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The local situation: Clark County Coroner Mike Murphy shows the equivalent of 258 case files — the number of deaths from prescription narcotics overdoses in 2007 — in the coroner’s office file room Wednesday. Murphy has called the prescription drug deaths a “dire situation.”
Monday, July 7, 2008 | 2 a.m.
Sun Series: The New Addiction
- Part 1: The painful truth about Nevada (7-6-2008)
- Part 2: Rising use of painkillers taking deadly toll (7-7-2008)
- Part 3: Officials urge action on painkiller abuse (7-8-2008)
Sun Interactive
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Dr. Harriston Bass Jr. of Las Vegas was convicted of murder in the death of a patient in 2006. Bass had prescribed large amounts of painkillers for the 38-year-old woman.
Matt Alberto, deputy chief of investigations for the Nevada Public Safety Department, said in Bass' case, a prescription drug wholesaler could not provide a good reason it was supplying narcotics to a doctor who didn't have Drug Enforcement Administration clearance.
When Bass' home was searched by police after the overdose death of Gina Micali, 38, they found $150,000 in cash and hydrocodone in bottles labeled with the name of his company -- DOCS-24-7. Bass was sentenced this year to 25 years to life in prison.
Beyond the Sun
The skyrocketing use and abuse of prescription narcotics in Las Vegas is accompanied by a similarly startling increase in the number of fatal overdoses, a Sun analysis has found.
Fatal overdoses involving prescription painkillers more than quadrupled in a decade and now exceed those involving illicit drugs, according to data compiled by the Clark County coroner’s office.
The trend reflects the extraordinarily high use of narcotic painkillers by Nevadans. The Sun reported Sunday that its analysis of Drug Enforcement Administration data shows that Nevadans per person use more hydrocodone — the potent ingredient in the drugs Vicodin, Lortab and Norco — than residents of any other state. Nevadans rank fourth nationally in per person consumption of methadone, morphine and oxycodone, the main ingredient in OxyContin.
The increased use and availability of the drugs are primary factors in the rise of addiction, illegal distribution and fatal overdoses, experts say.
In 1997, there were 57 fatal overdoses in Clark County in which prescription narcotics were a contributing factor, a rate of about five per 100,000 people. In 2007, 258 people died in Clark County from overdoses of prescription narcotics, a rate of 13 per 100,000 people.
In contrast, the number of deaths caused by illicit drugs has plateaued. Street drugs such as cocaine, methamphetamine and heroin were involved in a combined 197 fatal overdoses in 2007.
Deaths involving prescription narcotics exceeded or rivaled those caused by firearms (321) and motor vehicle accidents (234) in Clark County in 2007.
Clark County Coroner Mike Murphy called the prescription drug deaths a “dire situation.”
Doctors who specialize in pain management, and pharmaceutical companies that make the drugs, emphasize that many people are helped by prescription narcotics while acknowledging that a small percentage may become addicted.
Prescription drug overdoses draw national attention when the victims include such celebrities as Heath Ledger and Anna Nicole Smith, but aside from the sensational anecdotes, little is reported about the overall toll of overdoses.
Poisoning, usually caused by unintentional drug overdose, is the second leading cause of injury death in the United States, surpassing firearms in 2004, according to the National Center for Health Statistics.
Prescription narcotics deaths accounted for 56 percent of poisoning deaths nationally in 2005, according to the Centers for Disease Control and Prevention, and their absolute number increased by 84 percent from 1999 to 2005.
Some regional data compiled by medical examiners further illustrate the problem:
• In King County, Washington (Seattle), prescription opiates killed 148 people in 2006, a 572 percent increase since 1997.
• In Virginia, prescription narcotics took 399 lives in 2006, compared with 146 deaths from cocaine and amphetamines.
• In Oklahoma, of 603 drug-related deaths in 2006, more than half, 327, were attributed to hydrocodone, methadone or oxycodone.
• In Florida, people who died of drug overdoses in 2007 had prescription drugs in their systems more often than illicit drugs.
No prescribed narcotic is involved in more deaths among Nevadans than methadone. The long-acting painkiller was named in a third of the 1,771 prescription drug overdoses in Clark County from 1991 to 2007, according to the Clark County coroner’s office. The number of deaths involving methadone climbed from three in 1993 to 20 in 1998 and 105 in 2007. (Cocaine was a factor in 116 Clark County deaths in 2007.)
Methadone, widely used to wean addicts off other drugs, has grown in popularity as a painkiller in recent years. Several doctors said it’s preferred by insurance companies because it’s inexpensive — though insurers dispute this, saying there are many low-cost generic narcotics so there would be no reason to favor methadone.
But methadone is a challenging drug to prescribe because it stays in a person’s system for five to 11 days, even after its effects have worn off, said Las Vegas pain specialist Dr. Jim Marx. That means a patient could take multiple doses of methadone over time to keep pain in check, allowing potentially lethal amounts of the drug to build up in the body. In comparison, hydrocodone leaves the body within hours.
“It’s trickier to prescribe because of its persistence,” Marx said.
Methadone deaths have increased more than those involving any other narcotic, the Centers for Disease Control and Prevention reports.
Its data show Nevada had almost four methadone deaths per 100,000 people from 1999 to 2005, the fourth-highest rate in the United States, behind Maine, Utah and Washington.
The CDC said it’s hard to determine whether the increase in opioid-related deaths is due to prescribing practices, a failure by patients to take drugs properly, or illegal abuse.
CDC medical epidemiologist Leonard Paulozzi told Congress in March the drug overdose deaths correspond to the rapidly rising rates of prescription narcotic use reported by the Drug Enforcement Administration, and the overdose deaths are expected to continue.
Statistics through 2005 “probably underestimate the present magnitude of the problem,” Paulozzi said.
•••
There are many ways to get prescription narcotics illegally, said Matt Alberto, deputy chief of investigations for the Nevada Public Safety Department, the state’s lead prescription drug policing agency.
Unscrupulous doctors sell prescriptions for cash. Abusers shop for doctors who prescribe narcotic painkillers without asking many questions. Children fish around in their parents’ medicine cabinets. Patients forge prescriptions. Pharmacy workers, clinic workers and hospital employees steal the drugs.
The most notorious criminal case of a doctor in Las Vegas illegally providing narcotic drugs involves Dr. Harriston Bass Jr., who, according to evidence at his trial, made house calls to prescribe and distribute prescription narcotics.
Bass drove to patients’ homes, conducted 10-minute exams and then sold the patients two or three bottles of 100 pills each — even though he had no license to distribute controlled substances, according to testimony at his trial. He also wrote prescriptions for patients to fill at pharmacies.
Among his patients was Gina Micali, who received about 300 hydrocodone tablets from Bass every other month, plus a prescription for another 180 and one refill. On each visit she also received the muscle relaxant Soma and the anxiety medication Xanax, plus prescriptions for each. In pills and prescriptions, Bass sold Micali a total of about 1,400 pills per visit, said Conrad Hafen, the chief deputy attorney general, who prosecuted the case.
On Oct. 5, 2005, Micali, 38, died after ingesting too many painkillers she got from Bass.
Hafen told the jury that when police searched Bass’ home, they found $150,000 in cash and large quantities of hydrocodone in bottles labeled with the name of his company — DOCS-24-7 — and a wholesale prescription drug company in Illinois.
Alberto said the Illinois company offered no good explanation for why it was selling drugs to a doctor who didn’t have clearance from the Drug Enforcement Administration.
In March, Bass was convicted of second-degree murder in Micali’s death and was found guilty on more than 50 drug-related charges. He was sentenced to 25 years to life in prison.
A more typical case of illegally diverting prescription painkillers involves Stephanie Ortiz, a former pharmacy technician at four Smith’s grocery stores in Las Vegas. She admitted to the pharmacy board that she gave unauthorized refills of Lortab — a painkiller made with hydrocodone — and free drugs to friends posing as patients. Ortiz filled out refill requests but never faxed or phoned them to physicians for approval, the complaint against her says. She admitted illegally diverting 10,680 doses of the painkiller.
In a letter she wrote admitting her guilt, Ortiz says she started giving the purloined drugs to people she knew, and then got text messages and phone calls saying a random person would come by for another pickup. In exchange for the drugs, Ortiz said, she received VIP tables at nightclubs and access to hotel rooms on busy weekends.
Authorities say young people are cavalier with prescription drugs, sharing them among themselves or sneaking them from their parents and passing them around to their friends. Such a transaction ended in death two years ago this week in Mesquite.
According to an affidavit filed by the Nevada Public Safety Department, Brett Sawyer, 19, was found dead in his bedroom on July 8, 2006. Hidden in a gym bag by his bed was an empty bottle of hydrocodone pills prescribed by a dentist in St. George, Utah, to one of his friends.
Sawyer’s family told investigators he was a drug user. “Brett was the type — if one aspirin worked, three would work better,” his mother said.
Police learned that Sawyer was addicted to OxyContin and often obtained drugs from Cody Morris, who was also an addict and dealt the drugs to his friends.
On July 7, 2006, Morris sold Sawyer three 80 mg OxyContin pills — what some call the Cadillac of prescription narcotics — for $45 each. Morris said he warned Sawyer not to take more than one at a time and to avoid mixing them with alcohol.
Sawyer was dead the next day.
Morris pleaded guilty to manslaughter and was sentenced to three years’ probation.
Alberto, the investigator, said it’s as common for drug dealers to sell prescription narcotics as it is methamphetamine or cocaine — and more profitable. An ounce of methamphetamine might sell wholesale in Las Vegas for $700, he said, but the same weight in OxyContin pills would be $3,000. He guessed the illegal abuse of prescription painkillers could account for 10 percent of the state’s total use.
Alberto laments that policymakers and the public are focused on street drugs, and virtually ignore the dangers in people’s medicine cabinets. Narcotics investigators for Metro Police do not investigate prescription drug dealing and deal with the drugs only on a reactive basis, a spokesman said.
Yet prescription narcotics are becoming more popular than marijuana for new abusers. The 2006 National Survey on Drug Use and Health found that among new drug abusers, 2.2 million people chose prescription painkillers and 2.1 million preferred marijuana.
Nothing stimulates the brain with pleasure more than drugs. But doctors disagree about the threat of drug addiction. People at risk of becoming addicted to them range from 3 percent to 18 percent of the population, depending on the study or the expert.
Prescription narcotics can change the brain’s chemistry, creating a physical and psychological dependence that compels addicts to forgo career, children, money, sleep, sex and all-around well-being in pursuit of the drug of choice.
Officials with the Nevada Substance Abuse Prevention and Treatment Agency say the rise in prescription narcotic addiction in the state cannot be quantified because of the way records are kept. Nationally, a 2006 Substance Abuse and Mental Health Services Administration survey showed that an estimated 5.2 million people 12 and older took narcotic painkillers for nonmedical purposes 30 days before the survey, up from about 4.4 million in 2002.
People seem to think that because the drugs are commercially manufactured and approved by the Food and Drug Administration, their abuse is less risky than that of illicit drugs, said Steve Pasierb, president of the Partnership for a Drug-Free America.
“This is a deadly behavior,” Pasierb said of the drug abuse. “When prescription drugs are abused in the same way as illegal street drugs, they’re every bit as addictive and they’re every bit as deadly.”
Part Three in this Series: Officials urge action on painkiller abuse
Painkiller and Heroin Addiction. Do you know someone who needs help?
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Articles like these tend to be one sided. Some of us who need pain medication on a daily basis to be able to walk upright and work find these articles somewhat scary. It is as though everyone wants us to stop medicating and do something homeopathic for the pain. Usually we have already tried surgery, physical therapy, and many other procedures before turning to daily medications. We are generally able to function as a normal person and have few side effects if the doseage is correct for the pain. Just wanted people to know that some of us don't really have a choice if we want to live out of bed and have a productive life. Kathryne
Kathryne is absolutely correct. These articles tend to sensationalize a small sub-culture of presription abusers, without mentioning the millions of people that responsibly use this newer class of pain killers to substantially increase quality of life.
Often times, the poisoning is a result of the tylenol mixed with these narcotics. The patients (or addicts) die from Tylenol posioning that destroys the liver, not from the opiate derivative.
The two previous posts exemplify the denial people who are addicted to the drugs demonstrate. Anyone who is on the opioids for a long period of time now have two problems. Pain and a drug problem. My sympathy remains with the people who are addicted to the drugs and look for sympathy by rationalizing that there is no other way than to sit on their rear ends and wait for the next addictive dose to satisfy their addiction. I hope this series is a beginning to reveal the lies and misinformation the drugs have created.
You and I are just one illness, one accident away from joining the millions of chronic pain patients across this country. Pain knows no ethnic or socio-economic boundaries. It is an equal opportunity malady.
Call your US senator and Congressional representatives today. Ask them to please support the National Pain Care Act. This bill will facilitate the allocation of increased research dollars to the area of pain management at the National Institutes of health where at the present time approximately less than 1% of the dollars spent on research are designated for pain research.
Unrelieved pain is a growing Public Health crisis in this country. Millions of individuals are suffering in silence and isolation desperate for any relief that might be offered. Many are vulnerable prey to the newest fade or gizmo that proclaims it can “cure” their pain. We need better designed research studies that can get to the core of the problem of why the human nervous system can get turned on and generate continuous pain signals even in the absence of quantifiable pathology.
It is of grave concern that the same class of medications called OPIOIDS (Narcotic is a legal term used in the judicial system and has a very negative connotation) are being abused by a growing number of individuals. It is also of grave concern that the death rates are rising but it is not surprising, these are potent drugs and if not used properly they WILL kill. Insulin is also a drug that can kill if not used properly...the only reason it is not being abused on this grand scale is because you can not get high on Insulin. Pain patients do not get high...they get relief.
The truth of the matter is, there have been and will continue to be accidental deaths from prescription drugs. People will continue to use poor judgment and do stupid things in the use of their prescription drugs. People still drink and drive and thousands die on our highways each year. Are cars or alcohol rationed or decreased as a means of reducing the number of accidental deaths? Guns are dangerous. But the reality is that guns can kill and accidents will happen. And no matter how many deaths occur annually, abolition of firearms will never happen in our life time.
What is needed is balance. Balance in the news reporting of the issues. There are 2 sides to every story. and The Balance of policy and regulation to curb addiction, diversion and unintended deaths against the needs of millions of persons in pain who depend on this class of drug to function and have any quality of life.
To learn more about what you can do to advocate for quality pain care go to www.painfoundation.org
For anyone that has set by a loved one wracked with pain and had to deal with a doctor who refuses to write a prescription for the proper dosage of pain medication knows what sheer helplessness feels like. My mother's problem started with a nagging pain in her back. It got worse and moved into her legs. She became bedridden and was in constant pain. Her managed care physician made a referral to a specialist. In the meantime, although her pain became increasingly more severe, he refused to write a prescription for more than Vicodin. Even though the doctor knew her mobility was compromised by whatever was causing the pain, he still required her to be brought to his office every other week, where she would wait, in pain, for several hours, so he would write another prescription, for Vicodin, for minimal relief. Why, if she wasn't caught in a managed care system where one doctor said she needed immediate surgery and a second doctor said less invasive treatment interventions should be tried first, she wouldn't have been suffered for ten months. Finally a third doctor was called in and evaluated my mother and said her condition had deteriated seriously and immediate intervention was needed. The pain was in her legs and back and robbed her of her ability to walk. A preop exam revealed a small nodule in her chest and further testing proved it to be cancer. But she was in the hospital, on a morphine pump and for the first time in over a year, she was pain free for the last 60 days of her life. Do you think I worried about her becoming "addicted". So for anyone who hasn't had to walk the walk with a loved one who suffers because some "do-gooders" want to protect people who misuse or overdose on medication and those others who want to instill such fear in doctors that they "under" medicate their patients stop it. You haven't completed the first part of your job - you know, the drinkers, the pot smokers, the crack addicts...once you get them under control, then maybe you can look to add some more jobs but until then, you have more than you can handle.
Of the 258 fatal overdoses from prescription narcotics in Clark County in 2007, a rate of 13 per 100,000 people, how many of those that overdosed were under a doctor's care for pain management? It would seem that the Coroner's office would have that information. Then the next sentence could read, Of the 13 per 100,000, 3 were under a doctors care or 6 or 8 or ?. Right now, the missing factor is whether there were any overdoses of patients under the care of a physician. Could we get that information?
To advocate for quality pain care through the Pain Foundation, ask if they are funded by Purdue Pharma, a criminally convicted pharmaceutical company for marketing OxyContin to physicians and patients as less likely to be addictive or abused. Purdue Pharma and its 3 CEO's Michael Friedman, Howard Udell and Paul Goldenheim wer criminally charged, pled guilty and were sentenced in Federal Court in 2007. Their actions have resulted in an epidemic of death and addiction of OxyContin in every state in the country. The "undertreatment of pain" has proven to make a greedy pharmaceutical company worth $10 billion at the cost of thousands of lives. The Pain Foundation being associated with convicted felons and its Board of Directors lends to a lack of credibility.
"Small sub-culture of presription abusers"? This type of characterization of a large and diverse array of victims of prescription drug abuse in this country reflects a common misunderstanding of a very complex and pervasive problem that is a result of an extensive overreliance on opioids to treat pain patients in this country.
Two years ago we lost our wonderful 18-year-old daughter to an accidental overdose of OxyContin. My daughter had cancer and herself had been on morphine in a hospital after her three surgeries, so I am not opposed to the appropriate use of opioids to treat pain. But all too often, physicians are prescribing these dangerous drugs for people with only moderate pain ailments: indeed, government statistics indicate that most opioid prescriptions are not for severe pain. This overreliance on opioid narcotics, a class of drugs that has been shown to result in dependency and addiction and also reduced effectiveness when relied upon as a long-term treatment, has resulted in availability to the point where our young people have too much access to these dangerous drugs, with often fatal consequences. Free and widely-accessible drugs that are presumed to be safe because they are "FDA-approved" and doctor-prescribed are commonly found in the family medicine cabinet. Most kids who abuse these prescription opioids are normal teenagers, who as we all know tend to make poor decisions at this time of their lives.
The use of dangerous opioid drugs like OxyContin to treat moderate pain is akin to using a hammer and chisel to clip a fingernail. These drugs need to be appropriately restricted to where they are most needed. And people who use them need to be made aware of their true dangers.
The facts are that over the past ten years the production and sale of opioids have increased dramatically in this country. 80 percent of the world’s supply of opioids is consumed in the U.S., including 71 percent of all oxycodone and 99 percent of all hydrocodone. Drug deaths track closely the rapid rise in sales of opioids per capita. In 2005 an estimated 22,400 people died from drug overdoses, a toll largely attributed to opioid analgesics, which now cause more deaths than heroin and cocaine combined.
Leading national experts on drug abuse strongly concur that we are in the throes of a serious epidemic of prescription opioid drug abuse. National Institute on Drug Abuse Director Nora Volkow stated: “Prescription pain medications are driving the upward trend in drug poisoning mortality. The number of deaths involving prescription opioid analgesics increased 160% in just five years, from 1999 – 2004.”
I agree that the discussion of opioids needs balance. Unfortunately to this point the discussion, as well as drug policy in this country, have been entirely controlled by the drug companies, with the result that people continue to die or become addicted in increasing numbers.
Pete J
I don’t understand why the media continues to miss the bottom line problem and source in this issue, which is the shamefully inadequate, ill-prepared number of physicians, who have created this medical scandal. Not to mention the agencies like the above “ pain foundation, who sisnce the 90’s has had one mantra: We need more pain treatment and the utilization of narcotics for pain. Huge amounts of self serving reports, studies, propaganda, were cleverly marketed to physicians in the 90’s to get them to prescribe opiates more liberally. Physicians in turn, contributed enmass to this situation by irresponsibly relying on profit driven agencies to tell/teach them their medicine. That’s a scandal of itself. Physicians, in the thousands, who, like the majority of (narcotic) licensed doctors, had (continue to have) less than 8 HOURS of pain management, narcotic dispensing, and pain medication training and education during their schooling. Now who doesn’t think that’s a mighty big problem?
10 years ago Pain Org’s professed that less than 1% of chronic pain patients became addicted. That’s not true. It came from “junk science” and independent doctors are just now scrambling to do the research that should have been done back then, before enticing every Dr. Tom, Dick, and Harry to dispense these dangerous and potentially deadly drugs so liberally.
The debate relevant to the outrageous numbers of never before seen death, overdose, elderly addiction, “accidental addiction, etc. is only due to greed and ignorance. It is a medical scandal and disgrace. Thousands of doctors have inappropriately over-prescribed narcotics/opiates to thousands of patients.
The Pain foundations would have you think this is about some crisis of undertreated pain. Or the problem rises out of bad patients who trick doctors, or take their medication incorrectly. Or “just a few” bad apple doctors. Or street addicts. Or even the DEA. All of which has been used to terrify the suffereing pain patient into thinking that those issues are ruining their opportunity to get adequate pain care. It’s not true.
What is the Federation of medical boards doing with these numbers and statistics? If they answer “ We are now instituting more education and training”, I rest my case. Too late. Too little. People are dead. Unsuspecting “accidental” addicts have been created. Families have been devestated.
We need a system that delivers appropriate pain treatment (as well as therapy) to appropriate pain patients, by appropriate/trained pain physicians, based on well founded medical principals. And it doesn’t take a genius to know that the science of pain should NEVER be funded by pharmaceutical manufacturers. Don’tcha think?
I know Pain treatment isn’t brain surgery, but it is no less a matter of life and death, when handled poorly
Annie
My son passed away 5-23-08, he was 8 days away from turning 18 years old. When I woke up in the morning & went to his room he was unresponsive and I called 911. Please see more of my story at:
http://www.lasvegasweekly.com/news/2008/...
He passed from prescription drugs he got off the street. There was no text messages regarding these pills, only xanax, lortab & marijuanna.
Debbie Zarder
I just lost the love of my lfe to an accidental methadone overdose.He had been on maintanance for four years but had now been clean for 5 years.We have a beautiful baby boy,3 months old,and have been trying our hardest to adapt and build a family.we've had good days and fusterating days....last wednesday was a fusterating and a little overwhelming for my boyfriend...we went to 7-11 and out of the blue some random guy came up to the car and wanted to know if we wanted any pills.I desperatly wanted him to say no.....but he felt he needed a little escape from reality for a day....I got upset tried to take the pills out of his mouth but ultimatly he swallowed them(80 mgs) I was hurt, i wanted nothing more than to live a normal sober life raising our son (up untill we met eachother we both lived crazy lifes with drugs,jail,&prison but that was our past....)
I didn't know what to do....enable him or let him know that drugs were NOT an option in our relationship I opted for the second and asked him to leave.......I never saw him again...I waited and waited for him to come home, I new he just needed an escape for a night,some breathing room,but when he didn't come home at check out time, I new something wasn't right.I waited all day ,till about 6pm... that's when the coroners office knocked on my door to inform me that the man I am so completly in love with,the father of my 3 month old boy,the person i looked my whole life for and finally found..... went straight to a hotel near our house to get some sleep,take a breather and never woke up.In a matter of minutes ALL my hopes and dreams were shattered with a few pills.methadone is VERY dangerous and changed my life and my sons life forever
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