Prescription Drug Abuse Epidemic

[palmspringsbum]

Health Business

Agency concerned about pain-drug abuse

United Press International

WASHINGTON, June 19 (UPI) -- Federal officials said Monday more people began non-medical use of narcotic pain relievers in the past year than marijuana or cocaine.

The report, which was released by the Substance Abuse and Mental Health Services Administration, analyzed data from the 2004 National Survey on Drug Use and Health and found that 2.4 million people 12 or older used prescription pain drugs for non-medical reasons compared with 2.1 million who used marijuana and 1 million who used cocaine.

"While overall illicit drug use continues to decline among our young people we are always paying close attention to the data to identify any potential areas of concern," said Charles Curie, SAMHSA's administrator. "The initiation rates show we must continue our efforts help the public confront and reduce all drug abuse."

The report shows that the most commonly abused drugs include Vicodin, codeine, Oxycontin and morphine. Approximately 48 percent of new initiates used Vicodin, Lortab or Lorcet; 34.3 percent used Darvocet, Darvon, or Tylenol with codeine; 20 percent used Percocet, Percodan or Tylox; 8.4 percent used Oxycontin; and 4.3 percent used morphine.

<span class=postbold>See Also</span>: Prescription Drug Abuse in Teens

<span class=postbold>See Also</span>: West Virginia sees flood of prescription junkies

<span class=postbold>See Also</span>: Opiate-Related Deaths Soar

<span class=postbold>See Also</span>: Cannabis as a Substitute for Alcohol: A Harm-Reduction Approacl - Tod H. Mikuriya

[palmspringsbum]

PHARMACEUTICALS: MORE PEOPLE MISUSING PRESCRIPTION PAINKILLERS.

Profnet Wire
1 Jul 2006

EDWIN SALSITZ, M.D., is a physician in the Division of Chemical Dependency at Beth Israel Medical Center in New York: "People are not aware of the risks of misusing opioid prescription painkillers, and inappropriate use can lead to addiction. With growing abuse of opioid drugs, it is apparent that we need to educate consumers that opioid dependence is a chronic disease and that treatment is available, as it is for other chronic diseases, in the privacy of a doctor's office. The government agency SAMHSA released a report last week that found more people initiated misuse of prescription painkillers (2.4 million) than marijuana (2.1 million) or cocaine (1 million), clearly showing the need to help the public confront, reduce and treat opioid dependence." News Contact: Kelly Smith, kelly.smith@fkhealth.com Phone: +1-617-761-6779 (6/29/06)

[budman]

HOW RVD & SABU'S ARREST RELATES TO THE WWE DRUG POLICY

Pro Wrestling Insider
by Buck Woodward @ 2:08:00 PM on 7/3/2006

With the news that WWE & ECW Champion Rob Van Dam and Sabu were arrested yesterday evening and found to be in possession ofr controlled substances, there has been a lot of questions regarding how this relates to WWE's Substance Abuse And Drug Testing Policy, which was introduced on February 27th of this year.

WWE's general policy states that:
<blockquote>
"The non-medical use and associated abuse of prescription medications and performance enhancing drugs, as well as the use, possession and/or distribution of illegal drugs, by WWE Talent are unacceptable and prohibited by this policy, as is the use of masking agents or diuretics taken to conceal or obscure the use of prohibited drugs."
</blockquote>
Obviously, marijuana would fall into the "illegal drugs" category and is a violation of the policy. WWE does not include marijuana in their "random testing" unless there is "reasonable cause" to do so. However, it is included on their list of prohibited drugs under the following listing:
<blockquote>
"Illegal drugs. The possession, use, and/or distribution of any drug made illegal to possess, use and/or distribute by the laws of the United States of America and/or any of its fifty states is prohibited by this Policy."
</blockquote>
As for Vicodin, which Van Dam allegedly had in his possession, that would fall under the category of "prescription drugs" and WWE's policy has a section regarding the non-medical use of such drugs, stating:
<blockquote>
"For purposes of this Policy, the phrase “non-medical use” shall mean use of a drug by a WWE Talent for other than a legitimate medical purpose pursuant to a valid prescription from a licensed and treating physician. Prescriptions obtained over the internet and/or from suppliers of prescription drugs from the internet shall not be considered to have been given for a legitimate medical purpose."
</blockquote>
So, if Van Dam does not have a legitimate prescription from a physician for the Vicodin, he would be violating the policy.

While most of WWE's policy outlines the steps involved in testing for drugs, and the consequences of a positive test, item 13 of their policy is very clear on the punishment for violating the law:
<blockquote>
"13. DISCIPLINE FOR VIOLATION OF LAW

Any Talent who is arrested, convicted or who admits to a violation of law relating to use, possession, purchase, sale or distribution of prohibited drugs will be in material breach of contract and subject to immediate dismissal."
</blockquote>
It will be very interesting to see how WWE publicly handles this incident in light of the above information.
<hr class=postrule>
World Wrestling Entertainment posted their Substance Abuse and Drug Testing Policy on their official website on February 27, 2006. The Policy reads as follows:
<blockquote>
2006 SUBSTANCE ABUSE AND DRUG TESTING POLICY
February 27, 2006

1. GENERAL POLICY
The non-medical use and associated abuse of prescription medications and performance enhancing drugs, as well as the use, possession and/or distribution of illegal drugs, by WWE Talent are unacceptable and prohibited by this policy, as is the use of masking agents or diuretics taken to conceal or obscure the use of prohibited drugs.

2. NON-MEDICAL USE

For purposes of this Policy, the phrase “non-medical use” shall mean use of a drug by a WWE Talent for other than a legitimate medical purpose pursuant to a valid prescription from a licensed and treating physician. Prescriptions obtained over the internet and/or from suppliers of prescription drugs from the internet shall not be considered to have been given for a legitimate medical purpose.

3. LIST OF PROHIBITED DRUGS

A. Performance Enhancing Drugs

(1) Anabolic Androgenic Steroids (AAS): The non-medical use of anabolic androgenic steroids, which include and are based on the natural steroid Testosterone, is prohibited.

The list of prohibited AAS includes, but is not limited to, those on the list below as well as related compounds.

▪ androstenediol
▪ androstendione
▪ bolasterone
▪ boldenone
▪ chloroxomesterone (dehydrochlormethyltestosterone)
▪ clostebol
▪ dihydroepiandosterone
▪ dihydrotestosterone
▪ dromostanolone
▪ epitestosterone
▪ 4-chlortestosterone
▪ fluoxymesterone
▪ formebolone
▪ furazabol
▪ mesterolone
▪ methandienone (methandrostenolone)
▪ methandriol
▪ methenolone
▪ methylclostebol
▪ methyltestosterone
▪ methyltrienolone
▪ mibolerone
▪ nandrolone
▪ norandrostenediol
▪ norandrostenedione
▪ norethandrolone
▪ norethindrone
▪ oxabolone
▪ oxandrolone
▪ oxymesterone
▪ oxymetholone
▪ stanozolol
▪ stenbolone
▪ testosterone
▪ trenbolone

(2) Peptide Hormones and Analogues: The non-medical use of Human Growth Hormone (hGH), Human Chorionic Gonadotropin ((hCG), Luetenizing Hormone (LH) and Insulin-like Growth Factor (IGF-1) is prohibited.

(3) Clenbuterol, used as an anti-catabolic drug or beta-2 agonist or for any other purpose, is prohibited.

B. Other Prohibited Drugs

(1) Stimulants. The non-medical use of amphetamine, methamphetamine, Ecstacy (MDMA), Eve (MDEA), MDA, PMA, Phentermine, Ephedrine class and other amphetamine derivatives and related compounds is prohibited.

(2) Narcotic Analgesics. The non-medical use of drugs belonging to this class, including, but not limited to, heroin, morphine and/or its chemical and pharmacological analogs and related compounds, is prohibited. Additionally, codeine and codeine based combinations, including those available over the counter in some countries, are considered prohibited drugs if used for a non-medical purpose.

(3) Benzodiazepines. The non-medical use of drugs belonging to this class, including, but not limited to, Alpha-hydroxy-alprazolam (Xanax), Lorazepam (Ativan), Nordiazepam (Valium), Oxazepam (Serax), Temazepam (Restoril) and/or chemical and pharmacological analogs and related components is prohibited.

(4) Barbiturates. The non-medical use of drugs belonging to this class, including, but not limited to, Amobarbital (Amytal), Butabarbital (Butisol), Butalbital (Anolor 300, Esgic, Fioricet, Fiorinal), Phenobarbital (Luminol, Solfoton), Pentobarbital (Nembutal, Nembutal Sodium), Secobarbital (Seconal) and/or chemical and pharmacological analogs and related components is prohibited.

(5) Diuretics. The non-medical use of diuretics, including, but not limited to, those on the list below as well as related compounds, is prohibited.

▪ acetozolomide
▪ amiloride
▪ bendroflumethiazide
▪ benzthiazide
▪ bumetanide
▪ canrenone
▪ chlormerodrin
▪ chlorthalidone
▪ diclophenamide
▪ ethacrynic acid
▪ furosemide
▪ hydrochlorothiazide
▪ mersalyl
▪ spironolactone
▪ triamterene

(6) Prescription drugs. WWE recognizes that there are many prescription and over-the-counter medications that serve essential or beneficial purposes for the health and well being of WWE Talent, and nothing in this Policy is intended to discourage the proper use of these medications. Conversely, there are some medications that, even when used properly, may affect safety or health and also medications which can be abused and affect safety and health. Accordingly, the following uses are prohibited regarding prescription and over-the-counter medications.

(a) The use of such a medication in a manner which is inconsistent with the instructions provided by the prescribing physician.

(b) The use of such a medication so as to cause an increased risk to health, safety or an impairment of ability to perform duties on the day of a WWE Event.

(c) The use of prescription drugs taken without a proper prescription given for a legitimate medical purpose by the personal physician of the person tested.

(d) The use of prescription drugs obtained from a physician who was not advised that another physician was prescribing the same and/or similar drug(s).

(7) Illegal drugs. The possession, use, and/or distribution of any drug made illegal to possess, use and/or distribute by the laws of the United States of America and/or any of its fifty states is prohibited by this Policy.


4. MASKING AGENTS AND TECHNIQUES USED TO AVOID DETECTION

The use of any agent or technique which is designed to avoid detection of a prohibited drug and/or compromise the integrity of a drug test is prohibited. This includes providing false urine samples (for example, urine substitution), contaminating the urine sample with chemicals or chemical products, the use of diuretics to dilute urine samples, the use of masking agents (such as probenecid and related compounds), and/or the use of epitestosterone either systematically or directly to artificially alter the testosterone/epitestosterone ratio.

The use of any such agent or technique shall be treated as a positive test for substances prohibited by this Policy for disciplinary purposes.


5. ALCOHOL ABUSE

The use and/or abuse of alcohol in such a fashion so as to impair the ability to perform is prohibited by this Policy. Talent are expected to be free of the influence of alcohol when performing for WWE. Accordingly, the use of alcohol at any time twelve hours prior to any scheduled performance is prohibited by this Policy.

(1) Testing for alcohol use or abuse in violation of this Policy shall be for reasonable cause only as defined in Section 7A.

(2) The initial positive test for use and/or abuse of alcohol in violation of this Policy will be treated as a medical issue requiring evaluation for alcohol rehabilitation treatment. All subsequent positive tests for alcohol-related violations of this Policy shall be treated as disciplinary matters in accordance with this Policy.


6. ADMINISTRATION OF THE POLICY

The administration of this Policy is directed by the Program Administrator (PA) for the WWE. The PA shall be David L. Black, Ph.D., D-ABFT, D-ABCC of Aegis Sciences Corporation (“Aegis”), Nashville, Tennessee. The PA shall be responsible for scheduling Talent for testing, administering collection of samples, coordinating secure shipment of samples to the testing facility, interviewing Talent and determining whether any WWE Talent has tested positive for the existence of a prohibited drug and, if so, directing that the appropriate penalty as set forth herein is imposed.


7. TESTING FOR USE OF PROHIBITED SUBSTANCE

A. Reasonable Cause Testing

(1) Reasonable Suspicion. WWE may require Talent to submit to a test or tests, including, without limitation, urine, blood, saliva, hair, and/or breath tests, if there exists reasonable suspicion that the Talent has violated any part of this Policy or has diminished ability to perform as a result of using any prohibited substance. Some of the conditions, observations and/or reports that may cause WWE to have such a reasonable suspicion are as follows:

(a) When a Talent is found or observed in possession of illegal drugs or illegal drug paraphernalia at any time.

(b) Observation of signs, symptoms and/or behaviors known to accompany the use of prohibited substances including, but not limited to:

1. physical signs of red or droopy eyes, dilated or constricted pupils;

2. slurred speech, stumbling, or hyperactivity;

3. needle marks;

4. repeated unexplained disappearances from an Event;

5. unexplained lateness in arriving for an Event;

6. nose constantly runs, appears red, or persistent sniffling;

7. time distortion, including repeated tardiness and missed appointments;

8. chronic forgetfulness or broken promises;

9. accidents during Events;

10. inability to concentrate, remember, or maintain attention;

11. mental confusion, paranoia, or presence of abnormal thoughts or ideas;

12. violent tendencies, loss of temper, or irritability;

13. extreme personality change or mood swings;

14. deteriorating personal hygiene or appearance.

(c) A drug related conviction.

(d) Receipt of a report from a reliable source that a Talent is using, possessing or selling illegal drugs.

(e) An examination or test, as provided by the Policy, which shows evidence of use of a prohibited substance or adulteration or manipulation of the specimen.

In addition, WWE may require a Talent to submit to a test or tests, including without limitation, urine, blood, saliva, hair, and/or breath tests, following an incident in which careless acts were observed during a WWE Event.

(2) Tests for violation of this Policy for alcohol and marijuana shall be on the basis of reasonable cause only.

B. Random Testing

With respect to all substances and drugs prohibited by this Policy except alcohol and marijuana, which will be tested only if reasonable cause exists to do so, WWE Talent will be subject to unannounced testing at any time, as determined by the PA. WWE may require Talent to submit to a test or tests, including, without limitation, urine, blood, saliva and/or hair in a random selection program. The random selection program conducted throughout the year will result in all Talent being tested on average four times and at least twice but may result in more frequent testing due to the random selection process. WWE Talent placed into the follow-up random testing program will be tested more frequently than four times per year.

C. Refusal To Test

A refusal to submit to a drug test by Talent shall be treated as a positive test for disciplinary and all other purposes pursuant to this Policy.


8. COLLECTION AND TRANSPORT OF SPECIMEN(S)

The Program Administrator will be in charge of collection of specimen(s) and they will carry out the following procedures:

(a) Ensure that the specimen(s) is/are from the Talent in question (including observation of the collection of the specimen(s)).

(b) Ensure that the specimen(s) is/are collected within the time period designated. Normally, collection shall be made within one hour or less of the notification of the Talent that testing will be conducted, unless a different time is designated based on the circumstances.


(c) Ensure that the specimen(s) has/have not been manipulated by promptly measuring the temperature of the specimen(s). Where results indicate that the sample is inappropriate for testing, the PA may require the Talent to provide additional specimen(s) as necessary.

(d) Label, secure, and transport the specimen(s) to the designated testing facility in such a manner as to ensure that the specimen(s) is/are not misplaced, tampered with, or relabeled.


9. FACILITY FOR TESTING

All testing will be done at a facility or facilities selected by WWE from among those facilities that have been certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the United States Department of Health and Human Services, College of American Pathologists Forensic Urine Drug Testing Program (CAP-FUDT) and/or American Society of Crime Laboratory Directors (ASCLD).


10. TECHNOLOGICAL ASPECTS OF TESTING

The WWE designated testing facility will determine whether and in what amount a particular specimen tests positive with respect to a prohibited substance and whether the specimen has been adulterated or manipulated. The testing facility will transmit the results to the WWE PA. The PA shall promptly notify the Talent and the designated WWE representative whether or not the specimen(s) yielded a positive result for a prohibited drug and/or were adulterated or manipulated.


11. DEFINITION OF A POSITIVE TEST

(a) A positive test is one which confirms the presence of a prohibited drug or a metabolite of a prohibited drug.

(b) The initial test of Talent under this Policy shall be considered baseline testing and shall not, if positive, subject Talent to disciplinary action. Any subsequent positive test for non-medical use after the initial baseline test shall be treated as a positive test for disciplinary reasons if, in the opinion of the PA based on the evidence of testing and its interpretation of that evidence, the Talent has continued to use any such drugs.

(c) For testosterone, the following standards shall apply:

1. A Testosterone/Epitestosterone (T/E) ratio above ten (10) shall be conclusively regarded as a positive test result.

2. A Testosterone/Epitestosterone (T/E) ratio greater than four (4) but less than ten (10) shall require follow-up testing and/or medical evaluation to determine if the test shall be interpreted as positive for the active use of Testosterone or evidence of other steroids influencing the T/E ratio.

3. A Testosterone/Epitestosterone (T/E) ratio of four (4) or less shall be regarded as a negative test result.


12. PROCEDURE FOR A POSITIVE TEST

(1) The PA shall notify the Talent and the designated WWE representative of any positive test detected on the initial baseline test as defined in Section 11(b) of this Policy.

(2) After the initial baseline test, any and all subsequent positive tests for the non-medical use of drugs shall be subject to the penalties set forth herein.

(3) In the event that a Talent tests positive for a prescription drug, it shall be the responsibility of Talent to provide to the PA, within five (5) days of notification of a positive test, suitable proof that the drug in question has been taken pursuant to a valid prescription for a legitimate medical purpose given by a licensed and treating physician, and to provide copies of the prescription and the name, address and telephone number of the prescribing physician. The PA, as part of this Policy, shall have the consent of Talent to contact the prescribing physician to confirm that the prescription provided by Talent is valid and for a legitimate medical purpose. The failure to provide suitable proof shall be treated as a positive test. For purposes of this Policy, prescriptions obtained over the internet and/or from suppliers of prescription drugs from the internet shall NOT be considered valid and/or to have been given for a legitimate medical purpose. The Talent may be required to participate in follow-up testing to verify compliance with prescription medication use.

(4) Upon being notified by the PA that a Talent has tested positive for a drug prohibited by this Policy, the Talent shall have five (5) days to request a second opinion test be conducted. The second opinion test shall be conducted at the WWE designated testing facility using bottle “B” from the original collection. If the second opinion test fails to confirm the original test, then the test will be recorded as “negative” and there will be no penalty.


13. DISCIPLINE FOR VIOLATION OF LAW

Any Talent who is arrested, convicted or who admits to a violation of law relating to use, possession, purchase, sale or distribution of prohibited drugs will be in material breach of contract and subject to immediate dismissal.


14. PENALTIES FOR POSITIVE DRUG TESTS

First Offense. In the event of an initial positive result for drugs prohibited by this Policy, as amended from time to time, the Talent shall be suspended without pay for 30 days.

Second Offense. In the event of a second positive result for drugs prohibited by this Policy, as amended from time to time, the Talent shall be suspended without pay for 60 days or, in cases where the Talent appears to be in need of a drug rehabilitation program, an indefinite suspension without pay until the individual has successfully completed the drug rehabilitation program.

Third Offense. In the event of a third positive result for drugs prohibited by this Policy, as amended from time to time, the Talent’s contract with WWE will be terminated.


15. APPLICABILITY OF THIS POLICY

This Policy, as it may be amended from time to time, is applicable to and binding upon all WWE Talent under contract to WWE who regularly perform in-ring services as a professional sports entertainer.
</blockquote>

[budman]

Easy-to-find prescription drugs fueling increase in opiate addicts

The Wilmington Star
July 3, 2006

Heroin isn't the only opium-derived substance luring users. Some of the most-abused drugs may be as close as the family medicine cabinet.

Teens in New Hanover, Pender and Brunswick counties rank prescription narcotics third among their drugs of choice, after alcohol and marijuana, according to a recent study.

Many teenage clients report it's easy to get prescription pills at school or from home, said John Dail, a Coastal Horizons Center substance-abuse counselor who works with adolescents.

"There has been a rise in opiate use among kids in the last five years," Dail said. "You can get just as addicted to prescription narcotics as you can to heroin."

Guidance from family members and counseling at facilities like Coastal Horizons can help teens at risk make positive decisions about their lives, Dail said.

"Drugs don't discriminate against age, race or social class. Anybody can become addicted," he said. "Normally, they will start out with alcohol and go to marijuana. It can affect anybody, really. Sometimes the parents just don't know."

"Wilmington, historically, has always had a huge heroin market, but prescription opiate use has taken over statistically, although the percentage of heroin users is still higher than other areas of the state," said Kenny House, Coastal Horizons clinical director of treatment services.

One Wilmington woman whose life unraveled after becoming addicted to narcotic painkillers said it was easy to obtain medications like Lorcet and Percocet.

"I knew how to work the system. I would go to a doctor and know exactly what to say and get the pain pills, and there is always somebody you can get them from," said "Lynn," whose name is being withheld to protect her identity.

Lynn was addicted to painkillers for about seven years and has been enrolled in the Coastal Horizons Center's methadone program for five years.

Methadone is a synthetic opioid that blocks the effects of heroin and other narcotics, eliminates withdrawal symptoms and relieves cravings. Coastal Horizons Center's methadone program has 150 clients, many of whom have never used heroin.

The program saved her life, Lynn said one recent morning at the clinic off Shipyard Boulevard. "Heroin use was the next step, and I thank God I got in here," she said.

Lynn, 50, had a history of marijuana and cocaine use when she began obtaining prescription drugs to alleviate migraine headaches. By the time she entered treatment at Coastal Horizons, she was facing a three-year prison term for breaking into a home to steal some pills.

"I'm not a bad person. I'm a sick person. I wish more people were educated in the methadone program," Lynn said. "In my addiction, I had no idea how many people I affected besides myself."

According to a report released last month by an agency of the U.S. Department of Health and Human Services, more people started using narcotic pain relievers for non-medical reasons in 2004 than began use of marijuana or cocaine.

A survey conducted by the Substance Abuse and Mental Health Services Administration found that 2.4 million people older than 12 started using prescription drugs for non-medical reasons, compared with 2.1 million for marijuana and 1 million for cocaine. The study also found that in 2004, an estimated 31.8 million Americans had used pain relievers non-medically in their lifetimes, up from 29.6 million in 2002.

Those trends are borne out locally. More people are treated at New Hanover Regional Medical Center for overdoses of prescription drugs than heroin, said Michael Moulton, an emergency room physician at the hospital.

"We are not unlike the rest of the country. We have a very large percentage of people who are on prescription medications and abuse them," he said.

Sometimes elderly people accidentally take more than their recommended dosage and overdose. But many young adults also end up in the emergency room, Moulton said.

About 80 percent of Coastal Horizons clients are white, and about 60 percent are female. An increasing number of people are seeking treatment for the abuse of prescription drugs, said House, the Coastal Horizons clinical treatment director.

"It's the fastest growing addiction problem in the country," he said. "Generally, the population has gotten younger over the last 10 years, and we have a larger female population."

The availability of narcotic painkillers can lead to use of other drugs like heroin, House said. "Family members are prescribed prescription painkillers. People start out with pain and they end up with addiction," he said.

Lynn knows firsthand how easy it is to obtain prescription opioids and was disturbed when her teenage son told her he had been offered drugs like OxyContin at his local high school.

"It is very scary. We just lost a guy who died from an overdose of heroin," she said. "I've seen so many young people come up here, 19 or 20 years old, and they're already on heroin. There is some bad stuff out there, but they don't care. All they care about is getting a fix. There is nothing worse than having to go through withdrawal."

House is an advocate of methadone therapy to treat narcotics addiction. He acknowledges there is a negative perception of the drug.

"Methadone actually serves to normalize body or brain function," House said. "If I'm on a stable dose, my life has the possibility and the opportunity to return to normal."

The purpose of the treatment program "is not any different from a corporate executive who goes to AA meetings," he said. "Recovery is a daily activity for folks."

Lynn started a new job last month. She is optimistic about her future and plans to continue on the methadone program.

"My life is wonderful," she said. "I have not even thought about getting off it at this point. My life was such a mess that it took me a long time to get on my feet and earn the trust of my family."

Ken Little: 343-2389

ken.little@starnewsonline.com

[palmspringsbum]

<img src=./bin/spacer.gif width=500 height=0>

Prescription Pain Killers: Illicit Use and Deaths Increasing Say Two New Reports

Senior citizens mostly uninvolved as drug abuse and under treated pain become public health crises

<table class=posttable align=right width=250><tr><td class=postcap><b><center>Misused Pain Relievers</center></b></td></tr><tr><td class=postcell><img class=postimg src=bin/DrugChart-6-07-24.gif></td></tr><tr><td class=postcap>Specific Types of Pain Relievers Used during the Past Year among Initiates of Non-medical Use of Pain Relievers: 2004 – Source SAMHSA</td></tr></table>July 24, 2006 – Two recent reports show a significant jump in the use of prescription pain killers for uses other than prescribed medical treatment. But senior citizens, which many would assume to be among this growing trend, due to the large number that suffer with pain and rely on drugs for relief, just do not seem to be involved.

A report released today says trends analysis of drug poisoning deaths has helped explain a national epidemic of overdose deaths in the US that began in the 1990s. This conclusion was by Leonard Paulozzi and colleagues at the Centers for Disease Control and Prevention. The contribution of prescription pain killers to the epidemic has only become clear recently, the study says.

Drugs called "opioids" are frequently prescribed to relieve pain, but if abused they can kill. Over the past 15 years, sales of opioid pain killers, including oxycodone (OxyContin), hydrocodone (Vicodin), methadone and fentanyl, have increased, and deaths from these drugs have increased in parallel.

In 2002, over 16,000 people died in the US as a result of drug overdoses, with most deaths related to opioids, heroin, and cocaine. Opioids surpassed both cocaine and heroin in extent of involvement in these drug overdoses between 1999 and 2002.

This increase in deaths from drug overdoses is particularly alarming when combined with the government report released last month alerting America that 2.4 million Americans initiated the non-medical use of narcotic pain relievers in the past year – more than marijuana or cocaine. Interestingly, the findings show, however, that senior citizens are just not – nor do they appear to have ever been – a significant factor in the use of narcotic pain relievers.

This report from the Substance Abuse and Mental Health Services Administration that extracted data from the 2004 National Survey on Drug Use and Health was released June 19.

<table align=right width=360><tr><td><table class=posttable align=left width=360><tr><td class=postcell><img src=bin/DrugsByAge-6-07-24.gif width=360></td></tr></table></td></tr><tr><td><table class=posttable align=center width=100% ><tr><td class=postcap></td><td class=postcap align=center>65 or older</td><td class=postcap align=center>60-64</td><td class=postcap align=center>55-59</td><td class=postcap align=center>50-54</td><td class=postcap align=center>45-49</td><td class=postcap align=center>40-44</td><td class=postcap align=center>35-39</td><td class=postcap align=center>30-34</td><td class=postcap align=center>26-29</td></tr><tr><td class=postcap>2003</td><td class=postcell align=center>0.4</td><td class=postcell align=center>1.6</td><td class=postcell align=center>0.8</td><td class=postcell align=center>2</td><td class=postcell align=center>4.4</td><td class=postcell align=center>3.8</td><td class=postcell align=center>4.9</td><td class=postcell align=center>5.4</td><td class=postcell align=center>7.8</td></tr><tr><td class=postcap>2004</td><td class=postcell align=center>0.4</td><td class=postcell align=center>0.4</td><td class=postcell align=center>1.7</td><td class=postcell align=center>1.6</td><td class=postcell align=center>3.6</td><td class=postcell align=center>4.1</td><td class=postcell align=center>4.1</td><td class=postcell align=center>5.5</td><td class=postcell align=center>7.6</td></tr></table></td></tr></table>The report, "Nonmedical Users of Pain Relievers: Characteristics of Recent Initiates," shows that 2.4 million persons ages 12 or older initiated non-medical use of prescription pain relievers in the 12 months prior to the survey, 2.1 million initiated use of marijuana, and 1 million initiated use of cocaine.

The SAMHSA report also shows that 48 percent of new initiates used Vicodin, Lortab or Lorcet; 34.3 percent used Darvocet, Darvon, or Tylenol with codeine; 20 percent used Percocet, Percodan or Tylox; 18.4 percent used generic hydrocodone; 14.3 percent used generic codeine; 8.4 percent used Oxycontin; and 4.3 percent used morphine. Over half of persons who initiated non-medical use of pain medications (54.9 percent) in 2004 were female.

Further, the report found that only 26.2 percent of the new initiates to pain medications started using pain relievers as their first illicit drug of abuse. Marijuana was used by 66.2 percent prior to starting narcotic pain medications; hallucinogens were used by 24.9 percent; and inhalants were used by 21.3 percent.

The deaths from this increased use also appear to be accelerating, according to today's report from the CDC data.

Between 1979 and 1990 the rate of deaths attributed to unintentional drug poisoning increased by an average of 5.3% each year.

Between 1990 and 2002, the rate increased by 18.1% per year.

<table class=posttable align=left width=200><tr><td class=postcap><center><b><span class=postbold>Related Stories</span></b></center>

Admissions for Drug Treatment Up for Older Adults

Agencies start new campaign aimed at seniors - Do the Right Dose

May 5, 2005 - Admissions for substance abuse treatment increased by 32 percent among older adults over the eight-year period 1995- 2002, concludes a new study released today by the Substance Abuse and Mental Health Services Administration. SAMHSA, with the support of other government agencies, is launching a new campaign aimed at educating senior citizens on the use of pain relievers. Read more...
<hr>
Medication Errors Injure 1.5 Million People, Mostly Seniors, Every Year

Medication errors are among the most common medical errors

July 21, 2006 – A report was released yesterday that should make senior citizens sit up and pay attention. It was a damning report on the injury to people in the U.S. by medication errors, which the report says occur at least 1.5 million a year – a statistic the authors say "is sobering." Senior citizens, because they are the largest consumers of medication, are at the highest risk from these errors. Read more...
<hr>
COX-2, NSAID Can Spell DEATH for Recovering Heart Attack Patients

After heart attack people may be more vulnerable to the harmful effects

June 20, 2006 - After a heart attack, patients may be at higher risk of death if they are treated with pain killers in a drug class known as COX-2 inhibitors or with high doses of other non-steroidal anti-inflammatory drugs (NSAIDs), according to a large review published in Circulation: Journal of the American Heart Association. Read more...</td></tr></table>The contribution played by opioids is also increasing. Between 1999 and 2002 the number of overdose death certificates that mention poisoning by opioid pain killers went up by 91.2%. While the pain killer category showed the greatest increase, death certificates pointing a finger of blame at heroin and cocaine also increased by 12.4% and 22.8% respectively.

This research is published this week in the journal, Pharmacoepidemiology and Drug Safety.

In an accompanying 'comment' article, David Joranson and Aaron Gilson of the University of Wisconsin School of Medicine and Public Health Comprehensive Cancer Centre; Pain & Policy Studies Group, of Madison, Wisconsin. They caution against increasing unwarranted fears of using opioid analgesics in pain management, noting that much of the abuse of opioid analgesics is by recreational and street users and individuals with psychiatric conditions rather than pain patients.

Joranson and Gilson also point to the large quantity of opioid analgesics stolen from pharmacies every year, saying that "overdose deaths involving prescription medications do not necessarily mean they were prescribed. It is also crucial to know that most overdose deaths involve several drugs and these data cannot attribute the cause to a particular drug."

In a second commentary, Scott Fishman, Professor of Anaesthesiology and Pain Medicine at University of California, Davis concludes that drug abuse and under treated pain are both public health crises, but the solution to one need not undermine the other. "The least we can do is make sure that the casualties of the war on drugs are not suffering patients who legitimately deserve relief," he says.

External Links:

About Opioids from Psychology Today

The Opioids are a class of controlled pain-management drugs that contain natural or synthetic chemicals based on morphine, the active component of opium. These narcotics effectively mimic the pain-relieving chemicals that the body produces naturally.

Opioids are the most often prescribed pain-relievers because they are so effective. Moreover, many studies have shown that opioid analgesic drugs are safe and rarely cause clinical addiction or compulsive usage if taken as directed.

Morphine, heroin, codeine and related drugs are among the opioids. Morphine is frequently prescribed to alleviate severe pain after surgery. Codeine can be helpful in soothing somewhat milder pain, as are oxycodone (OxyContin, an oral, controlled-release form of the drug), propoxyphene (Darvon), hydrocodone (Vicodin), hydromorphone (Dilaudid) and meperidine (Demerol), which is used less often because of its side effects. Diphenoxylate or Lomotil can also relieve severe diarrhea, and codeine can ease severe coughs. Read more from special section on Opioids in Psychology Today…

2.4 Million Started Using Pain Relievers in Past Year

June 19, 2006 - More persons initiated non-medical use of narcotic pain relievers in the past year than initiated use of marijuana or cocaine. This is the finding of a new report from the Substance Abuse and Mental Health Services Administration that extracted data from the 2004 National Survey on Drug Use and Health.

The new report, “Nonmedical Users of Pain Relievers: Characteristics of Recent Initiates”, shows that 2.4 million persons ages 12 or older initiated non-medical use of prescription pain relievers in the 12 months prior to the survey, 2.1 million initiated use of marijuana, and 1 million initiated use of cocaine.

The report is available on the web - click here

Prescription of Opioids For Back Pain Needs Improvement

April 15, 2004 - Physicians' prescriptions of opioid drugs for back pain are inconsistent, found a Duke University Medical Center study, the largest and most comprehensive of its kind. The study found significant regional, social and economic disparities in the use of the powerful painkillers. Specifically, the researchers found that patients are more likely to take opioid drugs for their back pain if they live in the South, hold public insurance, are less educated and have low income. Moreover, the use of a powerful opioid drug, oxycodone, doubled from 1996 to 1999, found the researchers. Click to story…

http://www.seniorjournal.com/NEWS/Healt ... illers.htm

[Midnight toker]

DEA Congressional Testimony
<center>
Statement of

Joseph T. Rannazzisi
Deputy Assistant Administrator
Office of Diversion Control
Drug Enforcement Administration
U.S. Department of Justice


Before the

House Government Reform Committee

Subcommittee on Criminal Justice, Drug Policy, and Human Resources

July 26, 2006

“Prescription Drug Abuse: What is Being Done to Address This New Drug Epidemic?”



<hr class=postrule>
</center>
Chairman Souder, Ranking Member Cummings, and distinguished members of Subcommittee, on behalf of Administrator Tandy and the Drug Enforcement Administration (DEA), I appreciate your invitation to testify today regarding DEA’s efforts to address the issue of prescription drug abuse.


<center>Overview</center>

Addressing the growing problem of the diversion and abuse of controlled pharmaceuticals continues to be one of the top priorities of the Drug Enforcement Administration. DEA has made great strides in dealing with this ever-changing, global drug issue. We continue to concentrate on identifying, targeting, and dismantling large-scale organizations that seek to divert and distribute controlled pharmaceuticals in violation of the Controlled Substances Act (CSA). An illustration of the Administration’s focus on this problem occurred on June 1, 2006, when the Department of Justice, along with the DEA, the Office of National Drug Control Policy, the Department of Homeland Security, the Department of Health and Human Services, and other agencies announced a comprehensive Synthetic Drug Control Strategy, which among other significant drug threats, specifically targets prescription drug abuse. The DEA is keenly aware of this problem.

An examination of youth drug abuse data reveals that the percentage of young Americans abusing prescription drugs is second only to marijuana and ahead of cocaine, heroin, methamphetamine, and other drugs. DEA, as the nation’s primary law enforcement agency dedicated to enforcing the Controlled Substances Act, plays an integral role in achieving the goals of the Administration’s Synthetic Drug Control Strategy. As outlined in that Strategy, we have committed to an ambitious goal of reducing the abuse of controlled pharmaceuticals by 15 percent over the next three years.

DEA's obligation under the law and to the public is to ensure that pharmaceutical controlled substances are prescribed and dispensed only for legitimate medical purposes in accordance with the Controlled Substances Act. By carrying out this obligation, DEA strives to minimize the diversion of pharmaceutical controlled substances for abuse while ensuring that such medications are fully available to patients in accordance with the sound medical judgments of their physicians. In this manner, DEA is committed to balancing the need for prevention, education, and enforcement with the need for legitimate access to these drugs.

In developing a strategy to balance these priorities, the Administration has worked to obtain better data on how people acquire and abuse controlled pharmaceuticals. It is important to understand that there are distinct differences between drugs such as heroin or marijuana and controlled pharmaceuticals. As we know, illegal drugs such as cocaine, heroin, and marijuana often are obtained through secretive and dangerous transactions. Typical drug control strategies used to attack organizations that focus on distribution of clandestine drugs do not necessarily lend themselves to attacking those organizations that illegally traffic in controlled pharmaceuticals.

Controlled pharmaceuticals are readily available for legitimate purposes through one’s physician and pharmacy. Distribution channels that are otherwise legal are often manipulated to acquire controlled substance prescription drugs for illegal purposes. Compounding this matter is the perception, particularly among teenagers and young adults that controlled pharmaceuticals are safe even when used “recreationally.” Abusers of controlled pharmaceuticals are using these medicines for non-medical purposes in a manner for which they were never intended. This practice, coupled with the erroneous perception of safety, makes these medicines much more dangerous.


<center><b>DEA Initiatives</b></center>

DEA has not remained idle in response to this growing threat. DEA has made it a priority to disrupt and dismantle organizations that illegally traffic in controlled pharmaceuticals. This priority is reflected in the fact that diversion control is a strategic goal in the DEA five-year Strategic Plan. Part of this strategy is to attack the economic basis of the drug trade by inflicting upon the illicit drug business what every legal business fears: escalating costs, diminishing profits, and unreliable suppliers. To do so, DEA uses all of the tools at its disposal. We have dismantled major pharmaceutical trafficking and distribution organizations through criminal investigations. We have also used our regulatory authority to take action against DEA registrants found to be in violation of regulatory requirements under the CSA. Through regulatory authority, DEA has subjected registrants to significant civil fines, licensing restrictions, or even suspended registrations. Such civil remedies have proven to be an effective deterrent to potential violators.

As we have observed the pharmaceutical controlled substances abuse problem grow, DEA has significantly increased the amount of resources and manpower dedicated to investigating the diversion of controlled pharmaceuticals. We continue to focus our drug enforcement efforts on the most significant diverters in the drug supply chain. Specifically, DEA has increased the number of Special Agent work-hours on diversion investigations by 114 percent between FY-2003 and FY-2005. DEA has increased the number of Intelligence Analyst work-hours by 234 percent during that same period. Enforcement efforts undertaken by the DEA are also aimed at the economic base of drug traffickers, and strong emphasis is placed on seizures of financial and other assets. In FY-2002 DEA seized approximately $1.8 million in assets related to diversion investigations. In FY-2005 that increased to approximately $32.4 million, an 1,800 percent increase.

In early FY 2005, the DEA began working with its industry partners to develop public service announcements that now appear automatically during Internet prescription drug searches. These announcements are designed to alert consumers of the potential dangers and the illegality of purchasing controlled substances, particularly pharmaceuticals, over the Internet. Both Yahoo and Google have responded by instituting voluntary compliance measures and corporate commitments to taking affirmative steps to curtail the illicit sale of pharmaceuticals on their networks.

In addition, DEA’s Demand Reduction office has produced an anti-drug website for teens, www.justthinktwice.com. This site provides young people with straightforward information on the consequences of drug use and trafficking, including health, social, legal consequences. It is continually updated to provide current information to teens and will be expanded and refined to reflect the needs of teens. This site has been a valuable (and popular) resource for teens seeking information on drugs for their own education or for school research projects. The Demand Reduction Program also continues to provide the public and school age children with a variety of demand reduction presentations on a national and local level regarding the abuse of controlled prescriptions.

Finally, the DEA has met with the leading certifying medical boards and encouraged them to develop educational programs concerning the prescribing of controlled substances, especially high-dose opioids.


<center><b>Sources of Abused Pharmaceuticals</b></center>

Pharmaceutical investigations and surveys of state and local law enforcement agencies and state medical boards have revealed that the most common methods of controlled substance prescription drug diversion include “doctor shopping” or other prescription fraud, illegal online pharmacies, theft and burglary (from residences, pharmacies, etc.), stereotypical drug dealing (selling pills to others), receiving from friends or family, and negligent or intentional over-prescribing by physicians or other practitioners. What is not yet adequately understood is the relative proportion of these methods.


<center><b>Doctor Shopping and Prescription Fraud</b></center>

“Doctor shopping” by drug addicts is one of the most common ways that addicts get illegal controlled substances. Generally, this term refers to the visit by an individual—who may or may not have legitimate medical needs—to several doctors, each of whom writes a prescription for a controlled substance. The individual will visit several pharmacies, receiving more of the drug than intended by any single physician, typically for the purpose of feeding an addiction.

Associated illegal activities may include the forgery of prescriptions, or the sale or transfer of the drug to others. Unfortunately, in many states, physicians and pharmacists have not been able to automatically cross-check multiple prescriptions given to the same patient.

To address this problem, Congress first appropriated funds to the Department of Justice in 2003 to promote the deployment of Prescription Drug Monitoring Programs (PDMPs) by States. That commitment continues as part of the Administration’s National Drug Control Strategy for 2006. PDMPs help cut down on prescription fraud and doctor shopping by giving physicians and pharmacists more complete information about a patient’s prescriptions for controlled substances.

While the specifics of these programs vary from state to state, they generally share the characteristic of allowing prescribers (for example, a physician) and dispensers (for example, a pharmacist) to input and receive accurate and timely controlled substance prescription history information while ensuring patient access to needed treatment. Most states also have some mechanism for law enforcement to receive this information in cases where criminal activity is suspected. Some states also allow health care providers to use this information as a tool for the early identification of patients at risk for addiction in order to initiate appropriate medical interventions. In other states the justice system can use this information to assist in the enforcement of laws controlling the sale and use of controlled substance prescription medication.

The PDMP program has steadily expanded through the Harold Rogers Prescription Drug Monitoring Program, with a total of 33 states with active or planned PDMPs as of July 1, 2006. These grants can be used to implement or enhance PDMPs at the state level. The Administration plans to continue its work with states that have PDMPs to obtain better data as to the extent and nature of the controlled substance prescription drug abuse threat, to encourage the expansion of the PDMP program nationwide, and to share best practices information with states that already have PDMPs (e.g., on cost effectiveness, the benefits to monitoring all scheduled controlled substances, and measuring performance).


<center><b>Improper Prescribing</b></center>

Improper prescribing is another method of controlled substance diversion. Improper prescribing differs from doctor shopping and prescription fraud in that the latter situations, the abusers are attempting to deceive or mislead the medical professionals who are doing their jobs responsibly.

The overwhelming majority of prescribing in America is conducted responsibly. Often these responsible doctors and pharmacists are the first to alert law enforcement to potential prescription problems. However, the small number of physicians who over prescribe controlled substances—carelessly at best, knowingly at worst—help supply America's second most widespread drug addiction problem. Although the problem exists, the number of physicians and pharmacists responsible for this problem is a very small fraction (less than 1 percent) of those licensed to prescribe and dispense controlled substances in the United States.


<center><b>Sharing Among Family and Friends</b></center>

As DEA increases its understanding of where abusers acquire prescription drugs, preliminary data suggest that the most common method in which controlled substance prescriptions are diverted may be through friends and family. For example, a person with a lawful and genuine medical need for a controlled substance may use only a portion of the prescribed amount. A family member or friend may complain of similar symptoms, and the former patient shares excess medication. Alternatively, for someone addicted to controlled substance prescription drugs or to an inquisitive youngster, the mere availability of unused controlled substance prescriptions in the house may prove to be an irresistible temptation.

The solution to this aspect of the problem lies both with the medical community and the legitimate patient population. Greater educational efforts are needed regarding quick and safe disposal of unused and unneeded medications. Prescribers need to carefully consider the potential for abuse of controlled substances and prescribe only the amount of a controlled substance required medically. Patients must also be educated about the legal and social ramifications of providing a controlled substance to a friend or family member. It is not merely illegal, but could feed, or lead to, an addiction, and place that loved one in a life threatening situation.


<center><b>Illegal Online Pharmacies</b></center>

Perhaps the most potentially dangerous and increasingly used method for the diversion of controlled pharmaceuticals is through the Internet. As the number of Americans with Internet access has increased, so too have opportunities for individuals to acquire controlled substance prescription drugs over the Internet. There are strong societal benefits to allowing individuals with a valid prescription to get their prescriptions over the Internet, as long as the pharmacy that fills these prescriptions is a legitimate one and there is a legitimate doctor-patient relationship. This may be helpful in rural areas or for individuals who are homebound due to illness or other factors. However, the anonymity of the Internet, and the proliferation of websites that facilitate illicit transactions in controlled substance pharmaceutical drugs, have given drug abusers the ability to circumvent both the law and sound medical practice.

There are legitimate pharmacies that provide services over the Internet and that operate well within the bounds of both the law and sound medical practice. The National Association of Boards of Pharmacy has established a registry of pharmacies that operate online and meet certain criteria, including compliance with licensing and inspection requirements of their state and each state to which they dispense pharmaceuticals.

By contrast, other websites used by Internet facilitators will often advertise themselves as pharmacies, but they do not operate in the same manner as brick-and-mortar pharmacies. Many of these websites advertise controlled substances without a prescription, and none include an in-person medical examination from a licensed physician.

Of particular concern is the cursory and abbreviated nature of the medical interaction. Often, if there is any interaction with a medical professional at all, the Internet facilitator will provide only a cursory doctor consultation by computer or telephone for customers. This brief interaction is not meant to elicit meaningful health information, and is generally done by way of a “questionnaire” filled out by the “patient” without any face-to-face meeting between the doctor and the patient. Without this face-to-face interaction, it is not possible for the doctor writing the prescription, who has never met the patient, to verify the information provided by the individual and assess legitimate medical need. This is particularly troubling in the context of youth drug abuse. Unlike when the patient visits the doctor, a minor can easily log onto a website and provide an inaccurate age.

Doctors, who are often paid by the number of prescriptions they sign in these situations, have no incentive to spend time seeking additional patient information. Law enforcement has discovered website-affiliated doctors who sign hundreds or thousands of prescriptions a day. After receiving the prescription from the doctor, the facilitator will then submit the prescription to a cooperating pharmacy. Because there is often no identifying information on these rogue websites, it is very difficult for law enforcement to track any of the individuals behind them.

The Administration is using all available tools to go after the operators of these rogue Internet-facilitator websites. We are conducting investigations and working to intercept controlled substance prescriptions illegally sent into the United States through the mail system. For example, the DEA’s Internet investigation unit at its Special Operations Division continues to coordinate Internet cases, and the DEA has issued a number of immediate suspensions of the DEA registrations of doctors and pharmacies operating illegally via the Internet. The Department of Justice has prosecuted doctors and pharmacies who illegally distribute via the Internet.

The tangible aspects of manufacturing, distributing, prescribing, and dispensing pharmaceutical controlled substances remain squarely under the jurisdiction of the CSA. Any legitimate transaction over the Internet must be in compliance with these existing laws.

Additional clarification of the roles and responsibilities for professionals seeking to use the Internet to meet the needs of clients would not only allow us to more readily identify legitimate online pharmacies and persons operating and promoting them, but it would also assist in gathering information pointing to abuse patterns. Such clarification would also help us investigate drug traffickers hiding behind the façade of an otherwise legitimate practice.

Additionally, there exists no statutory definition of a valid "doctor/patient" relationship. Finally, the penalties associated with the illegal sale of Schedule III-V substances, which are those most commonly sold controlled substances over the Internet, are not as significant as may be warranted.

States can play a significant role in addressing the problem of online facilitators, particularly through PDMPs. As part of the Administration’s work with states regarding PDMPs over the next several years, states will be encouraged to consider addressing, either by statute, regulation, or interstate agreement, a number of scenarios that primarily involve pharmacies dispensing or delivering controlled substance prescription drugs to patients across state lines. To be effective, laws must be updated to reflect the changing ways people live and in which business is conducted.


<center><b>Coordinating Regulatory Responsibilities</b></center>

As the DEA fights against diversion and drug abuse across the nation, the proper regulatory control of new pharmaceuticals is vital. Appropriate control mechanisms are particularly important given the strength and formulations of products as they become available to the consumer. This is important to the DEA as we are seeing an overall increase in the commercial dispersion of pharmaceuticals which results in a significant increase of pharmaceutical doses available for diversion. Understanding the differences–and the similarities–between prescription drugs and controlled substances is an important aspect of evaluating the causes and possible policy solutions regarding the rise in prescription drug abuse.

Congress signaled its full recognition of the abuse potential of certain prescription drugs in 1914, when it passed the Harrison Narcotic Act, regulating the sale of opiates for the first time. With the passage of the Federal Food, Drug and Cosmetic Act (FDCA) in 1938 and in subsequent amendments, the United States Congress recognized the critical importance of indicating the medically proven uses of prescription drugs for legitimate medical needs.

The CSA is the legal foundation for the United States fight against abuse of drugs and other substances. It was passed to minimize the quantity of abuseable substances available to those likely to abuse them, while providing for legitimate medical, scientific and industrial needs for those substances in the United States. Control under the CSA encompasses both licit and illicit substances and regulates chemicals used in the clandestine production of controlled substances. The Department of Justice (DOJ), through the DEA, and the Department of Health and Human Services (HHS), through the FDA, both have a role in implementing the CSA.

The CSA requires that substances be scheduled by a determination made by the Attorney General, after a scientific and medical evaluation and recommendation by the Secretary of HHS (See 21 USC 811(b)). Substances with a substantial potential for abuse are considered for control under Schedules II through V. Schedule II substances have the highest abuse potential and dependence profiles with the most restrictive regulatory requirements, while III through V drugs have progressively less abuse potential and dependence profiles and are subjected to less restrictive regulatory requirements.

The placement of a substance in a given schedule is based on its medical use, safety, potential for abuse, or dependence liability, and consideration of specific factors as listed in the CSA. For drug products containing substances that are not already controlled under the CSA, as in the case of new molecular entities, HHS will forward their scientific and medical evaluation and a scheduling recommendation to the DEA. FDA has the statutory responsibility to determine the safety and effectiveness of new drug products for medical use in the United Sates. As a part of their evaluation, FDA also examines the abuse potential of drug products.

The CSA includes seven major control mechanisms. They are scheduling, registration, quotas, records and reports, import and export authorizations, security and investigational authority. These mechanisms allow DEA to monitor and regulate a controlled substance and its movement: in the case of the most potentially dangerous drugs, in Schedule II, we register all persons who handle them; we inspect the documentation of their distribution; we control their import and export; and we control the amount produced, bought, sold, and otherwise transferred.

These controls have been extremely effective in preventing diversion at the importer, manufacturer, and distributor levels. However, as described earlier, the vast majority of diversion occurs at the retail level, once the product is in the hands of practitioners and patients.


<center><b>Conclusion</b></center>

The diversion of pharmaceutical controlled substances continues to be a significant challenge. Nevertheless, the DEA is committed to using the necessary tools at its disposal to fight this growing problem on all fronts, while simultaneously ensuring an uninterrupted supply of pharmaceutical controlled substances for legitimate demands. DEA's core competency, the disruption and dismantlement of drug trafficking organizations impacting the United States, is an integral component to the Synthetic Drug Control Strategy and we will continue to implement this aspect of the Strategy with our inter-agency partners to combat controlled substance pharmaceutical diversion.

Chairman Souder, Ranking Member Cummings, and distinguished Members of the Subcommittee, thank you again for the opportunity to testify before you today. Prescription drug abuse is an increasing threat that we must face, and DEA looks forward to working with you to address this important issue. I’ll be happy to answer any questions you may have.

[budman]

Antidepressants prove addictive to some

Yahoo News
By MATT CRENSON, AP National Writer
Sun Aug 6, 4:17 PM ET



<table class=posttable width=204 align=left><tr><td class=postcell><img class=postimg src=bin/stuck_on_meds.jpg></td></tr><tr><td class=postcap>Gina O'Brien poses in her Howard City, Mich. home in this July 16, 2006, file... </td></tr></table>When Gina O'Brien decided she no longer needed drugs to quell her anxiety and panic attacks, she followed doctor's orders by slowly tapering her dose of the antidepressant Paxil. The gradual withdrawal was supposed to prevent unpleasant symptoms that can result from stopping antidepressants cold turkey. But it didn't work.

"I felt so sick that I couldn't get off my couch," O'Brien said. "I couldn't stop crying."

Overwhelmed by nausea and uncontrollable crying, she felt she had no choice but to start taking the pills again. More than a year later the Michigan woman still takes Paxil, and expects to be on it for the rest of her life.

In the almost two decades since Prozac — the first of the antidepressants known as SRIs, or serotonin reuptake inhibitors — hit the market, a number of patients have reported extreme reactions to discontinuing the drugs. Two of the best-selling antidepressants — Effexor and Paxil — have led to so many complaints that some doctors avoid prescribing them altogether.

"It's not that we never use it, but in the end I will tend not to prescribe Effexor or Paxil," said Dr. Richard C. Shelton, a psychiatrist at the Vanderbilt University School of Medicine. Shelton has received grant support from the makers of both drugs and consulted for a number of other pharmaceutical companies.

Patients report experiencing all sorts of symptoms, sometimes within hours of stopping their medication. They can suffer from flu-like nausea, muscle aches, uncontrollable crying, dizziness and diarrhea. Many patients suffer "brain zaps," bizarre and briefly overwhelming electrical sensations that propagate from the back of the head.

Though not exactly painful, they are briefly disorienting and can be terrifying to patients who don't know what they are experiencing. There are case reports of people who have just quit antidepressants showing up in hospital emergency rooms, thinking they are suffering from seizures.

Toni Wilson certainly didn't know how unpleasant going off Zoloft could be when her doctor recently switched her to Wellbutrin, telling her that the new drug would "take the place of" the old one. The two antidepressants actually work on entirely different neurochemical systems, so going straight from one to the other was equivalent to quitting Zoloft cold turkey.

"After about three days I felt real anxious and irritable," the Kansas woman said in an e-mail message. "I would shake, not eat much, it felt like little needles in my body and head."

Cases like Wilson's would be virtually nonexistent if physicians took more care in weaning their patients off antidepressants, said Philip Ninan, vice president for neuroscience at Wyeth, the maker of Effexor.

"The management of discontinuation symptoms is relatively easy if you know about it," Ninan said, and noted that Wyeth had made efforts to educate both physicians and patients.

Yet surprisingly few doctors know enough about SRI discontinuation to manage it effectively. A 1997 survey of English doctors found that 28 percent of psychiatrists and 70 percent of general practitioners had no idea that patients might have problems after discontinuing antidepressants. Awareness may have increased since then, but the phenomenon is so little studied that no one has done the necessary research to find out.

The condition's prevalence is equally mysterious. Studies put the rate at anywhere from 17 percent to 78 percent for the most problematic drugs.

So little is known about it that researchers aren't even exactly sure what causes the symptoms. It may be related to the fact that the brain chemical affected by most of the antidepressants on the market today, serotonin, does a lot more than regulate mood. It is also involved in sleep, balance, digestion and other physiological processes. So when you throw the brain's serotonin system out of whack, which is essentially what you're doing by either starting or discontinuing an antidepressant, virtually the whole body can be affected.

Generally the drugs that are metabolized most quickly cause more severe symptoms, Shelton said. Effexor, which breaks down in a period of hours, is one of the worst SRIs in that regard; Prozac, which has a half-life of about a week, is considered the best.

Some doctors have been able to minimize withdrawal symptoms in patients who are quitting Effexor or Paxil by gradually switching them over to Prozac, then tapering them off the more easily discontinued drug.

Critics of the pharmaceutical industry complain that drug companies downplay the severity of drug discontinuation symptoms. The prescribing information companies provide to doctors warns that patients occasionally experience mild symptoms when they stop taking SRI antidepressants, but imply that tapering off the medication can prevent problems. Medical journals describe the ill effects of going off the drugs as "mild and short-lived," and usually avoidable if the dose is tapered.

"I don't think they're difficult to go off," said Alan Schatzberg, chairman of the department of psychiatry and behavioral sciences at the Stanford University School of Medicine. "The vast majority of people aren't that sensitive."

Schatzberg recently chaired a Wyeth-sponsored panel of physicians that offered guidelines for how to manage "antidepressant discontinuation syndrome," the preferred medical term for what a layperson would think of as withdrawal. He has also served as a consultant to several other pharmaceutical companies.

Terms like "antidepressant discontinuation syndrome" demonstrate the pharmaceutical industry's efforts to downplay the problem, charged Karen Menzies, an attorney who has been involved in litigation over the phenomenon.

"Withdrawal is the word that is used in Europe," she said.

In December 2004 Britain's drug regulatory agency issued a report that warned that all SRIs "may be associated with withdrawal" and noted that Paxil and Effexor "seem to be associated with a greater frequency of withdrawal reactions."

But drug companies insist antidepressants can't cause withdrawal because they are not technically addictive. Even so, many patients who have gone through the experience say it feels like withdrawal to them. Some can't work, drive, socialize or do other everyday things for weeks.

"You just feel awful," said a New York children's entertainer, who asked not to be named for professional reasons. He has taken a small dose of Effexor for eight years rather than suffer through the withdrawal experience. But he said the inconvenience is worth it for the benefits the drug provided him when he needed it.

Taking SRIs indefinitely is not an attractive option for many patients because it means putting up with unpleasant side-effects such as weight gain and sexual dysfunction. For women who want to have children it's an especially risky choice; researchers have documented withdrawal in newborns whose mothers were taking antidepressants, and some SRIs have been linked to birth defects.

Having to keep taking Paxil makes O'Brien angry because she feels at the mercy of GlaxoSmithKline, the company that makes it.

Though a GSK spokesperson said the symptoms associated with discontinuing Paxil are generally mild and manageable, in O'Brien's eyes the company is profiting by having hooked her on one of its drugs.

"If they ever did quit making Paxil, I'd be in so much trouble," O'Brien said. "What really makes me mad is if I can't get off it, why am I paying them? They should be paying me

[palmspringsbum]

Region's biggest substance problem is legal drugs used illegally

Published 08/13/2006
By BECKY CAMPBELL
The Kingsport Times-News


Over the years, the drug trade in Sullivan County has changed.

There's been an influx at various times of marijuana, LSD, heroin, powder cocaine, crack cocaine and methamphetamine, just to name a few.

And in the last decade, drug officers have broken up more than one major drug ring including all kinds of illegal narcotics.

Those drugs are still around, but one that many people might not think of has a legal and legitimate use.

"Our biggest problem from a standpoint of the number of people involved (in drugs) is not crack cocaine," said District Attorney General Greeley Wells.

The most abused drug? Prescription pain medication.

"It's more abused than anything else, and because they're in the medicine cabinet, kids can get them," Wells said. "Most kids caught with drugs have gotten them from their parents' medicine cabinet."

But it's not just abuse of legitimately obtained prescription drugs. Another real problem is forged prescriptions.

"We probably prosecute 75 to 100 cases a year for prescription drug fraud," Wells said.

Pain medications are very addictive, Wells said, so when someone has a legitimate need for them, they can get hooked.

"Most of these drugs have a real use, and most were developed for people with great pain," he said.

Kingsport Police Chief Mark Addington tells the story of a conversation he overheard at a ball game.

Addington said he heard two women talking about an ankle sprain one had, and he expected to hear that she doctored it by taking an over-the-counter pain reliever and applying ice to the injury.

Instead, she relayed that she went to the doctor and got a prescription for Lortab.

"The soccer mom takes Lortab and keeps going. The pain medication is a bigger problem than people realize, it's almost overwhelming," he said.

Such medicines can also be an entry point for using heavier drugs, Wells said.

"Drug problems are widespread in society. People would be surprised at how the drug problem stretches across all demographics."

Addington said he's seen cases involving people who have standing in the community.

"I know of three cases in the past year where college-educated, professional people in the medical industry are diverting prescription medication for their own use," he said.

Addington also told the Times-News that more people in Northeast Tennessee use prescription medications than any other part of the state.

"People out here on pain pills, I swear it's becoming an epidemic. They quit work because they're hooked on painkillers."

Wells said even with the number of active prescription drug fraud cases in Sullivan County, drug officers still have to deal with the marijuana and cocaine trade.

In the last two years, there have been two double-murder cases in Kingsport that police say are drug related.

Because the cases have not been resolved, Wells said he could not discuss the specifics involved.

But he did say that as long as there is a demand for drugs, drugs will be available.

"The general perception of the public is that drug-related crimes are committed by addicts. That's not true," Wells said.

Instead, it's an issue of money and profit that drives drug-related crime.

"People here have money to buy drugs. That's one thing that drives the drug trade," he said.

In addition to that, the drug trade is affected somewhat by race.

"The selling of crack cocaine is largely a black issue. Other types of drugs are a white issue," he said, adding that prescription drugs and methamphetamine are primarily "white" drugs.

Still, local officials agree that it's prescription drugs that have taken the new stronghold in the area.

Johnson City Police Chief John Lowry said the problem is here and isn't going away anytime soon.

"If you look at some of the crimes we're seeing, they're related back to drugs. I'm not talking about just crack cocaine and powder cocaine. It relates back to prescription drugs - morphine patches and all these things. We're just seeing an overabundance of prescriptions being written for Lortab or Xanax. We're not just trading coke and pot anymore, we're trading those things (for others)," he said.

[palmspringsbum]

Drug culture: A pill for every ill

Published 08/13/2006
By RAIN SMITH
The Kingsport Times-News

Northeast Tennessee's most dire drug problem isn't crack, methamphetamine or marijuana. Because of common medical practices and the growing philosophy of a pill for every ill, Sullivan County District Attorney Greeley Wells says prescription medications have become the drug of choice for many.

"In numbers, what we're talking about in this area, the biggest problem we see is with prescription drugs," Wells said.

In 2005, the 2nd Judicial District saw 93 people indicted for prescription drug fraud. This year there have already been 48 separate counts of prescription fraud, with 32 defendants indicted.

Based on his caseload, Wells said folks in the middle to upper classes appear most prone to abuse and becoming hooked on pills.

"My own personal feeling is there's a lot more prescriptions being written for addictive painkilling medications than have been written in the past," he said.

"I think the medical profession really should look at what they are doing more closely in dispensing these drugs."

And, according to a recently released survey from the American Prosecutors Research Institute, the Southeast is abusing prescription medication at a rate higher than elsewhere in the country. Based on the responses of 560 district attorneys, including Wells, the most prevalent drugs in caseloads nationwide are marijuana, followed by methamphetamine and cocaine.

Prescription drugs ranked fourth, and the survey noted that "prosecutors in the Southern region had significantly more cases of prescribed drugs when compared to other regions."

In 2002, according to health research company Novartis, Tennessee led the country with an average of almost 18 prescriptions per person per year. The Volunteer State's prescription-use rate has risen 28 percent since 1999 and is more than twice that of California.

"There is no question prescriptions are being written for pain medication that are much stronger then needed to alleviate the pain of the sufferer." Wells said.

"Pain is a relative matter, and it is a very subjective thing. I can go to the doctor and tell them I'm in a great deal of pain, and the doctor doesn't know if I am or not. If my objective is to get one of these pain medications, I can fool the doctor by saying I'm in a great deal of pain."

Wells and some members of the medical community believe medicine in America has become compromised by special interests.

"I'm aware of cases where folks in the medical community have been taken along on free vacation trips for the number of sales they've (prescribed to patients)," Wells said.

Wells believes pain-management clinics - where morphine and methadone are often prescribed for pain - are also a factor in people becoming addicts.

"The police that investigate those cases are certainly aware who those physicians are," Wells said of pinpointing the source of prescription abuse.

Though it doesn't possess methamphetamine's immediate, explosive risks to a child's health, Wells sees a nation of pill-popping children on the horizon.

"From talking with folks in juvenile court, and talking to school children, prescription drugs are the biggest problems for our children," Wells said. "It's trickling down. The drug cases that come into juvenile court are mostly kids that have gotten into the medicine cabinets of their parents or a friend's parents."

According to Novartis, U.S. consumers spent $115 billion on prescription medication in 1999 –– about 10 prescriptions per person per year.

Wells sees the trend as creating an uphill battle for prosecutors, law enforcement and families trying to battle prescription abuse.

"I'm concerned it's habituating a number of children into the excessive and nonessential use of drugs," Wells said. "Unless something occurs to break the trend I'm seeing right now, the outlook is bleak. There are an increasing number of people becoming addicted to prescription painkillers. As those numbers increase, dangers to the public increase."

[budman]

September 10, 2006 at 13:32:54

Glaxo Promotes Mental Disorders - Then Paxil

by Evelyn Pringle
OpEdNews

After gaining FDA approval for Paxil to treat depression in 1992, GlaxoSmithKline spent the next decade launching creative advertising campaigns aimed at promoting not only Paxil but also a myriad of treatable "disorders."

And as a result, Glaxo was able to convince doctors and consumers alike that the drug was appropriate for treating just about every common anxiety of life. In the end Paxil was approved for the following conditions:
<blockquote>
Depression
Panic disorder
Social anxiety disorder (SAD)
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)
Generalized anxiety disorder (GAD)
</blockquote>
Experts say that since the restrictions on advertising were lifted in 1997, drug makers have been using direct-to-consumer marketing as a tool to get people to believe they are mentally ill. According to Marcia Angell, former editor of the NEJM, and author of the best-selling book, "The Truth About the Drug Companies: How They Deceive Us and What to Do About It:"

"If you can define everyone who has the blues as having depression that needs to be treated, you've created a huge market. If you define everyone who is shy as having social anxiety disorder, that enlarges the market. There's probably not a soul alive who hasn't felt shy. If you listen to the pharmaceutical industry, many of the ordinary discontents of life are medical conditions that require drugs."

Other experts are equally appalled over the tactics used in the mass drugging of society. There is nothing more despicable than a physician who knowingly tells normal patients that they are "sick," "ill," or "diseased," for profit, according to neurologist Dr. Fred Baughman, author of, The ADHD Fraud. "Yet this has become standard practice throughout medicine," he says.

Dr. Baughman recently received an email from Barry Turner, a professor of law in the UK, in response to hearing the news about the new, "Intermittent Explosive Disorder," which Mr. Turner called "another outrageous insult to common sense."

"Anger is an emotion and is expressed in different degrees by different people," he wrote, and concluded the message by asking Dr. Baughman: What is the perfect human supposed to look like?
<blockquote>
How much attention is normal?
How much activity can be allowed before it is hyperactivity?
How angry are we allowed to be before we are disordered?
How shy can someone be before they are deranged?
Is it possible to be unhappy without being 'depressed'?
</blockquote>
Over the years, Big Pharma has learned that selling diseases and drugs to the public at the same time is much easier with the support of heavy hitters. In 2003, as part of the campaign to promote the Paxil-treatable mental disorders, Glaxo hired football icons Terry Bradshaw and Ricky Williams to encourage Americans to "take action if their lives were being impacted by depression or anxiety."

"To kick off National Mental Health Awareness Month," Glaxo wrote in a May 1, 2003 press release, "the football heroes will share their experiences with depression and anxiety at an event in New York City, the first stop on a multi-city tour sponsored by GlaxoSmithKline as part of their ongoing efforts to empower and encourage depression and anxiety sufferers to seek help and treatment."

Glaxo described Terry Bradshaw, as a former quarterback for the Pittsburgh Steelers, four-time Super Bowl winner, member of the Football Hall of Fame and two-time Emmy winner for Outstanding Sports Personality.

The press release quoted Terry as saying: "My hope is that by sharing my story with others, it will help people understand that they don't have to be embarrassed to ask for help."

"Taking that first step towards a diagnosis and treatment," he stated, "was one of the bravest things I've ever had to do."

Ricky Williams was described as a running back for the Miami Dolphins, leading NFL rusher for the 2002 football season, Most Valuable Player of the 2002 Pro Bowl and 1998 Heisman trophy winner.

Ricky was quoted as saying: "Going public with my battle with social anxiety disorder has not only made me a better friend and father, it has had an impact on people I never even met. I am amazed at the response I get from people across the country who tell me that my story has helped them or a loved one get treated."

"At one point," he said, "I would have not been able to get on a plane or talk to a group of three people."

"Now," Ricky added, "I look forward to traveling across the country to speak to large groups about taking the first step towards a better life."

The press release said that, just two years ago, Ricky had dreaded speaking to his teammates, fans or the media due to his condition. However, since "receiving treatment with therapy and Paxil," Glaxo wrote, "Ricky has been able to socialize without anxiety and use his recognition in the public as a football player to help others who may be suffering like he did."

And if Glaxo is to be believed, SAD was an epidemic in the US in 2003. "Ricky is just one of more than 10 million Americans to suffer from social anxiety disorder," the press release reported.

SAD was described as a "condition marked by an intense fear of being scrutinized by other people in social or performance situations and of negative evaluation," and the third most common psychiatric disorder in the US after depression and alcoholism.

The press release even included a link to a web site for readers who wanted to download a list of Terry and Ricky's tips or learn more about their stories. By clicking on the link, people could also learn about National Anxiety Disorders Screening Day and obtain a list of screening sites all across the country.

However, a little over a year after praising Paxil as a cure-all, in July 2004, Ricky did an about face. He announced his early retirement from football, and at the same time relinquished any hope of winning the Paxil "celebrity spokesman" of the year award when he declared during an interview with Dan Le Batard, a reporter for the Miami Herald and ESPN The Magazine, that he had found "marijuana to be 10 times more helpful than Paxil."

It should be noted that the link to the web site no longer provides access to tips or stories about Ricky Williams.

However, at first glance, Paxil seemed to be back on top of its game the following year, when the announcement came that Glaxo had won an award for its achievements in promoting Paxil in 2004, from the Prescription Access Litigation Project.

PAL hosts an annual event known as the "Bitter Pill Awards: Exposing Drug Industry Manipulation of Consumers," to call attention to the harm caused by runaway drug advertising. For the year 2004, PAL presented "The Cure for the Human Condition Award: For Hawking Pills to Treat the Trials of Everyday Life," to Glaxo stating:

"This past year, the recipient of our award, GlaxoSmithKline, was repeatedly taken to task for practices related to its antidepressant, Paxil. In June, the FDA issued a warning letter to GlaxoSmithKline for its "Hello, My Name is." television ad campaign for Paxil.

"The FDA said that this ad wrongfully "suggests that anyone experiencing anxiety, fear, or self-consciousness in social or work situations is an appropriate candidate for Paxil CR" when these are simply not approved uses of the drug. Despite the warning letter, the harm had already been done as millions of consumers had already seen the ad.

"Marketing campaigns that encourage people to take strong medications like antidepressants for the normal "anxiety, fear or self-consciousness" that we all feel on occasion are deeply irresponsible and show the harms that Direct to Consumer Advertising can cause."

PAL noted that in 2004, Paxil had more than $870 million in sales and Glaxo had the 2nd highest drug company sales of $18.8 billion.

Over the past several years, a steady stream of studies have shown Paxil is associated with serious health problems in infants born to women taking the drug during pregnancy.

In September 2005, the results of studies conducted by Danish and US researcher determined that the use of SSRIs in the first three months of pregnancy was linked to a 40% increased risk of birth defects such as cleft palate and a 60% more likely risk of cardiac defects.

On December 8, 2005, the FDA issued a public safety alert after the results of Paxil studies suggested that the drug increases the risk if heart defects, when women take it during the first three months of pregnancy.

Research published in the February 9, 2006 New England Journal of Medicine found that mothers who took SSRIs, in the second half of their pregnancies were 6 times more likely to give birth to infants with a lung disorder called persistent pulmonary hypertension (PPHN).

The condition occurs when a newborn's circulation system does not adapt to breathing outside the womb and causes high pressure in the blood vessels of the lungs making them unable to get enough oxygen into their bloodstream and can be fatal. Researchers estimate that between 10% and 20% of infants with PPHN will end up dying even after receiving treatment.

Critics say the news about dangerous drugs such as Paxil never reaches consumers because Big Pharma doles out billions of dollars to the media each year and if a negative study is about to come out, a company can just buy a few million bucks worth of ads from each major media outlet to ensure that the story gets minimal coverage, with the unspoken understanding that the ads will be canceled if the story gets too much exposure.

Families seeking justice for infants born with Paxil related birth defects can contact the Baum Hedlund Law Firm at: (800) 827-0087; http://www.baumhedlundlaw.com/

Evelyn Pringle
evelyn.pringle@sbcglobal.net

<hr class=postrule>
<small>Written as part of the Paxil Litigation Monthly Round-Up, Sponsored by Baum Hedlund's Pharmaceutical Antidepressant Litigation Department, www.a-paxil-lawyer-source.com/, www.antidepressantadversereactions.com/, www.paxilbirthdefect.com



Evelyn Pringle is a columnist for OpEd News and investigative journalist focused on exposing corruption in government and corporate America.</small>

[palmspringsbum]

Prescription drug abusers misuse system

By Marty Roney
Montgomery Advertiser


September 17, 2006

PRATTVILLE -- Drug dealers and those with a habit are using local law enforcement agencies and doctors to help them. They report their prescriptions lost or stolen, then head to the pharmacy for a refill.

The Autauga County Sheriff's Department has written more than 20 reports for stolen prescription medication in the past six months, Sheriff Herbie Johnson said. Other law enforcement agencies in the tri-county area have seen an increase in reports of stolen medication, but exact numbers aren't available.

"Some people come in and get a report, then go to their doctor to ask for a new prescription," Johnson said. "They do that to get drugs to sell on the street, or more drugs to abuse themselves. We're not qualified to prescribe drugs, and in a lot of these instances, I think that's exactly what we are doing."

Prescription drugs are responsible for about 40 percent of drug abuse nationwide. They are second only to marijuana, according to the American Medical Association. They'll be the most abused drugs within the next two to five years, according to reports and surveys conducted by national health-care groups and the federal government.

Abusers and dealers come from all walks of life, said John Burke of the National Association of Drug Diversion Investigators. White females ages 20 to 45, however, are the most likely group to abuse prescription drugs. The abusers are usually affluent and have health-care coverage, he said.

John Burke, president of the National Association of Drug Diversion Investigators, said several billion dollars a year is scammed in health fraud by drug diverters and prescription drug abusers.

The group's research shows that so-called "doctor shoppers" on average visit five to 10 practitioners to get illicit prescriptions. That amounts to fraud figures reaching $10,000 to $15,000 a year per individual abuser, figures show.

Hydrocodone and its family of powerful pain killers, like Lortab, account for 60 to 70 percent of the prescription drugs abused in the country, he said.

With 16 years as sheriff, Johnson relies on past contacts with law enforcement and tips from the public to track people who might abuse drugs and file bogus reports.

Johnson has told his deputies not to file a report if the person has a history of drug abuse or is acting suspiciously. When a report is filed, his office might not release a copy to the "victim" for 30 days.

"They'll just have to go to their doctor if they need another prescription," he said. "The doctor is in a much better position to make that determination. If someone comes in and says their house was broken into and the TV, jewelry and guns were left alone but only prescription drugs were stolen, that's a red flag."

The Montgomery Police Department hasn't seen a spike in reports, but a department spokesman said officers are aware of the tactic.

"We're keeping a watch out in case we see a trend developing," said Capt. Huey Thornton. "People often don't realize how widespread prescription drug abuse is. People can get very creative in how they get more prescription medication."

The Alabama Board of Medical Examiners provides information to doctors on how they can stop "doctor shopping," said Larry Dixon, executive director.

"A legitimate patient will always be able to get medicine, if theirs is lost or stolen," Dixon said. "But doctors know their patients. They know who has the potential for abusing prescription drugs."

Doctors have taken steps to prevent prescription drug abuse, said several physicians interviewed in the tri-county area.

No longer are prescription pads left unattended in examining rooms because sheets from the pads can be stolen to write fraudulent prescriptions. Many also won't prescribe narcotics to new patients, the doctors said.

"I've had new patients come in and tell me during the first visit that W, X and Y medications don't work for them, but Z does," said Dr. Charles Cloutier, a Prattville family practitioner. "When patients take that approach, it's a huge tip-off."

Cloutier said he doesn't call in prescriptions for controlled drugs after hours or on weekends, and he is cautious when he catches weekend calls for four other doctors.

"If you need pain medicine, you know how many doses you have," he said. "If you are going to run out over the weekend, a legitimate patient will call their doctor during regular hours to get it taken care of."

Emergency room visits and trips to urgent-care clinics are often used to get medicines after hours, doctors and law enforcement officials say.

"Every emergency room has what we call 'frequent fliers,' patients who make regular trips," said Peter Frohmader, spokesman for Jackson Hospital. "If you come into the emergency room complaining of pain, we can't tell you, 'We're not going to give you medicine.' "

<hr class=postrule>

[palmspringsbum]

OTHER VIEWS

Doctor or dealer?

Karen P. Tandy
Special to the Sentinel
The Orlando Sentinel
December 6, 2006

To find new patients, Dr. Freddie Williams, a general practitioner in Panama City in the Florida Panhandle, would send two recruiters, one of whom was a heroin addict, searching for people looking for easy prescription drugs -- and frequently found them in bars. The recruiters were paid in OxyContin prescriptions, and the new "patients" received practically limitless amounts of high potency OxyContin. The OxyContin was not for pain, nor any other medicinal purpose, but simply for abuse. Patients were injecting and snorting it for the heroin-like high it gave.

Williams created addicts. Patients were overdosing. Parents called his practice pleading for him not to give their children any more drugs. He did anyway. Williams was even demanding sex in exchange for prescriptions.

He was diverting so many OxyContin pills to abusers and traffickers that after Drug Enforcement Administration (DEA) agents and our partners arrested him, the street price of OxyContin nearly doubled in the area because of the significantly diminished availability of OxyContin. Similarly, pharmacy burglaries and patients seeking treatment increased.

A jury convicted Williams on 94 counts of conspiracy to distribute controlled substances and health-care fraud, among other violations, and he was sentenced to life imprisonment.

Fortunately, these kinds of criminal doctors are few and far between. In any given year, including 2005, fewer than one in every 10,000 physicians in the United States -- less than 0.01 percent-loses their authority to prescribe controlled substances based on a DEA investigation.

These few doctors cause grave harm and contribute to the alarming prescription-drug-abuse problem in our country. Prescription controlled substances are the second most abused type of drugs -- behind only marijuana. Nearly one out of every 10 high-school seniors abuses dangerous painkillers.

The addictions these drugs cause are rapidly swelling the number of Americans seeking treatment -- 63,000 at last count. The consequences can turn deadly as illustrated by the deaths of Jason Surks of New Jersey and Ryan Haight of California, who died at ages 19 and 18 after overdosing on prescription narcotics they obtained through the Internet. The Centers for Disease Control and Prevention report that Jason and Ryan are part of a disturbing trend: Prescription painkillers now cause more drug-overdose deaths than cocaine and heroin, combined.

It is DEA's job to enforce the laws of this nation to ensure pharmaceutical narcotics and other controlled drugs are used only for the health and welfare of the public. Prescription drugs help millions of Americans every day, but when these drugs harm citizens' health, feed addictions, ruin innocent lives and put more dangerous substances in our neighborhoods, the DEA must target that diversion and those responsible.

In September, the DEA announced three steps to ensure that people who medically need drugs get them, and that those who are diverting them, don't. We issued a proposed rule that will make it easier for patients with chronic pain or other chronic conditions to avoid multiple trips to a physician. The DEA also released a first-of-its-kind pain statement to give the medical community the information they requested on prescribing and dispensing controlled substances to treat pain. Finally, DEA launched a new page on our Web site (www.dea.gov) to provide everyone with the facts on DEA cases against the small number of doctors who violate federal drug laws.

There is much debate within the medical community about how chronic pain should be treated, how aggressively and with what medications. The DEA doesn't enter into that debate except to ensure the drugs aren't being diverted for illegal purposes as we are required to do by federal law. Doctors need to practice medicine as they have been trained to do and as they are sworn to do: to help their patients. The DEA in turn will do what we are sworn to do: to protect the American public by putting dealers like Williams out of business.

Karen P. Tandy is the administrator of the U.S. Drug Enforcement Administration. She wrote this commentary for the Orlando Sentinel.

[palmspringsbum]

Prescription-drug cases plague state
<span class=postbigbold>Officials: Abuse high in South</span>


<table class=posttable align=right width=300><td><tr class=postcell><img class=postimg width=300 src=bin/headley_ricky.jpg></td></tr><tr><td class=postcap>In all, five people have been arrested in the case in which Williamson County Sheriff Ricky Headley was arrested this week.</td></tr></table>
By BRAD SCHRADE
Staff Writer
The Tennessean

Published: Friday, 02/02/07

The pharmacy sting that led to the arrests of Williamson County Sheriff Ricky Headley and three others highlights a drug problem that some law-enforcement officials say is growing — the illegal distribution of prescription drugs.

In fact, the problem — called drug diversion — appears to be a particular problem in the Southeast and some parts of Tennessee, according to the National Association of Drug Diversion Investigators Web site.

The group cites a recent study by a national prosecutors group that says cases of prescription- drug abuse are worse in the Southeast than in other parts of the country. Prescription-drug cases rank fourth in the survey among all drug cases, behind marijuana, methamphetamine and cocaine.

"We've seen a proliferation in the past couple years, particularly in the past year in Tennessee," said Harry Summers, assistant special agent in charge of Tennessee for the federal Drug Enforcement Administration, which has a unit that focuses on these investigations.

Summers said the availability of drugs over the Internet, particularly from off-shore pharmacists — some of whom are in business to traffic the stuff illegally — had created a problem in recent years. His agency is increasingly training officers to work these cases, along with other drug- diversion cases.

<span class=postbold>Five arrested in sting</span>

In all, five people have been arrested in the case in which Headley was arrested this week.

Besides the sheriff, pharmacist Glenn Brooks, 69, the longtime owner of Brooks Pharmacy, was arrested Wednesday on two counts — one felony, one misdemeanor — of illegally distributing prescription drugs, Metro police spokesman Don Aaron said.

Authorities have been investigating various claims of illegal drug distribution at the pharmacy on and off for the past two years. An employee was arrested in January 2005 and charged with distributing pills and liquid medication from his home, Aaron said.

Three others were arrested overnight Wednesday in the case.

One was Charles Thomas Burton, 57, of Smyrna, who retired in 1998 as an inspector for the Tennessee Board of Pharmacy, Metro police said. The board is the state agency that regulates pharmacists.

Also arrested was Richard Warren Jett, 56, of Franklin, a liquor store worker, police said. Both men are accused of receiving the painkiller Lortab from Brooks Pharmacy, which is at Trousdale Drive and Harding Place.

Also arrested overnight was Helen Michelle Weathers, 32, a former Brooks Pharmacy employee who is charged with illegally taking a bottle of painkillers under another woman's name, police said.

Weathers was also charged Jan. 20 with leaving the store with more than 800 Lortab pills stashed in a cooler.

Nashville attorney Ed Yarbrough, who is representing Headley, said the sheriff was addicted to painkillers as a result of arthritis in his back and a bulging spinal disk.

"To avoid surgery, he elected to use painkillers, and unfortunately the situation did not improve," Yarbrough said.

He said Headley, 43, had entered a drug treatment center outside the area Thursday night and that the sheriff had asked his lawyer to thank his supporters for their outpouring of support.

<span class=postbold>Painkillers in demand</span>

Metro police officials acknowledged that abuse of prescription drugs had long been a problem in the Midstate.

"What will sell in a pharmacy for a couple cents a pill will sell on the street for dollars per pill," said Aaron, the Metro police spokesman. "In addition to the marijuana and cocaine sold on the street, there's also a market for illegally obtained painkillers."

Aaron said certain painkillers were so in demand that some drug stores had stopped stocking them and placed signs in their windows to deter would-be thieves. Cases such as Wednesday's, in which the pharmacist is alleged to be part of a distribution scheme, are rare, Aaron said. Aaron would not rule out more arrests in the case.

"It's certainly possible," he said. "A number of records have been taken from the store to be reviewed by the TBI and the DEA."

The TBI said there appeared to be an increase in prescription drug abuse in parts of the state. In November 2005, more than 70 people were arrested in DeKalb County in an illegal prescription- drug sting in Smithville, said William Benson, TBI's assistant director over its drug investigation division. Many were on TennCare and selling their drugs to make money.

Benson said drug diversion was growing because the demand for legitimate prescriptions from an aging population has driven up the inventory of drugs for those wishing to obtain or sell them illegally. The agency has plans to direct more investigators to the problem, he said.

Also, there is more awareness about what drugs are available, and their effects.

"Rather than going out and buying cocaine or heroin, they get their high from different types of pills," Benson said.

<span class=postbold>State to track drug data</span>

In December, the state pharmacy board started a new database to track certain types of painkillers and other medications popular on the street. Doctors and pharmacists must report these prescription requests to the state, and later this year the database will allow medical professionals to view a patient's prescription history, said Meredith Sullivan, an assistant commissioner in the Department of Commerce and Insurance.

One goal of tracking such information is to stop people from "doctor shopping," going to several doctors in a short period to get prescriptions filled. The abuser either obtains more medication than he should or finds a doctor to fill a prescription after another doctor has refused.

So far, the database has more than a million prescriptions, Sullivan said. Still, once the program is running, there will be no requirement that pharmacists review a patient's case before filling a prescription.


Published: Friday, 02/02/07

[palmspringsbum]

Florida Has Prescription Problem

The Tampa Tribune
Tribune Staff Report

Published: December 28, 2007

Athletes aren't the only ones struggling with addiction and abuse of prescription drugs. The illegal sale of prescription drugs now constitutes the fastest-growing segment of the illicit drug market in Florida, authorities say. Increased use has resulted in more emergency room visits and deaths. Here are the numbers:

Florida medical examiners blamed prescription drugs for 2,181 overdose deaths in 2004, or roughly six people per day.

For the first half of 2007, cocaine caused 398 deaths in Florida, more than any other drug. Prescription drugs caused nearly all of the rest, lead by the painkiller and anti-addiction medicine Methadone (392); tranquilizers in the benzodiazepines family (353); oxycodone, the painkilling ingredient in OxyContin (323); hydrocodone painkillers (134); and morphine (122).

Deaths caused by oxycodone increased 9.5 percent in Florida during the first half of 2007. In that time, the painkiller caused the deaths of 99 people in Tampa and St. Petersburg.

Nationally, the number of emergency room visits that noted abuse of painkillers jumped to 119,000 in 2002, up 168 percent from 1994.

Nationally, recreational use of prescription drugs trailed only marijuana use as the most prevalent illegal drug activity. Annually, 4.8 percent of people 12 or older reported using prescription drugs recreationally, about half the number of those who claimed to have used marijuana.

Sources: Florida Department of Law Enforcement, Substance Abuse and Mental Health Services Administration under the U.S. Department of Health and Human Services

[palmspringsbum]

The Sunday Times
February 24, 2008

Prescription drugs: legal and lethal

<span class=postbigbold>Forget heroin and cocaine. The dangerous drugs claiming the lives and minds of the stars are prescription painkillers and a new class of happy pills that doctors are handing out by the million</span>

Robert Sandall


What finally killed Heath Ledger wasn’t heroin or cocaine. Despite his well-publicised problems with illegal hard drugs in the past, the potentially lethal compounds found in the Manhattan apartment of the 28-year-old Hollywood actor after his death in January had all been legally prescribed. Just another victim of the American private-health system, you might think, the prescription-on-demand culture that wiped out Elvis Presley and Marilyn Monroe. Not our problem.

Think again. Of the six sedatives, painkillers and anti-anxiety drugs Ledger was taking, three had been prescribed here during his recent spell filming in London. In common with a growing number of young serial drug abusers – including his fellow film star Owen Wilson, whose attempted suicide last year was attributed to a three-day binge on the legal painkiller OxyContin – Ledger had moved on from street drugs. Having been caught on film two years ago at the Chateau Marmont in LA snorting a white powder, he had discovered a less troublesome, if no less dangerous, route to oblivion.

That most of us haven’t yet registered this shift reflects the fact that when it comes to thinking about drugs, we’re like a broken record. We think about the drugs governments are prone to declare “war” on. So it is that the argument about the dangers of cannabis drags on, while the tabloids feast on pictures of Pete Doherty and Amy Winehouse with their crack pipes, or speculate that Britney Spears might be a victim of the new “drug scourge” methamphetamine, better known as “crystal meth”. But beneath the media headlines and moral panics, the ground is shifting. The problem with drugs is moving nsidiously closer to home. All of our homes.

In one of its less sensational aspects, our escalating fondness for taking drugs that won’t get you arrested can be measured in the 10% annual rise over the past three years in the use of antidepressants, notably our old friend Prozac. The NHS issued 31m scripts for Prozac in 2006, a blanket figure that, however it breaks down in terms of the numbers of users referred to, suggests that a lot of people are regularly taking a powerful antidepressant. Then there are the Valium guzzlers. The Council for Involuntary Tranquilliser Addiction (Cita), run by Liverpool University, guesstimates that there are as many as 1.5m nervous types in this country who have become accidentally addicted to benzodiazepines, the family of tranquillisers to which Valium belongs. Others take them knowingly, for fun. According to Professor Heather Ashton of Newcastle University, author of a pamphlet on addiction to benzodiazepines, these “are now taken illicitly in high doses by 90% of drug abusers worldwide. They are part of the drug scene”. So well integrated are they that abusers will crush the pills and snort or inject them, the same way they might cocaine or heroin.

More worrying in a way, because they attract less attention, are those habit-forming drugs that can be bought without prescription at high-street pharmacies. Concern about these has given rise to a new coinage in the world of drug dependency, “OTCs”, an abbreviation for painkillers bought “over the counter”. This usually refers to the more powerful varieties of OTCs, such as codeine, which contains synthetic opiates. At a conference of the General Medical Association in 2004 it was suggested that there might be 50,000 OTC addicts in Britain today. The authorities are also concerned about OTC drugs causing suicidal tendencies: the European Medicines Agency is calling for OTC drugs to come with a “suicide rating”.

A few words of reassurance at this point for those concerned that they might be developing a dependency on analgesics, anti-inflammatories, hay-fever tablets or other popular remedies. Drugs that carry a risk of addiction do so because they alter the binding of neurotransmitters to receptors in the brain. In short, they are, in different ways, mood-enhancers. A couple of aspirin cannot affect your Monday-morning feeling nor induce a sense of numbness the way synthetic opiates do.

We could, though, get hooked on other readily available painkillers. The comedian Mel Smith publicly confessed to having developed a dependency on Nurofen Plus – the enhanced version that adds an opioid to ibuprofen, the active ingredient – while treating himself for gout. Smith suffered a seven-year addiction he referred to as his “dark secret”. “They didn’t make me feel high. They helped me to relax.” His 50-tablet-a-day habit landed him in hospital with two burst stomach ulcers. The pharmacists’ trade body, the Royal Pharmaceutical Society, has become increasingly insistent that its members check the symptoms of anybody asking for OTCs; the move was prompted by a survey of its members in Scotland that revealed that nearly half suspected they had sold painkillers to customers with something other than pain relief in mind.

But would this help a user such as Mark, an IT manager from the Midlands in his forties? His OTC drug problem began after he contracted MRSA while in hospital with severe pneumonia. The excruciating pain he felt eventually passed, and he was discharged; but then a chest infection set in, reawakening memories of his MRSA agony. As he didn’t have a good relationship with his GP, he asked a chemist for the strongest pain relief available. He came away with co-codamols, which contain codeine. For years Mark carried on taking these tablets – primarily for migraine symptoms – until in 2004 he was diagnosed with high blood pressure. Signed off from work, he soon realised it wasn’t the anxieties of his job that were causing his blood pressure to soar: it was the stress he felt without his painkillers. “I managed to get them down to eight a day, but I couldn’t cut them out totally. I went on like this for about four months.” Luckily, the doctor he eventually confided in worked part-time with the South Derbyshire Substance Misuse team.

Clean for four years, Mark now helps to run Codeine Free, one of the websites that have sprung up recently to offer advice and discussion forums on OTC drug addiction. The best-known of these, Over Count, was set up in Dumfries by David Grieve, a former policeman who spent £18,000 over a two-year period getting hooked on a popular proprietary cough medicine with a synthetic opiate base.

The prescription drugs causing most concern are antidepressants. Prozac, which has been around for 20-odd years, is old news. The two newcomers currently causing medical debate are the branded drugs Efexor and Cymbalta. These are classed as “selective seratonin and noradrenaline reuptake inhibitors”, or SSNRIs. The added “N” is what makes them special. Unlike Prozac and other SSRIs, these drugs do not simply increase levels of seratonin, the brain chemical that makes us feel more sociable and relaxed. They also boost adrenaline, making us more energetic and sometimes slightly manic.

Cymbalta was developed by Eli Lilly after its patent on Prozac ran out in 2001, which meant that the latter could now be manufactured as a “generic” drug and sold more cheaply. During the clinical trials of Cymbalta in 2003, one of the paid guinea pigs, a female student, committed suicide; but it was approved for medical use in the US in 2004, and a year later was generating $1 billion worth of sales. In the UK, Cymbalta has only just started to be prescribed. In America it’s a phenomenon, one of the pharmaceutical industry’s greatest hits. The financial analysts at Merrill Lynch, which part-owns Eli Lilly, have estimated that the market for Cymbalta will be worth over $3 billion in 2009, overtaking the original SSNRI drug it was modelled on, Efexor.

Currently prescribed in the UK for conditions that range from chronic depression to hormonally related hot flushes, Efexor is less common but more controversial than Prozac. One of its most prominent former users is Robbie Williams. Hooked on cocaine and alcohol for most of the 1990s, Williams was back in rehab in February 2007 for what he described as “prescription-drug addiction”, the chief of these being his favourite antidepressant, Efexor. Whether Williams realised what was happening when he began taking pills prescribed by his LA psychiatrist is not clear. But he must have had an inkling that keeping depression at bay was not the only role Efexor played in his ostensibly sober life. He compared the feeling of taking it to “coming up on an E” (ecstasy tablet), and spoke glowingly to George Michael about its energising effect on his live performances – both of which endorsements were reported in Chris Heath’s biography of the star, Feel.

Efexor, which has been around for a decade, has become a cause for concern since an online petition was started in America in 2001. It now contains over 15,000 aggrieved signatories. There are complaints that doctors gave no indication, or flatly denied, that the drug carried any significant side effects or risk of dependency. For its part, the drug’s manufacturer, Wyeth, acknowledges that Efexor may cause unpleasant side effects such as nausea, insomnia and raised blood pressure in a small number of cases – its data suggest around 10%. The online complaints about the withdrawal symptoms go further, listing raging headaches, panic attacks, night sweats and vomiting. One petitioner writes: “I have lived my life saying ‘no’ to drugs. Now I’m having withdrawals from something my doctor gave me. This is a crime.”

It does at least suggest how hazy the line is that separates the gear you buy from a dealer on the street and the stuff prescribed by the guy in a white coat. Plenty of British doctors, however, disagree. One Harley Street GP with several highly stressed celebrity patients says Efexor is “a formidable agent that can change people’s lives in ways that are wonderful. To demonise it is wrong”. Efexor dependency is manageable, and ultimately avoidable, he says. The key lies in careful administration and monitoring to minimise the problems. “It’s like having a brilliant chainsaw. You don’t try to have a shave with it.”

) ) ) ) )

When predicting the future for prescription-drug abuse in this country, all eyes are on America, where the situation has been barrelling out of control for decades. It was reported last year that prescription drugs in the States are responsible for more deaths than either cancer or road accidents. Tranquillisers abused by recreational users enjoy a high profile

there thanks to Xanax. Designed to combat anxiety, but widely taken in excess with alcohol – whose effects it mimics and intensifies – Xanax is as common as Prozac, and far more socially troublesome. It has become synonymous, in law-enforcement circles, with wildly uninhibited behaviour and late-night call-outs to suburban addresses. It was one of the six prescription drugs found, along with empty bottles of booze, in Heath Ledger’s apartment.

The real worries, though, surround painkillers. Dihydrocodeine, or DF118, as it is referred to in the UK, is the preferred American alternative to diamorphine, the pharmaceutical name for heroin. In the US, which outlawed heroin in the 1920s, dihydrocodeine is the active ingredient in the popular branded painkiller Vicodin. Recently identified by the US Drug Enforcement Administration as the fourth most widely abused drug in the country – after cocaine, heroin and marijuana – Vicodin has seeped into American popular culture. The rapper Eminem wears a Vicodin tattoo on his arm. Celebrity abusers have ranged from Ozzy Osbourne to the ultra-conservative chat-show host Rush Limbaugh, who began taking it for back pain and went on to spend $300,000 on it in three years. Or at least that’s what his former housekeeper told the National Enquirer.

An English film producer who works in LA, and does not consider himself a druggie, was prescribed Vicodin for a back problem. “There was no warning that it was addictive,” he says. “But I knew it was dangerous the first time I took it. It gives you this warm feeling which is rather delicious, and I am very careful not to take it now unless the pain is serious.” His view is that in LA today the misuse of prescription drugs is “not about getting out of it. They keep you going.

They encourage a hyper work ethic”. The epidemic of prescribed antidepressants he holds in similar regard. “There’s an incredible stigma against depression in California, where it’s regarded as worse than bad breath.”

The actor Owen Wilson had his own prescription for a bout of severe depression last year: OxyContin (oxycodone). Manufactured in the UK, but only sparingly prescribed here while its effects are monitored by our Medicines and Healthcare products Regulatory Agency (MHRA), this powerful opiate offers a dystopian glimpse of future drug abuse. Its rocketing popularity with the recreational crowd derives in no small part from its superior design. Like many of the new prescribed substances, OxyContin is, by comparison with the powders that are traded on mean streets, a smart drug. Whereas a shot of heroin will deliver its entire opiate charge at once, with possibly fatal results, OxyContin is released in stages over six to eight hours. For the cancer sufferers for whom the drug was developed, this means longer and more effective pain relief. For an abuser, it means a longer, more consistent high, with a reduced risk of an overdose.

In the US, OxyContin is now regarded as the most dangerous substance in the recreational arsenal, widely tipped to take over from heroin as America’s favourite opiate. In its first year on the market, sales of OxyContin were worth $40m. Four years later the manufacturers were shipping $1 billion worth of a drug that had acquired the nickname “hillbilly heroin” because of its popularity among poor rural communities in the Appalachians. Sales of OxyContin have roughly doubled in America in this century. Since the cost of it is often covered in the first instance by health-insurance plans, it offers a double whammy for the potential abuser: a long, strong high that is both highly addictive and cheap.

This new pharmaceutical order has been vigorously embraced in the US, particularly by the young. Several studies have shown an alarming hike in prescription-drug abuse in the under-25s. A National Household Survey in 2001 discovered a doubling of the numbers of 12- to 17-year-olds reporting an interest in Xanax and Vicodin between 1996 and 2000.

Wherever youth pitches its tent, a new slang takes root. “Pharming” is consuming a cocktail of prescription drugs. “Doctor shopping” is visiting several physicians to fulfil a medicines wish list. And if that doesn’t pan out, there are always “pill ladies”, elderly prescription-holders who take advantage of the difficulties experienced by the young in obtaining heavy-duty drugs created to ease chronic back pain or the suffering of cancer patients. And for the truly desperate, the practice of robbery has acquired a new subdivision: “prescription theft”.

The most vivid insight into the transmission of the new drug culture has been provided by the stars of the real-life soap The Osbournes. The head of the family, metal guru Ozzy, was for years addicted to Vicodin, a subject he explored on his latest album, Black Rain. His children have long since overtaken him. His daughter Kelly entered a rehab clinic at the end of the TV series claiming: “They found 500 pills in my room when they cleaned it.” His son Jack started popping Vicodin aged 14. At 17 he was a multiple prescription-drug addict. Street drugs he never bothered with. After he cleaned up, Jack Osbourne spilt his guts on MTV, naming nine medications that he used on a regular basis. His favourite was OxyContin.

Evidence of just how deeply entrenched over-medication currently is in the US unfolded in the LA courtroom where Phil Spector stood trial last year for the murder of Lana Clarkson.

In one of the pre-trial hearings, his lawyers argued that the police, who kept their client locked in a cell for most of the day after the fatal incident, had acted unlawfully. Their reason was that Spector, at the time, was a prescription junkie, suffering withdrawal symptoms from seven named medicines. Two of these were powerful benzodiazepines. One, Klonopin, is a tranquilliser much more potent than Valium.

It is notoriously dangerous when taken with alcohol: users become quite unhinged. Which was why Spector’s lawyers were so insistent that although the accused spent a lot of time in bars on the night of Clarkson’s death, and ordered a number of alcoholic cocktails, he didn’t actually drink them. That Clarkson was, at the time, buzzing lightly on Vicodin, the painkiller she was still taking two years after breaking both of her wrists, was another twist in the tale. Spector and Clarkson were a very modern American couple: plain-clothes druggies whose habits were known only to their doctors.

The situation in the UK is nowhere near as bad, but it does seem to be getting worse. In the same week last year that Robbie Williams went public with his prescription-drug habit, a private GP was banned for nine months for prescribing addictive or dangerous drugs from his website, e-med. The General Medical Council ruled that Julian Eden had adopted a “cavalier” approach to patients who contacted him online. In particular, the GMC was appalled by the case of a 16-year-old boy, with a history of self-harming and mental instability, who tried to kill himself after Eden issued him with a prescription for the beta-blocker propranonol. Another woman, a mother of three, obtained a year’s supply of dihydrocodeine and Valium. A third “patient” received 51 repeat prescriptions for two so-called “hypnotic” sedatives similar to the date-rape drug Rohypnol.

Eden’s activities came to light after he was exposed by two undercover reporters, both of whom were prescribed drugs that usually require a full medical consultation within minutes of logging on to e-med. Making matters worse, the GMC said, was the fact that Eden made no attempt to contact the GPs of his online clients.

Eden is, or was, a real doctor. As anybody with a broadband connection on their computer knows, prescription drugs of the more popular kind are now being sold from thousands of websites by anonymous peddlers. Every day I receive spam e-mails offering unlimited quantities of, say, the tranquilliser Xanax, or the highly addictive and widely abused sleeping pill Ambien. The asking price is usually $2 a tab. This dodgy online pharmacy is invariably just a click and a credit-card payment away.

According to a report published in 2006 by the United Nations’ International Narcotics Control Board, the misuse of pharmaceutical drugs now outstrips the trade in illicit substances globally.

As many as a tenth of these “medicines” the UN estimates to be counterfeits – crude, even dangerous, chemical copies of generic drugs manufactured by criminals in the Third World. The UN report explains this growth as a guerrilla response to the “war on drugs” fuelled by improved electronic communications.

Parliament is at last waking up to the problem. Dr Brian Iddon MP, chair of the House of Commons all-party group on drugs misuse, is carrying out the first proper assessment of prescription and OTC drug abuse in this country. A scientist by training, with degrees in chemistry, Iddon understands the problem better than most MPs. He reports a surge in intravenous Valium and Prozac abuse by crack addicts in his Bolton constituency who use tranquillisers and antidepressants to soften their comedown. Iddon’s group hopes to publish its report in the spring.

Iddon, whose committee is considering the findings carefully and has already received evidence from many users and their families, says: “Whatever happens in the USA comes to the UK, usually about 5-10 years later. So my guess is that we’re heading for the rates of misuse of legal substances that the USA is seeing now. The internet supplies the drugs if doctors will not, or if patients do not want their doctors to know what they are up to. Anything is available on the internet, and there is little control of internet pharmacies or wholesale suppliers.

“The DoH has produced guidance for doctors which is still being ignored. For those who become addicted there should be more access to treatment. The NTA [National Treatment Agency] should treat all those with problems caused by ‘misuse’ of any substance – legal or illegal, including prescription medicines and OTCs, as well as alcohol.”

But the pharmaceutical companies have a responsibility too. The MHRA yellow-card scheme is slow to pick up problems and, even when adverse reactions to a new medicine start to come in to the MHRA, it has little power to take action against the drugs companies.

Not that a parliamentary report will do a lot to tackle the root of the matter: our proclivity as a species to seek chemical solutions to our chronic discontents. Harry Shapiro, who heads DrugScope, a British charity that offers advice on addiction issues, blames the rise in prescription and OTC drug abuse on our increasing tendency “to medicalise feelings which can’t simply be wished away by swallowing a pill”. Then again, depriving the desperately unhappy of what may turn out to be bad solutions won’t work either, Iddon believes. “What on earth do we prop these people up with, then?”

This is not a purely rhetorical question. Iddon has seen blue-sky policy documents, so-called “foresight programmes”, drawn up by the old Department of Trade and Industry, that call on drugs companies to invent a “safe” recreational drug: a happy high with no side effects and no risk of dependency. It could signal the beginning of the end of the war on drugs. It could also take us one step nearer to the zonked anaesthesia of Aldous Huxley’s Brave New World. More soma, anyone?

[palmspringsbum]

<span class=postbold>OPINION</span>

Question for patients: What's in your medicine chest?

<span class=postbigbold>Prescription drug abuse is a serious public health threat. Urging patients to take steps to protect their medicines is an important way to control it.</span>

Editorial. March 24/31, 2008.
American Medical News


A public service announcement now being aired highlights a danger lurking in many medicine cabinets. Simply stated, it's medicine.

The TV spot features a teenager -- he could be one of your patients, one of your patients' children, even one of your own kids -- sorting through his stash of pills. He points to one, left over from a hysterectomy; another was for use after a hip replacement; yet another remained after a bout of postpartum depression. The list goes on. Suddenly, the bell rings. He slides the collection into a container and off to class he goes.

The scenario is not at all far-fetched. Prescription meds have become drugs of choice for abusers, young and old. According to the U.S. Drug Enforcement Administration, nearly one in 10 high school seniors admits to abusing pain medicines. Moreover, Office of National Drug Control Policy data indicate that each day an estimated 2,500 young people ages 12 to 17 abuse such medications for the first time. More teens abuse prescription drugs than any illicit drug, except marijuana. They report mixing these meds together or with over-the-counter pills, cough syrups or alcohol. The result can be respiratory failure or even death. Related emergency department visits, for instance, increased 21% from 2004 to 2005. Still, 40% of teens and an almost equal number of parents think abusing prescription pain killers is safer than abusing street drugs.

But the problem reaches well beyond the teen years.

An estimated 7 million Americans by the DEA's count abused prescription drugs in 2005 -- more than the number abusing cocaine, heroin, hallucinogens, ecstasy and inhalants combined. That number was just 3.8 million in 2000. Misuse of painkillers represents the biggest slice.

Among the reasons the problem is so pervasive is that access to the drugs is so easy. Although some abusers go to lengths such as doctor shopping or pharmacy theft to gain a fix, many abusers report that they get the meds from friends or relatives, or from raiding unused pills left forgotten in their homes.

Earlier this month in observance of Patient Safety Awareness Week, the American Medical Association called on patients to be active partners in their own health care -- starting with a simple check of the items in their medicine cabinets.

The AMA recommended safely disposing of any unused prescription pills. Medications such as prescription pain relievers and sleeping pills should be locked up and kept far out of reach of children and teenagers. The organization also cautioned against sharing prescription medicines with family and friends. Other experts urge physicians to advise patients to be aware of signs around the house such as missing pills, unfamiliar pills, or empty cough and cold medicine bottles or packages.

The AMA also plans to consider a report on the subject at its Annual Meeting in June.

The situation also requires another sort of doctor-patient conversation -- the sometimes-awkward screening questions about personal histories of addiction or difficulties in controlling prescription drug use.

The doctors' task is made even more complicated by the other side of this very complex issue. Physicians constantly face the risk of not treating pain adequately or having patients afraid to ask for relief because they fear addiction. AMA policy notes that undertreating pain is a concern that must be balanced against the risk of abuse. It also supports physician education, research activities and the development of state-based prescription drug monitoring programs.

These searchable databases for tracking users of controlled substances can be particularly helpful in detecting doctor shoppers. The Indiana Scheduled Prescription Electronic Collection & Tracking program -- INSPECT -- is one such example. Previously accessible only to law enforcement, it became available to physicians in July 2007. Meanwhile, Congress enacted in 2005 but has yet to fund the National All Schedules Prescription Electronic Reporting Act. Many experts urge investment in this program.

All these actions are important. But doctors can help patients understand what is at stake -- if used or stored carelessly, prescription medicines can pose a serious public health threat. Doctors and patients alike should join together to close the gaps that have allowed these meds to be viewed as drugs of abuse instead of drugs of relief.

[palmspringsbum]

Prescription Drugs are 4th Leading Cause of Death

By Robert I Bender, M.D., FAAFP

<span class=postbigbold>Heath may still be teaching us a lesson</span>

HOLLYWOOD, CA (Hollywood Today) 9/29/08 — If there’s one thing the Heath Ledger tragedy proved, it that prescription drugs can be as dangerous as street drugs. The pharmaceutical industry markets, sells and profits greatly from prescription drugs that, at best, mainly work in 30% to 50% of people and, at worst, actually contribute to hospitalization, permanent disability, disease, illness and death. Prescription drugs have killed more Americans than the entire Vietnam War and on a yearly basis.

According to the Journal of the American Medical Association (JAMA), prescription drugs are now the fourth leading medical cause of death in the U.S. and Canada, behind only cancer, heart disease, and stroke.

One out of five (1 out of 5) new drugs in the U.S. is taken off the market for harming or killing patients or will have the highest level of warning placed on the label.

It has become more and more common to discover the dangers of drugs after they have been on the market, despite the FDA approval process, which has be been tainted over the years.

The American people have become the lab rats for the pharmaceutical industry and it isn’t until the damage has been done that these drugs are removed from the market. Half of new drug withdrawals occur in the first two years. An alarming 51% of drugs approved by the FDA have serious adverse effects that are not detected prior to approval. It is estimated that each year prescription drugs injure 1.5 million people to the degree that they require hospitalization.

According to a study in the Journal of American Medical Association, each year prescription drugs cause serious reactions and permanent disability for over 2.2 million people. Many researchers state that these figures are grossly understated and it is much higher, but fear of lawsuits prevent accurate reporting. Award winning medical journalist, Lynne McTaggart states that “the vast majority of drug-related deaths are never reported at all.”

A comprehensive study performed in the U.S. by three University of Toronto professors in 1998, revealed 106,000 deaths in U.S. hospitals were caused by prescription drugs administered as prescribed-not in error! Many observers believe there could be another 100,000 deaths caused by prescription drugs outside hospitals.

For example, David Graham, a reviewer for the FDA estimated that the drug Vioxx may have killed as many as 55,000 individuals. Not long after being introduced to the market, Viagra had serious side effects and deaths and the list goes on and on…

According to Kirstin Borgerson - “The population of North America is one of the most heavily medicated in the world.”

The profitable pharmaceutical industry has created a disturbingly “legal drug addicted” society. Peter R. Breggin, M.D., a Harvard-trained, (former full-time consultant at National Institute of Mental Health) Psychiatrist and expert in clinical psychopharmacology does an excellent job of bringing the problem of our drug addicted society to life in his latest book Medication Madness. Dr. Breggin refers to the horrendous effects of psychiatric drugs on those taking them, citing 50 case studies which resulted in everything from suicide to murder. With such a large percentage of the population taking over-the-counter and prescribed medications, Medication Madness, applies to our society as a whole.

Dr. Allen Roses, the worldwide vice-president of GlaxoSmithKline, has been quoted as saying that “the vast majority of drugs-more than 90%-only work in 30% or 50% of the people.” He said that “cancer drugs work 25% of the time, Alzheimer’s drugs work 30% of the time, and many others only 50%.”

The pharmaceutical industry spends more than twice as much on advertising and administration than on research. Since 1990, prescription drug rates have gone up 500%. Advertisements on TV constantly push everything imaginable from drugs for serious to mild ailments, making it seem that this drug is the answer for you. The problem that many fall into is thinking that since it’s prescribed it is okay, even with a few minor side-effects.

The pharmaceutical industry is riddled with conflicts of interest, from what some claim is the “sellout” of legislators and the co-opting of the FDA. It is also no secret that drug companies “buy” many in the industry from doctors to researchers. Pharmaceuticals do their own testing which is a huge conflict of interest and one of the biggest problems in the industry.

While the drugs may be causing death, the profits are soaring. It is no secret that the pharmaceutical industry is a billion dollar giant profiting hand over fist at the public’s peril.

From 1960 to 1980, prescription drug sales were fairly steady as a percent of the U.S. gross domestic product, but from 1980 to 2000, they tripled. Sales now stand between $200 billion to $300 billion a year.

The top ten drug companies (which included European companies) had profits of nearly 25 percent of sales in 1990.

In 2001, the ten American drug companies in the Fortune 500 list ranked far above all other American industries in average net return, whether as a percentage of sales (18.5 percent), of assets (16.3 percent), or of shareholders’ equity (33.2 percent). These are astonishing margins. For comparison, the median net return for all other industries in the Fortune 500 was only 3.3 percent of sales. The most startling fact about 2002 is that the combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together (33.7 billion).

Let me emphasize this again. The combined profits of the ten largest US drug companies reaches 35.9 billion - a sum higher than the combined profits for all other 490 corporations on the Fortune 500 List!

According to IMS Retail Drug Monitor, “Global pharmaceutical sales through retail pharmacies increased 5% to 386.23 billion from November 2005 to November 2006.”

There is incontrovertible evidence that many prescription drugs are harmful and we are paying a huge price, both in lives and dollars. It is also clear that many of the practices of the pharmaceutical monopoly are unethical and immoral. The “Father of Medicine,” Hippocrates is well known for saying that as far as disease, help or at least do no harm. If he were here today, he would be appalled at the callousness, corruption and greed of the pharmaceutical industry. Too many are hurt and die while others greedily rake in the profits. However, we need to clearly understand that the pharmaceutical companies are not here to help us become healthy, they are here to make money. Part of the problem is a total lack of accountability and it’s not just the drug companies that need to be accountable- we also have to be accountable for our health and that of our children. Wake up, America- it’s time to evaluate what makes sense and what doesn’t…

For further information on this and other topics, go to http://www.drbender.com

Susan Jenkins contributed to this story

<span class=postbold>See Also:</span> Selective Serotonin ReUptake Inhibitors

[palmspringsbum]

Drugs 'don't work on many people'

<span class=postbigbold>A senior executive at Europe's largest drug maker has admitted most prescription medicines don't work for most people, it is reported.</span>

BBC News - Health
December 8, 2003


Allen Roses, of GlaxoSmithKline, is quoted in a national newspaper as saying more than 90% of drugs only work in 30-50% of people.

He said: "Drugs on the market work, but they don't work in everybody."

Mr Roses, an expert in genetics, said new developments should help tailor drugs more specifically.

At present, pharmaceutical companies adopt a "one-drug-fits-all" policy.

But Mr Roses said refinements in genetic technology should make it possible to identify more precisely those people who were likely to benefit from a drug.

He said: "By eliminating the people that we predict will be non-responders we'll be able to do smaller, faster and cheaper drug trials.

"If you can determine who is going to have a response (to a drug) and who is not going to have a response, you can take your next molecule and aim it specifically at the people who haven't had a response with the first one so that you can create a set of drugs that cover the population, and then you are back to selling to everybody."

<span class=postbigbold>Big differences </span>

GSK announced last week that it had more than 20 potential $1 billion-a-year blockbuster drugs in development.

Mr Roses quoted research published three years ago by Brian Spear, an expert in medical diagnostics, which found that different drugs had vastly different success rates in treating patients.

Most drugs had an efficacy rate of 50% or lower.

Richard Ley, a spokesman for the Association of the British Pharmaceutical Industry, told BBC News Online, said Mr Roses' comments emphasised just how important it was to conduct research into new products.

He said: "It's not news to anyone that not all drugs work in all people all the time.

"Sometimes the government and the National Institute for Clinical Excellence want to try to find one drug for a particular condition.

"This shows quite clearly that is not a viable approach. A medicine might work well in one person, and not at all for another."

Cliff Prior, chief executive of mental health charity Rethink, said: "People with mental illness have been telling us for years that different medicines work for different people.

"The idea of pharmacogenetics, that you might have a clue as to which would work best before prescribing it, is excellent.

"But it's still years away from reality. Meanwhile doctors must listen to people taking medicine, and be ready to try a different one if it's not working or if the side effects are bad."