Officials urge action on painkiller abuse

Lawmaker calls rising death toll from prescription drugs ‘shocking’

Tuesday, July 8, 2008 | 2 a.m.

State legislators and regulators Monday called the Sun’s reports about the startling rise in the use of narcotic painkillers in Nevada a wake-up call to improve patient care in the state.

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)

Prescription drug use

Chris Morris

Reader poll

“Definitely Nevada is overusing narcotics,” said Assemblywoman Sheila Leslie, D-Reno, who leads the legislative committee on health care. “How could you not come to that conclusion?”

Leslie said she will work with Nevada Attorney General Catherine Cortez Masto to draft legislation to address the issue during the 2009 legislative session.

The Sun’s analysis of Drug Enforcement Administration data showed that Nevadans are the No. 1 users of hydrocodone — the primary ingredient in the brand-name drugs Vicodin and Lortab — and ranked fourth for per capita use of methadone, morphine and oxycodone, the primary ingredient in the painkiller OxyContin.

The skyrocketing rate of narcotics use — methadone use was up 12-fold in a decade — has been accompanied by a startling trend: The number of fatal overdoses in Clark County involving narcotic painkillers is now greater than those involving street drugs and surpasses the number of people killed by firearms.

“Shocking,” Leslie said of the rising prescription drug death toll. “I don’t think that’s well-known.”

Leslie said that among the Sun’s findings, she was concerned by how just a few providers prescribe the bulk of the narcotics — and how current law limits what authorities can do about it.

The Sun’s analysis of a Nevada Pharmacy Board database that tracks prescriptions for controlled substances found that about 5 percent of providers in the database wrote about 88 percent of prescriptions in the database in 2007.

The database was created to help identify patients who might be “doctor shopping” — illegally getting overlapping and concurrent prescriptions from multiple providers to get drugs to feed an addiction or to distribute illegally. By law, the database cannot be analyzed to examine the prescribing habits of a particular doctor, dentist or other medical professional.

Leslie said she wants to explore whether the law can be changed to monitor prescribing habits.

“There has to be a way to have someone more carefully review that information,” Leslie said. “It certainly seems like we could zero in on the doctors who are overprescribers.”

Leslie said the Legislature needs to support a campaign to prevent drug abuse — it’s common for abusers to get pills that were prescribed legitimately for others — and increase resources for the treatment of addiction, the lack of which she called one of the “biggest problems in Nevada.”

“There are a lot of people using (narcotics) who know they’re in trouble and know they’re addicted but can’t get help,” Leslie said.

Cortez Masto recently expanded the mission of the state’s methamphetamine working group to include the prescription drug problem. She said Monday the group is exploring legislative changes focused on preventing abuse, providing treatment and educating the public to prevent drug abuse.

Cortez Masto said any regulatory changes must respect patients who legitimately need narcotic painkillers, while making it more difficult for drug abusers to get them from doctors or on the street. To combat methamphetamine, the state requires people sign a log to purchase cold medicines that can be used to make the illegal drug.

Dr. Edwin “Flip” Homansky, an emergency room doctor, medical director of the Valley Health System and member of the Nevada State Board of Health, said regulators and influential members of the medical community need to further examine the Sun’s findings to address the problem.

He said he was most concerned about patients who take too many narcotics to alleviate pain. “These pills aren’t the answer and can lead to more trouble,” he said.

Homansky said medical providers need to learn about the long-term consequences of prescribing narcotic painkillers, which are not effective for long-term chronic pain.

Larry Pinson, executive director of the Nevada Pharmacy Board, said it’s urgent legislators and elected officials take action to prevent excessive use of the painkillers.

“You look at these types of numbers — prescription narcotic drug overdoses rivaling automobile deaths — that’s got to be a wake-up call,” he said.

In addition to help for patients addicted to painkillers, Pinson said, there is a need for patients to be educated about the law — that pharmacists are required to speak with patients about the drugs they receive, and that pharmacists are required by law to offer free consultations.

Pinson said he’s also in favor of licensing pharmacy technicians, who can easily divert drugs, so there’s a higher threshold to cross in terms of getting the jobs and to provide accountability once they are in their positions.

Pinson said the board will resurrect a program to help patients get help for their addiction if they are discovered to be shopping for doctors to obtain multiple prescriptions for narcotic painkillers.

Discussion: 8 comments so far…

By NancyNAABT

7/8/08 at 5:50 a.m.

Suggest removal

Painkiller and Heroin Addiction. Do you know someone who needs help?

Buprenorphine is a state-of-the-art medication, combined with psycho-social therapy, to treat the medical condition of opioid addiction in the privacy of a physician’s office. FDA approved in late 2002, this treatment has improved quality of life for patients and provided dignity to opiate addiction treatment. Buprenorphine is sold under the brandname Suboxone® by Reckitt Benckiser Pharmaceuticals.

Find a physician – www.naabtList.org:
The National Alliance of Advocates for Buprenorphine Treatment (naabt.org) national Patient/Physician Matching System has connected 11,427 patients with at least one of the 2,010 participating buprenorphine-prescribing physicians since the national launch in September, 2006.

This confidential Matching System (naabtList.org) helps connect people addicted to opioids to doctors providing medical treatment with buprenorphine. Available 24/7, the free online service allows patients to reach out for help anytime with complete privacy.

Patient registration takes less than three minutes. A short list of questions helps match patients to physicians with appropriate experience. All patient information is confidential residing on a secure server. After the application is submitted, alert emails are sent to physicians. The Matching System then allows the physician to contact patients confidentially by email.

For information visit www.naabt.org
By Chausie

7/8/08 at 3:35 p.m.

Suggest removal

I am worried by the fact that for the patient who needs pain relief that the overzealousness to control illegal use of prescriptions drugs will make it more difficult and Doctors more reluctant to prescribe medications. I am handicapped and current procedures are strict enough.I have to see my Doctor every month for a hand written prescription which is only good for ten days. I then have to take it tp the pharmacy within two days of the expiration of my previous medication. This must fall within the ten days the handwritten prescriptions are good for.If my Doctor goes on vacation or in my case maternity leave they can not postdate a prescription and another Doctor has to fill out the prescriptions which many are afraid to do. I could not function without my pain medication .I have had 3 laminectomies plus scoliosis in my neck and the last Doctor who evaluated my spine said if he were to do surgery he wouldn't know where to start. He said there isn't one part of my back from end to end that doesn't have some sort of medical problem in addition I have some kind of growth that they are currently trying to diagnose between c5-c6. In my life I have never gotten high from prescription drugs. I don't drink because of the drugs I take but when I did one or two beers would make me high like drugs never have. I may be dependent but I am definitely not addicted. Some of us need are medication and I just want to state that handicapped and disabled people already have extra requirements to get their medicines which in many cases are a hardship. These are the only prescriptions that can't be faxed in by a Doctor and those of us with limited mobility are already burdened with extra provisions and for us who need our medication we don't need or want anymore. As it is now life revolves around getting your prescriptions filled. If you are going on vacation you cannot get your prescriptions filled early and your plans must be changed so you can get your meds. Thank you for listening.
By Melis11577

7/8/08 at 6:34 p.m.

Suggest removal

In 2005 Methadone is indicated in over 4600 deaths nationwide and this number is underestimated due to an error in ICD10 coding and non uniform procedures in reporting and determining causes of death. Methadone is killing more people than any other prescription drug, killing 2 people for every 100 exposed.

Methadone is now the #2 Killer Drug in the U.S. Methadone is more addictive then any other pain medication including heroin and because of it’s extremely long half life, cardio toxic risks, numerous fatal drug interactions, dosages based on tolerance, and small margin of error.

Every day 10.9 people die from Methadone (according to 2004 stats, not including car accident deaths caused by drivers under the influence of Methadone)

We cannot continue to allow a legal medication to be killing more people then the illegal drugs. Our government cannot be allowed to use tax dollars to fund their legal drug dealing operations.

We are asking government agencies to enact stricter guidelines in prescribing methadone for any reason. It must be mandatory that all doctors be certified and trained in the pharmacology of methadone; inpatient stays must be required during induction to methadone; all staff be extensively trained in monitoring methadone patients for symptoms of toxicity. Clinic patients should be tested weekly for legal and illegal drugs that are taken with methadone to get “ high” or experience “euphoria” such as benzodiazepines, alcohol, cocaine, heroin, marijuana etc… and face severe consequences or mandatory detoxification from the methadone program after 3 dirty urines. Selling of take home doses must result in termination from methadone program permanently throughout the U.S. When presenting inebriated at clinic, clinic should also document such activity as well as prevent client from driving. Take home doses for all patients receiving methadone should be eliminated thus preventing the risk of diversion or precautions such as pill safe should be implemented. http://www.thepillsafe.com/

Current statistics show that nearly 4000 people a year die from methadone. These deaths are mostly happening to pain management and detoxification patients’ wit hi n the first 10 days of taking initial dose. Most of these deaths are related to methadone prescribed with other medications that react as additives with the methadone. Diversion of methadone is a serious problem because it lands t hi s most deadly drug on streets. Statistics also state that methadone is contributing to more deaths nationwide then heroin and only second to cocaine deaths.

The potential of abuse, diversion, and overdose to new patients being prescribed methadone is overwhelming. The unique properties of methadone, it's long half life, and it's negative interaction with numerous drugs make it an optimal choice as a last result treatment for chronic pain and addiction.

www.harmd.org
Helping America Reduce Methadone Deaths
By sfiver

7/8/08 at 11:56 p.m.

Suggest removal

Yeah, once again the "do-gooders" will do almost anything to "save" us from ourselves. I've known people at both ends of the spectrum. The "stasher" who hoards narcotics and fills every prescription on time - and by their own admission - rarely uses them except for friends and get-togethers. Another friend - who has severe fibromyalgia and can just about walk - has to beg for 30 Lortabs every month.

Maybe both cases are legitimate. The "stasher" having the meds is psychologically able to stave off a possible addiction or dependence by having bottles of rarely used narcotics in the medicine cabinet. My other friend in obvious pain - maybe she just needs to cope with it, huh? Logical, I think not.

I think the state has a responsibility to educate the public regarding the effects of prescription narcotics - but I also strongly believe this is a private matter between doctor and patient. From my perspective - doctor's routinely under prescribe narcotic medication for fear of being sued or worse. My stepsister died from lung cancer (and she was not a smoker) and I remember her doctor telling me that either the morphine would kill her or the cancer. He was making sure that it would be the cancer. I can only imagine how much unnecessary suffering she underwent in the last weeks of her pro-longed life because of her doctor's fears of legal retribution.
By AngryPostman

7/9/08 at 4:44 p.m.

Suggest removal

The last thing we need is politicians telling doctor's how to do their jobs. The politico's can't even run this state worth a damn, and our doctor's already suck.... the worst of all possible worlds I can imagine is our third rate politico's telling our third rate doctors what to do or not to do.

Unbeleivable.
By PatientAdvocate

7/9/08 at 6:12 p.m.

Suggest removal

People who want to abuse drugs will get them no matter what the laws are. More half-baked laws will only make it harder for people in pain to get the help they need. Keep the Legislature out of our examination rooms and medicine cabinets. Go after the people who divert drugs to the street and leave the doctors and the patients alone. But laws aren't very good for that. Instead, the guilty will continue to prosper and the legit pain patients will have to suffer when docs are too scared to help them. The lawmakers should focus on problems that laws can fix, not useless legislation that only makes it harder for people to get help. Politicians should stay out of the medical field. They only will add insult to injury. I will not vote for anyone who jumps on the nail-the-docs bandwagon and will actively campaign against those who support laws that can only get in the way of patients getting relief from pain.
By lasvegan2008

7/14/08 at 11:57 a.m.

Suggest removal

Open Secrets of Las Vegas, Nevada
First open secret was abuse of foreign doctors, more commonly referred to as J1 doctors, second open secret, hepatitis scare and third, narcotic abuse. All of the above has happened under the eyes and knowledge of our population. Shameful
I must commend Mr. Marshall Allen and other Las Vegas Sun journalists who have brought these open secrets of Las Vegas to light.
Prior to regular narcotic prescription a diagnosis of the condition for which the narcotic is being prescribed, is the absolute responsibility of the doctor and associated medical staff. Once doctor has a diagnosis, than prescribing and monitoring patient response and monitoring patient attitude to narcotics could be very easily done.
In all fairness, it is not only doctor’s responsibility to check narcotic abuse, the pharmacies, hospital’s and clinics are responsible too. It is also the responsibility of officials who monitor narcotic prescription and dispensing of such, to implement monitoring of abuse. Abuse happens when monitoring agency fails to implement monitoring. Laws are not broken if the agency which monitors such laws perform. Narcotic abuse is a multi dimensional issue. Lack of monitoring patient’s who abuse, unscrupulous doctors, nurses, pharmacy personnel and medical facility employees, allows abuse to continue and proliferate.
I read with interest of the fear that monitoring and implementation of laws would make it more difficult for patients to get their medication. I do not see this happening. Patient’s who deservedly need narcotics will get their prescriptions. Monitoring narcotic prescriptions would make doctors, pharmacies, hospital and clinic very aware of the consequences of unscrupulous actions. All in all monitoring narcotic prescriptions will result in significant decrease in abuse. The question is, are the monitoring agencies willing to implement the present laws and/or future laws?
By girlfrommo

10/17/08 at 1:27 p.m.

Suggest removal

I just wonder if Marshal Allen is going to get an MD degree and then he can determine if pain pills are needed. Most come from across the borders both North & mostly South. I think we have more things for him to invesigate than that. What about the sex offenders Las Vegas loses? or the strip clubs (very common place to get drugs) or the Budget Swts

« Previous Ten Next Ten »

Live chat: Tuesday, noon PST; Chat with Krista Creelman; Problem Gambling Center executive director Krista Creelman will answer questions about gambling addiction from Las Vegas Sun readers from noon to 1 p.m. Tuesday, Nov. ... Submit question