World of pain, but who gains?
Sales of painkillers are soaring, leaving a trail of battered users, a national analysis finds
By Frank Bass, Associated Press AP writers Dave Collins in Hartford, Conn., and Samira Jafari in Pikeville, Ky., contributed
August 21, 2007
Retail sales of five leading painkillers nearly doubled from 1997 to 2005, reflecting a surge in use by patients nationwide, according to an Associated Press analysis of federal drug prescription data.
The amount of five major painkillers sold at retail establishments rose 90 percent during that time, according to Drug Enforcement Administration figures.
More than 200,000 pounds of codeine, morphine, oxycodone, hydrocodone and meperidine were purchased at retail stores during 2005, the most recent year represented in the data. That is enough to give more than 300 milligrams of painkillers to every person in America.
Oxycodone, the chemical used in OxyContin, is responsible for most of the increase. Oxycodone sales jumped nearly sixfold between 1997 and 2005.
The drug gained notoriety as "hillbilly heroin," often bought and sold illegally in Appalachia. But its highest rates of sale now occur in places such as suburban St. Louis and Ft. Lauderdale.
"What we're seeing now is the rest of the nation catching up to where we were," said Robert Walker, a researcher at the University of Kentucky Center on Drug and Alcohol Research.
In Appalachia, retail sales of hydrocodone -- sold mostly as Vicodin -- are the highest in the nation. Nine of the 10 areas with the highest per-capita sales are in mostly rural parts of West Virginia, Kentucky or Tennessee.
Less regulated than similar prescription painkillers, drugs containing hydrocodone have become the most widely prescribed opiate painkillers on the market.
Steve Dotson, a southern West Virginia resident, is among millions of Americans who has experienced the harm of addiction to hydrocodone.
Dotson, 43, at one point lost his house, the state took his children away and he was spending nights under a bridge, where he hoped to die. "You get to where you don't even want them [pills] anymore; you just do them so you can get through the day," he said.
Dotson said he has been off drugs since a religious experience in 2001. Not all of his friends were so lucky, he said.
"You've got three choices," he said. "You either die, go to prison or get saved. Mostly, people around here are dying."
DEA figures analyzed by the AP include nationwide sales and distribution of drugs by hospitals, retail pharmacies, doctors and teaching institutions. Federal investigators study the same data trying to identify illegal prescription patterns.
It is impossible to reliably measure painkiller abuse.
A 2004 government study estimated between 2 million and 3 million doses of codeine, hydrocodone and oxycodone are stolen annually. The AP's analysis included only retail sales.
More people are abusing prescription painkillers, experts say, because the medications are more available.
Spooked by high-profile arrests and prosecutions, many pain-management specialists now say they won't write prescriptions even for the sickest people.
As a result, people who desperately need strong painkillers sometimes are forced to go long distances to find doctors willing to prescribe them.
Siobhan Reynolds, widow of a New Mexico patient who needed large amounts of painkillers for a connective tissue disorder, said she routinely drove her late husband to a doctor in Oklahoma.
In Myrtle Beach, S.C., during the eight-year period reflected in government figures, oxycodone distribution increased 800 percent, partly due to a campaign by Purdue Pharma of Stamford, Conn. The privately held company has pleaded guilty to lying to patients, doctors and regulators about the drug's addictive nature.
The U.S. attorney for South Carolina secured a 58-count indictment in June 2002 against seven physicians and an employee of the Comprehensive Care and Pain Management Center.
A Myrtle Beach internist who works in addiction medicine, Brian Adler, said physicians were flooded with patients seeking pain medicine after the clinic was shut down.
"There's a significant problem with narcotics in this area," Adler said. After the pain management clinic closed, "all those folks were like rats, scurrying from a burning building, trying to get their fix."
- - -
Fueling the increase
Reasons for booming sales of pain medication:
*Aging population -- In 2000, there were 35 million people older than 65. By 2020, that number will reach 54 million.
*Unprecedented marketing -- Spending on drug marketing zoomed to nearly $30 billion in 2005 from $11 billion in 1997.
*Change in pain management philosophy -- Doctors who once advised patients that pain is part of the healing process now mostly see pain management as an important factor in overcoming illness.
I like the simplified "You've got three choices. You either die, go to prison or get saved." Not saying religious conversion doesn't help a lot of people... but the only alternative to jail or death, come on.