Appalachia. But its highest rates of sale now

occur in places such as suburban St. Louis, Columbus, Ohio, and Fort Lauderdale,

Fla.

 

The world of pain extends beyond big cities and involves more than oxycodone.

In Appalachia, retail sales of hydrocodone — sold mostly as Vicodin — are the

highest in the nation. Nine of the 10 areas with the highest per-capita sales

are in mostly rural parts of West Virginia, Kentucky or Tennessee.

 

Suburbs are not immune to the explosion.

 

While retail sales of codeine have fallen by one-quarter since 1997, some of

the highest rates of sales are in communities around Kansas City, Mo., and

Nashville, Tenn., and on New York's Long Island.

 

The DEA figures analyzed by the AP include nationwide sales and distribution

of drugs by hospitals, retail pharmacies, doctors and teaching institutions.

Federal investigators study the same data trying to identify illegal

prescription patterns.

 

An AP investigation found these reasons for the increase:

 

_The population is getting older. As age increases, so does the need for pain

medications. In 2000, there were 35 million people older than 65. By 2020, the

Census Bureau estimates the number of elderly in the U.S. will reach 54 million.

 

_Drugmakers have embarked on unprecedented marketing campaigns. Spending on

drug marketing has gone from $11 billion in 1997 to nearly $30 billion in 2005,

congressional investigators found. Profit margins among the leading companies

routinely have been three and four times higher than in other Fortune 500

industries.

 

_A major change in pain management philosophy is now in its third decade.

Doctors who once advised patients that pain is part of the healing process began

reversing course in the early 1980s; most now see pain management as an

important ingredient in overcoming illness.

 

Retired Staff Sgt. James Fernandez, 54, of Fredericksburg, Va., survived two

helicopter crashes and Gulf War Syndrome over 20 years in the Marine Corps. He

remains disabled from his service-related injuries and takes the equivalent of

nine painkillers containing oxycodone every day.

 

" It's made a difference, " he said. " I still have bad days, but it's under

control. "

 

Such stories should hearten longtime advocates of wider painkiller use, such

as Russell Portenoy, head of New York's Beth Israel pain management department.

But they have not.

" I'm concerned and many people are concerned, " he said, " that the pendulum is

swinging too far back. "

 

Consider: _More people are abusing prescription painkillers because the

medications are more available. The vast majority of people with prescriptions

use the drugs safely. But the number of emergency room visits from painkiller

abuse has increased more than 160 percent since 1995, according to the

government. _Spooked by high-profile arrests and prosecutions by state and

federal authorities, many pain-management specialists now say they offer

guidance and support to patients but will not write prescriptions, even for the

sickest people. The increase in painkiller retail sales continues to rise, but

only barely. There was a 150 percent increase in volume in 2001. Four years

later, the year-to-year increase was barely 2 percent. _People who

desperately need strong painkillers are forced to drive a long way — often to a

different state — to find doctors willing to prescribe high doses of medicine.

Siobhan Reynolds, the widow of a New Mexico patient who needed

large amounts of painkillers for a connective tissue disorder, said she

routinely drove her late husband to see an accommodating doctor in Oklahoma.

Perhaps no place illustrates the trends and consequences for the world of pain

better than Myrtle Beach, a sprawling community of strip malls, hotels and bars

perched along a 60-mile strip of sand on the Atlantic Ocean. The metro area,

which includes three counties, is home to 350,000 people but sees more than 14

million tourists annually, drawn to its warm water, golf courses and shopping.

During the eight-year period reflected in government figures, oxycodone

distribution increased 800 percent in the area of Myrtle Beach, partly due to a

campaign by Purdue Pharmaceuticals of Stamford, Conn. The privately held company

has pleaded guilty to lying to patients, physicians and federal regulators about

the addictive nature of the drug. Use of other drugs soared in the area, too:

Hydrocodone use increased 217 percent;

morphine distribution went up 180 percent; even meperidine, most commonly sold

as Demerol, jumped 20 percent. It is no small wonder that federal

authorities suspected the area was home to a notorious " pill mill, " or a clinic

that dispenses prescription medication without verifying that it's needed. The

U.S. attorney for South Carolina secured a 58-count indictment in June 2002

against seven physicians and one employee of the Comprehensive Care and Pain

Management Center, a nondescript storefront on Myrtle Beach's main drag.

Tipped off by local pharmacists concerned about an increase in the volume of

painkiller prescriptions, the federal investigation created a furor in the

medical profession. The owner, D. Michael Woodward, was sentenced to 15 years in

the case and has relinquished his license. A second physician, Deborah

Bordeaux, had worked at the clinic less than two months before quitting in

disgust. Bordeaux, now serving a two-year prison term, was

threatened with a 100-year sentence if she did not help the prosecution.

Officials with the Justice Department and the DEA would not discuss what some

activists say is a " war on doctors. " Reynolds, the widow who drove her late

husband hundreds of miles for his pills, became an activist after the Myrtle

Beach indictments. She contributed money to appeal some of the criminal

convictions in South Carolina and started the Pain Relief Network, an advocacy

organization for people living in pain. She believes the doctors sent to prison

were railroaded. " It was a witch hunt, " she said. Bordeaux's husband,

Edworth Swaim, agrees. A retired U.S. Postal Service employee, Swaim believes

his wife was sentenced to two years because she would not turn on her former

colleagues. Even though Bordeaux had worked at the clinic less than two months

and eventually sued over what she alleged was rampant Medicare fraud, he said

she did not stand a chance of avoiding prison.

" She wasn't guilty of anything, so she wasn't going to plead to anything, "

Swaim said. " She was absolutely railroaded, made an example of. I can't tell you

how angry I am. " Myrtle Beach physicians are not convinced that the " Myrtle

Beach Eight, " as they became known, were innocent. A Myrtle Beach internist

who also works in addiction medicine, Brian Adler, said physicians were flooded

with patients seeking pain medicine after the clinic was shut down. The

community has a slightly higher-than-average number of older people and

relatively high numbers of people between 21 and 64 who describe themselves as

disabled. " There's a significant problem with narcotics in this area, "

Adler said. After the pain management clinic closed, " all those folks were like

rats, scurrying from a burning building, trying to get their fix. " Other

physicians were concerned about patients with legitimate needs for painkillers.

The federal bust raised the stakes. When

radio commentator Rush Limbaugh settled a federal case charging him with

illegally obtaining painkillers, he did not get prison time. Neither did NFL

star Brett Favre, who publicly acknowledged an addiction to Vicodin that he

obtained legally. To pain management specialists, they were being blamed

for everyone's addiction. The DEA cites 108 prosecutions of physicians during

the past four years; 83 pleaded guilty or no contest, while 16 others were

convicted by juries. Eight cases are pending, and one physician is being sought

as a fugitive. In congressional testimony, the agency's deputy assistant

administrator, Joseph T. Rannazzisi, estimated that fewer than 1 percent of the

nation's physicians — under 9,000 — illegally provide prescription drugs to

patients. He told lawmakers it is far more common for people to illegally obtain

prescription drugs from friends and family members. " It is not merely

illegal but could feed or lead to an addiction and place

that loved one in a life-threatening situation, " Rannazzisi said. It is

impossible to reliably measure painkiller abuse. A 2004 government study

estimated between 2 million and 3 million doses of codeine, hydrocodone and

oxycodone are stolen annually from pharmacies, distributors and drug

manufacturers. The AP's analysis only included retail sales and did not include

estimates of diverted pharmaceuticals. John Charles, director of medical

affairs at the Grand Strand Regional Medical Center in Myrtle Beach, practices

pain management. A few years ago, Charles said, he took a drastic step to reduce

his potential legal risks: He stopped prescribing painkillers. The decision

gave him peace of mind, but he does not expect there to be less of a need for

painkillers or physicians who prescribe them. " People with cancer are

surviving longer, elderly people are living longer, " Charles said. " So,

physicians are walking a fairly fine line. We're walking a

narrow path. And I think we'll continue to see it for a while. "

 

 

 

Got a little couch potato?

Check out fun summer activities for kids.

 

 

[Guest guest]

A reminder that Yin Deficiency and magnesium deficiency will lower the

pain threshold. Correcting these deficiencies when they exist obviously

won't take care of all cases of pain, but it will cut down on the

amount of pain in some cases.