Sun Editorial:

Prescription painkillers

Sun investigation points to the need for legislation to better address overdoses

Wednesday, July 9, 2008 | 2:09 a.m.

Drug addiction normally conjures up images of junkies shooting heroin into their arms or teenagers induced by methamphetamine to ransack homes. It’s the pusher on the dark street corner. It’s the rave party fueled by Ecstasy. It’s the line of cocaine on the coffee table.

One would not normally equate the use of prescription painkillers with the dangers of meth or cocaine, but a stunning two-part investigative report in the Las Vegas Sun on Sunday and Monday by Marshall Allen and Alex Richards provided convincing evidence to suggest otherwise.

The report, which should be required reading for all Nevada lawmakers and health care professionals, revealed that more people die in Clark County from prescription narcotic overdoses than from overdoses of illicit drugs or from vehicle accidents.

How is that possible? Try the fact that Nevadans consume twice the national average of painkillers. Nevada led the nation in 2006 in per capita use of hydrocodone, more commonly known as Vicodin or Lortab. The state also ranked fourth in the nation for methadone, morphine and oxycodone use.

This is a subject that obviously has flown under the radar, and that’s the problem. Something as deadly as a rash of prescription drug overdoses demands immediate attention from the Nevada Legislature and from the Nevada Pharmacy Board.

More specifically, there needs to be a state law that would allow for more thorough analysis of a database maintained by the board that tracks all prescriptions for controlled substances in the state. Law enforcement agencies can tap into the database for active investigations, but authorities are not allowed to examine the information to help identify practitioners who may be overprescribing painkillers. That needs to change, and Assemblywoman Sheila Leslie, D-Reno, to her credit, vows to take action during next year’s legislative session.

Consider that last year 258 people died in Clark County from overdoses of prescription narcotics, compared with 197 who succumbed as a result of street drug overdoses. That statistical comparison alone should serve as a wake-up call to lawmakers that the use of the database must be expanded so that authorities can get a better handle on a public health crisis that has gotten out of control.

If a high percentage of the victims received their drugs from a small number of physicians, identifying those practitioners could prove useful in an effort to prevent future overdoses. This would not necessarily mean that the physicians involved are guilty of criminal conduct, but if the evidence points in that direction, they should be dealt with accordingly by the Nevada Board of Medical Examiners and by law enforcement.

Another aspect of the overdose problem is that it points to the need for more access to drug addiction treatment in Southern Nevada. Many overdoses undoubtedly could have been prevented with earlier detection of addictive behavior. But there are only 323 licensed substance abuse treatment beds in the county to serve a population of 2 million. Unfortunately, we will never know how many of last year’s overdose victims might have been on waiting lists for a treatment bed or were never referred to a program.

It is time to get serious about addiction to painkillers. The fact that these narcotics are approved by the Food and Drug Administration and hyped by the pharmaceutical companies is no excuse to brush this troubling dilemma under the rug and hope it simply goes away.

Discussion: 6 comments so far…

By PainDoc

7/9/08 at 10:32 a.m.

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There are so many things wrong with the "analysis" and "research" done by these guys that's it's almost embarrassing. Amazingly, the braintrust at the Las Vegas Sun doesn't even know enough to know they have no idea what they're talking about.

Why does everything in Nevada have to be fourth-class, including the journalism??

What's "stunning" about the two-part "investigation" done by Marshall and Richards is that they seem to have almost no understanding of even basic statistics. All of this is based on "narcotics" prescribed on a mg/per capita basis? With no accounting for potency and bioavailability of the medication prescribed?? Are you kidding me??

There's a reason these groundbreaking "findings" have "flown under the radar." There's a reason why these findings haven't been published in a peer-reviewed legitimate medical journal. The reason is that Marshall and Richards DON'T HAVE A CLUE AS TO WHAT THEY'RE TALKING ABOUT!

How does this work? You're sitting at your desk at the Sun one day and then suddenly, the thought occurs to you that you're better at statistics and medical research than the people who do that kind of thing for a living? Did you guys stay at a Holiday Inn Express last night or are you just unbelievably dumb? I'm guessing it's the latter.

Now some ignoramus in the Legislature is going to formulate new law based on these "findings."

Vegas docs prescribing more hydrocodone may well be accounted for by 1) lack of more potent pain meds with longer half-lives on the formularies of many insurance companies in Southern Nevada, 2) doctors still prescribing like it's 1980 (multiple doses of short-acting drugs), 3) Inaccurate population statistics used as the denominator by the "researchers" at the Las Vegas Sun.

Nice work guys. You've taken junk science to a whole new level.
By PatientAdvocate

7/9/08 at 5:02 p.m.

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I agree with PainDoc. Numbers mean nothing without context. The MedExaminers already intrude on doctors who presecribe painkillers based on numbers alone, and when the docs are summoned it turns out the "excessive" meds were prescribed to elderly, non-ambulatory patients in intractable pain. The Sun's junk science and the lawmaker's naive reaction will only make more doctors afraid to prescribe medication to patients and result in incalcuable suffering for people who need the meds but can't get them. This was the case years ago before the AMA declared pain a "vital sign." The Sun's hysteria will bring us back to those dark ages, Shame on the Sun and the editors who publish nonsense and then call it "stunning" journalism. The only thing stunning is the Sun's stupidity.
By PainDoc

7/9/08 at 7:26 p.m.

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It's almost unbelievable that these guys would make these kinds of claims without controlling for diagnosis, tolerance, half-life, route of administration, co-prescribed meds, prescriptive setting, and most importantly, POTENCY OF THE DRUG PRESCRIBED. You're going to compare the amount of morphine prescribed to the amount of demerol prescribed without accounting for the fact that demerol is one-tenth as potent as morphine??

Sheila Leslie has become a tired cliche of self-serving irresponsible behavior. The scenario usually goes like this. Nitwits A and B make several absurd claims based on bogus statistics, misunderstanding, and profound ignorance. Sheila Leslie then injects herself into the media frenzy, accepting as proven whatever Nitwit A and Nitwit B claim. She then angrily demands that "something be done" and vows to deal with "the problem" during the next legislative session.

They say the most dangerous place to be is between Sheila Leslie and a television camera. I'm assuming the safest place to be would be between Sheila Leslie and a math book.
By PainDoc

7/9/08 at 7:49 p.m.

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One thing is for certain. When Marshall, Richards, and Leslie are in pain, they'll probably want adequate pain control. God forbid, but should it ever be the case that their bones are riddled with cancer or some other ailment, and their minds are ravaged with the hell that is chronic pain, I seriously doubt they'll be making these kinds of ignorant comments in the newspaper.

They strike me as the kind of tedious people who would ring their call buttons five times an hour and demand the nurse explain where their pain meds are and why the he11 it's taking so long.
By Marshall Allen (Staff)

7/10/08 at 2:44 p.m.

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PainDoc and PatientAdvocate -

The above editorial was written by the Sun's opinion section. But we wanted to respond since you are calling our reporting into question.

The numbers about prescription narcotic use in Nevada came from the Drug Enforcement Administration, and so far no one has questioned the accuracy of our analysis or our stories. In fact, we've received praise for their fairness and accuracy from a host of medical authorities and patients, from here in Las Vegas and nationally.

You clearly have a keen interest in our stories and are free to contact us directly if you have any questions or concerns.

Best,

Marshall Allen and Alex Richards
By unklerob

7/11/08 at 12:08 a.m.

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Did this investigation do any research within the Veteran Affairs (VA) health system? I have been trying to bring this problem up with VA officials for 4 years to point out there is a direct link between these numerous prescriptions and the increasing rates of suicides. Some health officials and doctors are not getting to the actual problems with patients in a timely mannner, instead, they substitute health care with pain medications instead of actually treating the problems of the patient.