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A prescription for danger

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Deaths from prescription-drug overdoses on the rise in Jeffco

By Emile Hallez

More people are dying every year in Jefferson County because of prescription-drug overdoses, a trend mirroring national statistics that the coroner’s office attributes to increased prescribing of opiate painkillers.

By year’s end, the office predicts, 45 residents will die from unintentional drug toxicity. And though 2010 saw a slight drop in prescription-drug deaths, the anticipated number for 2011 would represent a 73 percent rise over those of 2005.

Partly to blame is increased social acceptance of recreational use of the drugs, which are often pilfered and resold on the street, the coroner’s office said. But of equal concern is the number of poisonings due to misuse — accidentally ingesting too many pills in hopes of alleviating legitimate pain. Some patients take additional medication, not realizing they had done so shortly beforehand. Others think an initial dose is ineffective, and they take more medication that sometimes proves lethal.

“It used to be that the people we saw who overdosed would be on street drugs. But now, the majority of overdoses are prescription drugs,” Chief Deputy Coroner Carl Blesch said, citing the recent rise in misuse of prescribed drugs. “We’re not suggesting people don’t use pain medications. Used under the proper precautions, it’s pretty safe.”

The reasons for the unintentional overdoses are complex, experts say. Keeping track of doses can be difficult, particularly for patients already feeling lightheaded from a previous dose of potent medication.

“They may take two or three times the amount of medication they should in a given amount of time, because they just don’t remember,” Blesch said, adding that others are quick to take more meds when immediate effects are not realized.

“We see a fair amount of fentanyl patch (overdoses),” he said of the narcotic pain relievers, which dispense medication through the skin over the course of up to three days and take hours to have an effect. “When you put that thing on, it’s not going to work within the next 10 minutes. … We have seen folks put on a second patch, because it’s not enough.”

Further, increases in recreational use of opiate medication have contributed sharply to mortality, said Jennifer Place, head of the Peer Assistance Services Prescription Drug Abuse Prevention Program. Instances of abuse by teens and adults have risen in recent years, she said.

“It’s people abusing it intentionally; they’re not using it as prescribed — if it’s prescribed to them in the first place,” she said. “Childproof caps are not enough to protect our kids anymore — it’s teenagers and adults.”

When combined with alcohol, overdoses become even more common. Piling one depressant on top of another impedes the body’s ability to circulate oxygenated blood, slowing the heart and lungs to a near halt.

“They essentially have a heart attack,” Blesch said. “The synergic effects of those things can be sufficient to cause death in one (night of) sleep.”

And though some would wag a finger at recreational abuse, they might not hesitate to share prescribed meds to alleviate pain. One might, for instance, give Vicodin to a co-worker suffering a migraine, with neither person realizing the potential side effects or risks, Place said.

“It’s today’s Tylenol. People don’t realize it’s illegal, and it can be fatal,” she said. “We’re seeing a large amount of emergency-room visits in our adult population due to prescription medications. … This is alarming.”

Distressingly, Colorado has witnessed a related trend in heroin overdoses, she said. Some suspect that increased pain-medication prescriptions lead some patients to develop dependencies that they satisfy with cheaper street drugs.

“We’re seeing a rise statewide in heroin treatment admissions and heroin-overdose deaths, with the suspicion that those individuals got prescribed opiates — and heroin is cheaper,” Place said.

Not surprisingly, the illicit purchase of prescriptions pilfered from medicine cabinets or resold nefariously by patients themselves seems to be a white-collar affair.

“This is more of a suburban problem. The abuse is happening with individuals of moderate to high economic status,” Place said. “It’s a lot cheaper to get coke and heroin on the street than it is prescriptions.”

But interestingly, the same cost factor may be deterring experimenters from using other street drugs such as cocaine, the coroner’s office said.

“Cocaine has gone down. It’s probably too expensive compared to stealing, or obtaining through misrepresentation, prescription opiates,” Blesch said, noting that although prescription drugs have taken the national spotlight, alcohol abuse remains a massive problem in Jeffco.

“Alcohol is such a huge problem for us. Alcohol abuse is not adequately reflected in these numbers,” he said, explaining that long-term maladies such as cirrhosis and acute problems such as drunken-driving accidents might be overlooked. “It has been called a public-health epidemic for probably 100 years, but we still have it. … You don’t have to have a 300 blood-alcohol level to be a danger on the highway.”

 

Solutions are scarce

For as much as public officials are alarmed about the rise in prescription-drug-related deaths, there are surprisingly few solutions currently proposed. The most effective measure, most seem to agree, is for patients to keep better track of their medication, ensuring pills are locked securely in a safe, not a medicine cabinet.

But for people who would find the measure cumbersome if not impossible, a more plausible option would be to have a caregiver oversee treatment.

“If someone is that impaired because they can’t use a lockbox or they forgot where they stored their medication … they should probably have some other form of care,” Place said. “We’re not asking somebody to get a triple-lock safe, but keeping medications out of medicine cabinets. … You want something that’s not easily transportable out of the home, the same place you’d keep your Social Security card.”

But in some cases, entrusting care of pills to family members is problematic. A 50-year-old Jeffco man overdosed recently from medication intended for his 70-year-old father, Coroner John Graham said, adding that the son appeared to be using the opiate recreationally.

“I’m not picking on 18-year-old kids. This was a 50-year-old,” he said.

Disposing of prescriptions is another matter. Pharmacies, for example, don’t accept unused medications, even if only for disposal.

And because of environmental and health concerns, flushing pills down toilets has been discouraged, though the Food and Drug Administration says the practice is safe for a small list of drugs. And throwing unused drugs in the trash can also be permissible, provided prescriptions are mixed in with repugnant waste.

“Safe disposal is a huge issue, because right now we don’t have a viable way to dispose of these medications,” Place said. “I’ve thrown things away in dirty diapers before.”

However, the most acceptable means of ridding a house of unused prescriptions is to keep the pills stored in a safe until a community drug take-back event is held. Such an event several weeks ago at Dakota Ridge High School, sponsored by the Drug Enforcement Agency in conjunction with the Jeffco Sheriff’s Office, netted more than 405 pounds of medications. The amount was actually down 245 pounds from that of the same collection event last year.

“Other than these events, there really is no other way to get rid of these drugs, because you can’t take them back to a pharmacy. … The only person who can accept these drugs is a uniformed law officer,” Place said, adding that the 2010 Safe and Secure Drug Disposal Act could change that. The U.S. attorney general now has increased authority to change rules regarding safe disposal of drugs, she said, including the potential to allow pharmacies to accept unused meds.

Since patients often visit multiple doctors and pharmacies, sometimes attempting to game the system, keeping track of prescription abuse is a discouraging endeavor. The most recent attempt came in 2005, when the state implemented the Prescription Drug Monitoring Program, which has seen limited success. The program requires pharmacies to submit to a statewide register all medications dispensed every two weeks, including patient information. The program has enormous potential, but doctors are not required to check the register before writing prescriptions, Place said.

“The physicians that are using it love it,” she said. “(But) there’s not requirements for prescribers to look at that prior to writing a prescription.”

The lack of congruity in abuse prevention is hardly news to lawmakers, and efforts in the state to create uniform policies are on the horizon. On Nov. 10, for example, a representative from the National Office of Drug Policy met with state leaders in prescription-abuse prevention at the Colorado Prescription Drug Abuse Forum at the Anschutz Medical Campus.

“Many Medicare (patients) are using multiple pharmacies with multiple doctors,” Graham said. “The multiple pharmacies and multiple doctors is sometimes planned but never good.”

 

Contact Emile Hallez at emile@evergreenco.com or 303-933-2233, ext. 22. For updates, check   www.ColumbineCourier.com.