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    ACCIDENTAL ADDICTS

    Many Patients End Up Hooked on Doctor-Prescribed Painkillers

    Timothy Penny was an athletic 33-year-old when he started taking
    prescription pain pills in 1998. He couldn't seem to shake a deep, stabbing
    pain in his back, hip and leg after a nasty fall at his job in Escondido.

    Twenty-three miles away, in her University City home, Jane Kellogg was
    using prescription drugs to ease her depression, blunt her chronic
    pain, stop her cough and help her sleep.

    In El Cajon, Julie Thomas was swallowing Vicodin and other
    prescription drugs to blunt her migraines and dull the pain that had
    spread through her bones.

    By the end of 2002, Penny, Kellogg and Thomas were
    dead.

    According to the county Medical Examiner's Office, they died from
    accidental overdoses of prescription drugs, making them part of what
    federal officials say is a disturbing shift in the nation's drug abuse
    patterns.

    Deaths involving prescription drugs are increasing while deaths linked
    to "dirty drugs" such as heroin and cocaine are decreasing in many
    parts of the country, including San Diego County.

    Some of the dead are recreational drug users who simply added legal
    painkillers or antidepressants to their stash of illegal drugs.

    But a growing number are people who accidentally became hooked on
    drugs prescribed by their doctors for medical reasons.

    "People are quietly dying in their bed almost every day, and it draws
    no attention," said San Diego police Detective Kevin Barnard, who for
    two years specialized in prescription drug cases. "The focus is on the
    cocaine dealer. We overlook the average person who has an addiction."

    The problem is clouded by a lack of comprehensive nationwide
    statistics to define the scope and impact of prescription drug abuse.

    The best indicator may be a federal study released this month, showing
    that in 2003 more tha
    n 31 million Americans admitted having used
    prescription drugs for nonmedical reasons at some point in their
    lives, an increase of 1.6 million in one year.

    Another government study released this year, which looked at
    drug-related deaths in hospital emergency rooms in 25 cities, showed
    an uptick in deaths linked to prescription drugs in more than half the
    cities surveyed between 2002 and 2003.

    The U.S. Department of Health and Human Services, which released both
    reports, acknowledged the emergency room study didn't include all the
    accidental prescription drug deaths, so those numbers could be far
    higher.

    Even so, that report showed drug-related deaths in San Diego County
    were higher in 2002 than any year since 1998, an increase caused by
    prescription drugs and over-the-counter medications. Deaths from
    illegal drugs decreased that year.

    "Medical professionals have been caught off guard by the magnitude of
    the problem," said H. Westley Clark, head of Substance Abuse Services
    for the Department of Health and Human Services.

    Based on the available information, Clark estimates thousands have
    died from legal drugs and that millions more have become addicted.

    John Walters, director of the White House Office of Drug Control
    Policy, said prescription drug abuse is being taken so seriously that
    for the first time the White House has set aside money - more than
    $100 million - specifically for prescription drug education in the
    next fiscal year. The White House will spend $178 million on illegal
    drug abuse education during that period.

    "The power and the risk of death (from prescription drugs) pose a
    different kind of problem than we have seen," Walters said.

    The pill problem took center stage on Capitol Hill Thursday when the U.S.
    Senate's Health, Education, Labor and Pensions Committee met to begin
    searching for new ways to monitor prescription drugs.

    "Over the past 10 years the abuse and diversion of prescription drugs
    has grown from a regional crisis to a national epidemic," said Sen.
    Jeff Sessions, R-Ala., who chaired the hearing.

    Most worrisome are two popular painkillers:

    Hydrocodone, the primary ingredient in Vicodin, Lortab and more than
    200 other brands, is prescribed for mild to moderate pain.

    Oxycodone, often sold as OxyContin, is usually prescribed for severe,
    chronic pain, such as that associated with cancer.

    Between 1998 and 2000, the number of new prescriptions written
    annually for hydrocodone-based medications alone rose to more than 89
    million from 56 million, according to the U.S. Drug Enforcement
    Administration. Hydrocodone is now the nation's most abused
    prescription drug.

    In 2002, San Diego was among the top five cities in the number of
    deaths linked to hydrocodone, ahead of Dallas and behind Detroit, New
    Orleans and Las Vegas, according to the Department of Health and Human
    Services' emergency-room study.

    Hydrocodone and oxycodone give addicts a euphoric high, especially if
    the pills are crushed before they are swallowed.

    Antidepressants such as Paxil, Zoloft and Celexa also are of concern
    to authorities but have not been linked to as many deaths.

    From Walters' office two blocks from the White House to the streets of
    San Diego come stories of lives altered by prescription drug abuse.

    In June, Vice President Dick Cheney dismissed his personal physician,
    Dr. Gary Malakoff, in June after it was disclosed he had abused
    prescription drugs.

    Conservative radio talk show host Rush Limbaugh temporarily left his
    show last year after he acknowledged his addiction to painkillers.
    Limbaugh said his doctor originally prescribed the pills for back pain
    in the mid-1990s.

    President Bush's niece, Noelle Bush, was arrested in 2002 trying to
    pass a fake prescription for the anti-anxiety drug Xanax. She recently
    completed a court-ordered rehabilitation program.

    Less-publicized stories are recorded every week in San
    Diego.

    Mira Mesa produce supplier Sal Moceri has been arrested three times
    for illegally buying prescription painkillers. Like Limbaugh, Moceri
    said he was originally given the pills for a back injury.

    Over the years, Moceri's habit grew to 60 Vicodin tablets a day, a
    dose that addiction experts say is not extraordinary for someone who
    has developed a tolerance after long-term abuse.

    "The addiction controls your life," said Moceri, who says he has been
    clean since his last arrest in 2002. "You are not your own person.
    You're an addict. That's who you are."

    The Justice Department's inspector general, Glenn A. Fine, said more
    resources are needed to fight prescription drug abuse, which he
    describes as equal to cocaine abuse, or worse.

    Fine uses numbers from the Justice Department's recent reports on
    prescription drug abuse to Congress to tell the story:

    In 2002, an estimated 6.2 million Americans abused legal narcotic
    painkillers, while 4.1 million Americans used cocaine.

    The misuse of painkillers now accounts for 30 percent of
    emergency-room visits, a number that has increased steadily over the
    past decade.

    "We do not believe people should be living their lives in pain, but we
    think medical practices have to be safe and effective," said Clark of
    Health and Human Services. "The balance between appropriate pain
    intervention and maintaining legitimate therapeutic need - that's the
    issue."

    Pain Management

    Mary Staley's back pain began in the 1990s, soon after doctors started
    rethinking ways to treat pain.

    For decades, doctors had hesitated to prescribe opiate-based
    medications such as morphine and codeine to anyone who wasn't
    terminally ill because of the potential for addiction. They also
    feared being unfairly scrutinized by federal and state regulators, who
    monitor opiate prescriptions.

    In the late 1980s and early 1990s, physicians began debating this
    philosophy. Why, many wondered, should people suffer from chronic pain
    when so many new drugs were available to help them?

    "There was a culture change of sorts in the U.S.," said Dr. Russell K.
    Portenoy, chairman of the Department of Pain Medicine and Palliative
    Care at Beth Israel Medical Center in New York.

    Prescribing drugs for daily pain management "became widely accepted,"
    Portenoy said. "Then Purdue released OxyContin and it took off."

    In 1996, Purdue Pharma, the Stamford, Conn., company that developed
    OxyContin, began an aggressive campaign to promote the drug, which was
    newly approved by the U.S. Food and Drug Administration. The drug was
    hailed as a major breakthrough because it allowed patients suffering from
    chronic pain to receive 12 hours of medication from a single tablet.

    The company held pain-management seminars for physicians and sent
    samples directly to their offices. A promotional video, "I Got My Life
    Back," was mailed to 14,000 physicians nationwide.

    Purdue Pharma also sent letters to the FDA predicting the pill would
    change the nature of fighting pain.

    In a December 2003 Government Accountability Office report to federal
    lawmakers, the FDA described Purdue Pharma's marketing of OxyContin as
    "overly aggressive."

    Thousands of miles from Purdue's base in Connecticut, in a mobile-home
    park in Chula Vista, Mary and Oscar Staley were trying to ease Mary's
    chronic pain.

    Mary Staley had fallen on a sidewalk in the 1990s, just days before
    she retired from her job as a supervisor at the Marine Corps Recruit
    Depot San Diego. Over time, the pain in her leg intensified. Oscar
    Staley said he finally sent her to a pain specialist, who kept
    adjusting her medications.

    Eventually Purdue's revolutionary OxyContin was added to her lengthy
    prescription list, which included Vicodin, a hydrocodone-based painkiller.

    Oscar Staley said his wife knew the drugs could become addictive but
    was willing to take the risk to get rid of her pain. Eventually, she
    was taking 20 pills a day.

    On April 26, 2002, Oscar Staley found his 51-year-old wife dead in
    bed. The medical examiner's report blamed her death on an accidental
    overdose of at least five medications, including hydrocodone and oxycodone.

    Her death had to do "with the damn drugs," Oscar Staley said. "The
    body can only take so much."

    Staley still doesn't consider his wife a drug addict. She was a pain
    patient, he said.

    A year after Mary Staley's death, the Journal of Analytical Toxicology
    reported 919 deaths related to OxyContin between 2000 and 2003 in the
    United States.

    Portenoy, the Beth Israel Medical Center pain specialist, was among
    those who had pushed for the use of opiate-based drugs such as
    hydrocodone and oxycodone to combat pain in people who weren't near
    death. In a recent interview, he acknowledged that his early
    assumption that the drugs posed a relatively low risk of abuse was
    wrong.

    "There was no discussion about the assessment of abuse and diversion"
    of the drugs, Portenoy said. "We have this terrible thing happening
    with OxyContin and hydrocodone, and the tragic deaths of people and
    terrible outcomes.

    "I am a little embarrassed how the risk of abuse was not
    highlighted."

    Pain control advocates cite studies showing that relatively few
    patients who receive opioids, or opiate-like biochemicals, actually
    become addicted.

    The National Academy of Science's Institute of Medicine reported
    addiction in patients receiving opioids for pain ranged from 1 in
    1,000 to less than 1 in 10,000 in 1999, the latest estimates available.

    "Unfortunately, many politicians, law enforcement officials,
    journalists, pain patients and practitioners ... continue to labor
    under the misperception that prolonged use of OxyContin or any other
    opioids to treat moderate and severe chronic pain is likely to lead to
    addiction," said representatives of the National Foundation for the
    Treatment of Pain, the Drug Policy Alliance and other groups in a
    brief filed in an Ohio court case.

    Experts offer a variety of theories about why people become
    addicted.

    Some doctors don't give enough warnings. Some patients don't pay
    attention to the warnings. And some people have a genetic inclination
    to become addicted.

    The problem is compounded by the absence of a workable tracking system
    to find patients who go from doctor to doctor until they find one
    willing to prescribe what they want, or who learn how to draw
    prescriptions off the Internet.

    Until recently, doctors received little formal instruction in pain
    management. It was assumed they would understand how to ease a
    patient's suffering without special training.

    Paths to Addiction

    Timothy Penny was working as a nursing home administrator when he hurt
    his leg in 1998. Penny, who lived in Vista, was an athletic man who
    enjoyed scuba diving. He assumed his leg would heal quickly.

    The pain persisted, and his doctors prescribed morphine, hydrocodone
    and other potent drugs.

    "It was a classic spiral into drug addiction," said Penny's aunt,
    Kathy Frazier, who as a nurse had seen people with her nephew's
    symptoms time and again.

    "He became more and more dependent over a period of time, but he
    didn't want to admit he was hooked. When we'd try to say something
    about it, he'd just say no, no, no."

    Penny's mother, Lael Danto, said her son never saw himself as an
    addict because he never drank or abused illegal drugs. He died in his
    bed in January 2002 of toxic levels of methadone and
    hydrocodone.

    Some patients' pain is so severe that they continue using the
    medication despite clear signs of addiction.

    Jane Kellogg had a history of abusing prescription drugs and alcohol
    because of chronic pain and depression, according to medical
    examiner's reports. That toxic mix, combined with high blood pressure
    and heart disease, killed the 71-year-old Kellogg, who died alone in
    her apartment in October 2002. Painkillers and antidepressants were
    found in her body, medical examiners said.

    Julie Thomas, 33, originally took Vicodin to
    blunt pain caused by migraines and by fibromyalgia, a chronic illness
    characterized by widespread aches, pain and stiffness.

    But Thomas' growing addiction to the pills became the source of more
    suffering. Her liver had become irritated by the medication, according
    to the medical examiner's reports, and doctors prescribed methadone to
    slow the liver damage. Only days before her death, Thomas told
    relatives she felt great on the methadone and that there was so much
    she wanted to accomplish in life.

    On Valentine's Day 2002, Thomas' husband found her dead in their
    bedroom. The medical examiner's report said she died of an accidental
    mix of prescription drugs and alcohol.

    Neither Thomas' family nor Kellogg's family wanted to discuss the
    circumstances that led to their loved ones' deaths.

    Catching Addicts

    Veteran police officers such as Barnard, the San Diego detective,
    worry about the broader ramifications of prescription drug abuse by
    seemingly ordinary people.

    "It can be anyone," he said. "There's no cool ZIP code or social
    status that makes you immune to addiction."

    Think of the patients who could be harmed by a drug-addicted doctor,
    Barnard said. Think of the passengers a drug-addicted bus driver puts
    at risk. Or the students whose education is affected by a
    drug-addicted teacher.

    "How would you like to fly on a plane with a pilot whacked on some
    prescription painkiller?" Barnard said.

    In May, Barnard was taken off the San Diego Regional Pharmaceutical
    Narcotic Enforcement Team and reassigned for budget reasons to
    investigate petty thefts and burglaries.

    Currently, six law enforcement officers in San Diego County are
    assigned to the pharmaceutical task force. By contrast, about 300
    state, federal and local law enforcement officers in the county
    investigate illegal drug cases as their primary job.

    The pharmaceutical task force targets people who fraudulently use
    prescriptions to feed their addictions. Most are not hardened criminals.

    "Usually when we show up, it's the first time they've ever had contact
    with a police officer," said state Department of Justice agent Sara
    Simpson, the task force supervisor. "They're busted and they're scared."

    So it was no surprise that a man task force agents arrested at a
    Pacific Beach pharmacy in May turned out to be a 42-year-old
    contractor with a successful business.

    In the man's neatly organized truck, a task force agent found dozens
    of bottles of painkillers, as well as a flow chart the contractor had
    assembled to list the aliases he used and the dates he visited
    different pharmacies.

    The contractor said he had started using the pills a few years
    earlier, when he was given painkillers after hurting his back on the
    job.

    "It can dominate their lives," John Woo, a special agent with the
    California Department of Justice's Bureau of Narcotic Enforcement,
    said as he placed the pill bottles in evidence bags.

    A month later, the task force handcuffed a 54-year-old woman trying to
    use a forged prescription at a North Park pharmacy.

    She turned out to be an X-ray technician and former registered
    nurse.

    "You'd think if anybody would know the dangers, somebody with a
    medical background would," said task force special agent Holly Swartz.

    People arrested by the task force are usually sent to Drug Court, a
    yearlong program operated by the county that requires them to go
    through testing, counseling and rehabilitation. Those who don't
    complete the program can be sent to jail.

    Too Late

    Not everybody lives long enough to get caught.

    Donna Barron ended up in the San Diego County morgue a day before task
    force agents knocked at her City Heights door.

    Agents had started tracking the 45-year-old Barron several weeks
    earlier, after pharmacists from the Department of Veterans Affairs
    gave them a tip that she had been passing forged prescriptions for
    antidepressants.

    The agents went from pharmacy to pharmacy confirming Barron's identity
    and piecing together the extent of her drug use. But when they went to
    her home to confront her in November, her husband told them she had
    died the day before.

    Barron's husband, who couldn't be located for an interview, was with
    her when she collapsed. According to the medical examiner's report, he
    cautiously speculated that his wife might have taken too many pills.

    An autopsy showed that Barron had so much of the mood elevator
    Venlafaxine in her system that it could have caused her heart to stop
    beating regularly.

    "It makes you think what might have happened if we'd have been there a
    day sooner," Simpson said. "Could she have been helped?"

    [sidebar]

    OVERVIEW

    Background: Since the early 1990s, doctors have increasingly relieved the
    chronic pain of some patients by prescribing drugs that, while highly
    effective, are potentially addictive.

    Side effects: Many people have benefited, but a growing number are becoming
    addicted to painkilling drugs their doctors prescribed - sometimes with
    fatal results.

    What's next: Authorities are now considering tighter restrictions on these
    drugs even though patients advocates say they are desparately needed by
    those living with pain.

    THE SERIES

    Today: Patients become addicts

    Monday: Why some doctors over-prescribe

    Tuesday: The controversy over tighter controls

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