Prescription painkiller abuse in the United States has reached epidemic levels, and keeps spreading from three geographic centers: Florida, Appalachia, and affluent suburbs. Federal agencies such as the Drug Enforcement Agency (DEA) and the Centers For Disease Control (CDC) are stepping up their efforts to stop the epidemic, even as state legislators are passing new laws setting up electronic databases to track prescription drug sales. Doctors who prescribe too many painkillers are increasingly losing their jobs and medical licenses through actions taken by their employers and medical licensing boards.
Two painkillers, both chemical cousins of heroin, are fueling the epidemic. Oxycodone use has increased 16 times over between 2000 and 2010. This drug is the main ingredient in brand-name products like OxyContin, Percocet, and Percodan. The other most frequently abused painkiller is hydrocodone, found in trademarked drugs like Vicodin, Lortab, and Norco. Sixty-nine tons of pure oxycodone and 42 tons of pure hydrocodone were used in 2010 in the USA, amounting to 40 Percocets and 24 Vicodin for every person in the country. These drugs were only introduced about 15 years ago, and yet their sales amounted to $8.5 billion in 2011.
About seven million Americans are abusing painkillers for non-medical reasons, compared to the 1.5 million who abuse cocaine. The number of deaths due to these drugs in 2008, the last year for such statistics, was 14,800, more than the deaths from heroin and cocaine combined.
Hundreds of thousands of patients are taking painkillers at potentially dangerous levels, sometimes for years at a time. The reason for the increased number of prescriptions is an aging American population and a loosening of the medical standards for the management of pain.
Dr. Jane Ballantyne, who was in charge of pain management at Massachusetts General Hospital in Boston for more than ten years, said the situation is out of hand.
“We started on this whole thing because we were on a mission to help people in pain,” she said, “but the long-term outcomes for many of these patients are appalling, and it is ending up destroying their lives. … If doctors understood how hard it is to get patients off these drugs, they would not prescribe them to begin with.”
Another problem with prescription painkillers besides addiction is that as patients increase their tolerance for such drugs, they can take them at higher levels. This in turn creates quality-of-life problems, because patients often become less alert and less able to handle everyday life.
Dr. Ballantyne and certain other medical experts are advocating a return to non-drug management of pain by using therapies like counseling, biofeedback, and physical therapy. A recent study from Denmark found that patients in chronic pain recover four times faster using such methods instead of prescription drugs.
The American Pain Foundation, an advocacy organization for patients in chronic pain, has said that laws that reduce doctors’ ability to prescribe them and other measures to limit their use can be “inhumane.”
There is no doubt, however, that millions of people are taking these drugs for reasons that have nothing to do with pain. While the majority can get them from friends and family, some obtain their supply from “pain clinics” operated by unethical doctors, where people can easily get prescriptions for the drugs and then can buy them at adjoining pharmacies.
Recently DEA agents investigated six Walgreen drugstores in South and Central Florida and searched the company’s local headquarters in Jupiter, after reports that Walgreen was allowing high sales of prescription painkillers and that a high percentage of patients were paying in cash. Paying in cash instead of using insurance for drugs and doctors’ appointments can be a red flag for drug abuse. The DEA is looking into retail and distribution facilities within Walgreen.
A spokesperson for Walgreen, Robert Elfinger, said the company is “working with an operating with the DEA on this matter.”
Meanwhile, a DEA investigation of two CVS drug stores in Florida resulted in a ban of sales or distribution of controlled substances from the stores and from their distribution center.
Federal agents are increasingly demanding cooperation with such investigations, whether they take place in tiny family-owned stores or multinational companies. They are demanding access to information about who is obtaining what controlled substances, and in what amounts.
“Prescription medications can provide enormous health and quality-of-life benefits to patients,” Gil Kerlikowske, U.S. drug czar, testified to Congress in March 2012. “However, we now all recognize that these drugs can be just as dangerous and deadly as illicit substances when misused or abused.”