Narcopolis

Addiction to pharmaceuticals has become a nationwide epidemic, and nowhere has the human cost been higher than in Oklahoma.

The phrase “drug run” conjures a host of images: furtive exchanges in dark alleys, nervous negotiations in seedy apartments. But the most dangerous drugs in the state no longer require a trip to shady locations in a “bad” part of town. They now reside in your own medicine cabinet.    

Household Names

According to a 2011 document from the White House, opioid overdoses – once almost exclusively the territory of drugs like heroin – are now most often caused by prescription medication abuse. In Oklahoma specifically, medications like hydrocodone and oxycodone have taken the title from old champions like methadone and methamphetamines as the leading causes of fatal overdoses. The state is now number one in the nation in prescription medication abuse, a dubious honor that continues to exact a chilling price from Oklahoma’s law enforcement agencies, medical professionals, social services and most of all, its citizens.

Mark Woodward, public information and education officer for the Oklahoma Bureau of Narcotics, says that during the past nine years, drug overdose deaths in Oklahoma have increased 108 percent. 2011 was a dark year, as the state reached an all-time record of 715 drug-related deaths. In 81 percent of those cases, pharmaceuticals – often a mix of them – were the culprits. Even more tragic, the majority of these deaths occurred in children under the age of 17.

“As you can see from the numbers, a tremendous number of people die from prescription medication abuse,” says Scott Schaeffer, managing director of the Oklahoma Poison Control Center in the University of Oklahoma College of Pharmacy. “In my opinion, these people had no intent to harm themselves; they simply made a mistake with drugs that are powerful and have many interactions that increase their toxicity. Examples of these interactions include alcohol and other drugs (prescription or illicit), which amplify the toxic effects.”

Turning To Crime

But as prescription abuse becomes more common in Oklahoma, it’s not just the body count that’s climbing. Pharmaceutical drug-related crime has exploded in the past several years, placing increasing strain on the state’s law enforcement agencies. Woodward says that while addicts can resort to anything from swiping meds out of a loved one’s bathroom to robbery of a pharmacy, one of the most common types of criminal offenses is prescription fraud, in which patients will invent medical conditions, steal prescription pads to forge scripts or alter the legitimate dosage they are given.

“Our case load over the past 10 years has continued to skyrocket regarding investigation of individuals committing prescription fraud,” Woodward says. “We have had to hire additional investigators and legal staff to handle the increase.”

A frequent brand of prescription fraud involves “doctor shopping,” in which pill addicts visit multiple doctors to obtain larger amounts of medications.

In 2011, approximately 12 percent of the adults receiving services reported prescription drugs as a drug of choice, compared to five percent in 2006.

“Most are going to multiple doctors, medical clinics and hospital emergency rooms claiming to have severe pain,” Woodward says. “We have identified some scammers going to as many as 10 to 20 different doctors over a 30-day period to get prescriptions for pain medication.” He gives the example of an offender from McClain County who three years ago was arrested for visiting more than 195 doctors and 105 pharmacies over a nine-month period.

Woodward emphasizes that while the types of crime associated with prescription drug abuse vary from case to case, so do the perpetrators. “The offenders range from teenagers simply looking to make some quick cash by stealing and selling prescription drugs, to athletes, housewives and corporate professionals who develop a prescription drug addiction following some type of medical surgery or injury,” he says. “Addicts come from all walks of life.”

A Real Pain

But while pharmaceutical addiction can strike anyone, there is a definite trend in the types of medications being abused. “By far, the most common prescription medications we see being abused are pain medications, specifically a class of drugs known as opioids,” Schaeffer says. “Some examples include oxycodone, hydrocodone and fentanyl.  

“Our experience mirrors the rise seen on a national basis,” he adds, referencing the increase in prescription abuse cases handled by the Oklahoma Poison Control Center. And like Woodward, he believes one of the most common sources of these pills is the family medicine cabinet.

“From everything I’ve seen, the most common method of obtaining the drugs is from the medicine cabinet of a relative or friend,” he says. “People who are prescribed these powerful pain medications should be aware that they can provide a tempting target for friends or family members. Be aware of the number of tablets or capsules you have, and take steps to secure them.”

A Health Care Crisis

Law enforcement and poison control are not the only state agencies that have been affected by the recent swell in prescription drug abuse. Jeffery Dismukes, director of public information at the Oklahoma Department of Mental Health and Substance Abuse Services, says his organization has seen a “steady increase over the past several years. In 2011, approximately 12 percent of the adults receiving services reported prescription drugs as a drug of choice, compared to five percent in 2006.”  

Some of the people under the most pressure in the face of this epidemic are medical professionals, who must toe a line between providing genuinely needed medication and detecting a scam when they hear one. And making the right call when faced with a clever addict isn’t as simple as it might sound.

“Abusers often have complaints that are difficult or impossible to verify objectively or have a medical basis but are exaggerated,” says family physician Dr. Laurel Williston of Family Medical Care. “Like with other addictions, those who are addicted often find elaborate and multiple ways to get what they want … Since there is no tangible way to measure pain or anxiety, it is very difficult to discern who really needs medication and who doesn’t.”

Each month, approximately 20,000 to 30,000 medical personnel use the database to ensure patients requesting pain medication don’t have a history of abuse.

While the difficulties facing medical professionals and law enforcement continue to increase, one crucial component in the equation commonly is forgotten: the addict. Pill abusers – many of whom sink into addiction after receiving a legitimate prescription for injury or illness – often suffer from myriad health and psychiatric problems.

“Substance abuse in general leads to a host of other health problems, including heart disease, pulmonary disease and diabetes,” says Dismukes. “It also is often associated with various mental health issues. However, beyond health issues, it is also associated with increases in crime and incarceration, child neglect and demands placed on human services, teen pregnancy, school dropout and other negative outcomes that impact our state now, and will impact us in the future.”

And as Oklahoma’s pill problem grows, so do the health side effects, leaving mental health providers, medical professionals and social services in Oklahoma desperately treading water to keep up with the demand.  

“There is a growing need for more treatment options to be made available throughout the state,” Dismukes says. “The services that we currently offer are simply stretched beyond maximum capacity. There are hundreds of Oklahomans placed on a waiting list for services every day. These are people who have made the choice to seek help, but we don’t have the space within the system to provide them the services they need. This is a real tragedy, because many of these individuals simply become more ill as they wait, and ultimately grow increasingly at risk for negative results such as family fragmentation, involvement in the criminal justice system or death.”

Williston, too, has seen the powerful effects of pharmaceutical addiction on the health of Oklahomans. “Medication abuse has a very negative impact on the state’s citizens,” she says. “Some of the negative impact can be seen through loss of jobs leading to dependence on public assistance, inability to fulfill personal responsibilities, death and disability, the time and energy that is spent to prevent the abuse that is not available for other health priorities, overuse of emergency care to obtain the medications, breakdown of trust in physician-patient relationships, and many other direct and indirect effects.”

Ashley’s Story

“Ashley,” a former pill addict, knows firsthand the high personal cost of pharmaceutical abuse. Once a well-educated, happily married registered nurse, she suffered a neck injury in 2007 and was prescribed hydrocodone for her pain. It was then that her nightmare cycle of addiction began.

“It took a very long time to heal, so they continued to prescribe hydrocodone for my pain,” she says. “So after about six months, it took more of the medication to help my pain than it did in the beginning. So after another month or so, I began to forge my own scripts to get my hydrocodone.”

As a nurse, Ashley had access to pre-signed prescription pads and doctors’ Drug Enforcement Agency numbers, but she did not stop there. She also was obtaining medicine from her own physician and began doctor shopping to obtain more and more prescriptions. In the spring of 2008, she was arrested for prescription fraud and began to attend outpatient therapy to get clean. Shortly thereafter, she had her first grand mal seizure.

“I broke my jaw and hit my head pretty hard,” she says. “This caused me to have pain medications again. And though I had been clean for two months, it started right back up. First they all were legal scripts; then my tolerance built up again.”

She struggled to maintain her addiction in secret, but eventually worked up to a 60-pill-per-day habit and began to pawn her family’s possessions to support her dependence. After another try in rehab, her marriage began to fall apart – and with it, her resolve to stay clean.

“So of course my reaction was to self-medicate,” she says. “Some use alcohol or methamphetamines or food. I chose hydrocodone for my emotional pain and emptiness … I could not even get through the holidays happily with my children without getting this fix. So two days after Christmas, I attempted to forge another prescription.”

er latest attempt at prescription fraud landed her in jail. After 43 days incarcerated, she says she was given another chance to reclaim her life. But more seizures and ensuing injuries – this time, a broken collarbone – kept sending her spiraling back into addiction. When charges were filed without her knowledge by the district attorney, the breaking point came: bounty hunters showed up on her doorstep and arrested her in front of her children.

“I was humiliated, scared and angry,” she says. But she also admits she was lucky (after several months in the county jail) to receive a seven-year suspended sentence. Now, while she has been clean and sober for 11 months and has managed to rebuild her marriage, her struggles are far from over.  

“It is extremely hard to get a job because almost everyone does a background check now and they don’t even give people a chance to explain their faults,” she says. In addition, she must inform all medical professionals of her addiction and submit biweekly drug tests.

“The thing that has hurt me the most is the lying to everyone about my addiction,” she says. “Since I have lied so much, no one wants to trust me when I say I am clean and not taking any pills.”

When asked what non-addicts don’t know about the affliction, she says, “I want people that do not have addictions to understand that it is not just a mental addiction. I hated being told that it was easy to quit because it is all in your head. Well, it’s not just in your head. Your mental status can be a side effect of the addiction. To get sober, you need a lot of support from family, friends and counselors. It is a very painful ordeal. The withdrawals are serious and should not be overlooked.” For others struggling with pharmaceutical abuse, Ashley advises attending programs like Celebrate Recovery, which has helped her through her last 11 months of sobriety.

While looking forward to her future, she cannot forget her past. “Over the past four years, I have missed a tremendous amount of time with my children,” she says. “I have hurt them by putting my addiction first and everything else after. I now have my family back and running like it was prior to my addiction. I will always be an addict, but I am in remission right now.”

Take Notice

As Oklahoma addicts continue their own struggles, health care and law enforcement workers in the state have been waging an uphill battle against pharmaceutical abuse. Oklahoma was the first state to monitor prescription drugs electronically, and implemented its Prescription Monitoring Program in 1990. Each month, approximately 20,000 to 30,000 medical personnel use the database to ensure patients requesting pain medication don’t have a history of abuse.

“When a prescription controlled drug is filled at an Oklahoma pharmacy, the prescription is immediately put into the system in real time,” Woodward says. “This allows doctors and pharmacists to enter a patient’s name into the system to see if this person is going to multiple doctors or emergency rooms to get medication and failing to disclose that information to the doctor. It is a great intervention tool. Many doctors are able to identify someone attempting to fraudulently obtain prescription drugs. The doctors can call police, simply deny giving any medication or can visit with the patient about their addiction and offer them treatment resources.”

“Some doctors have told us ‘it has changed the way we practice medicine,’” he says.

But while Woodward says legislation has been proposed to require doctors to utilize the Prescription Monitoring Program, the service is not mandatory and doctors are under no obligation to use it.

“In my opinion, the Prescription Monitoring Program has great potential to combat the problem,” Schaeffer says. “The primary problem, as I see it, is having prescribers be vigilant in reviewing their patient’s history of obtaining prescription medication.”

Woodward says that beyond the PMP and initiatives like establishing public drop boxes in which people may dispose of unneeded medication, education and outreach are essential to stopping this epidemic in its tracks. “Education is a big key,” he says. “The OBNDDC is working to educate parents and teens on the dangers of prescription drugs, how to spot someone with an addiction and how to prevent prescription drug addiction.”

“Everyone involved in health care must work together to identify and treat this problem,” Williston says. “Public awareness is another important step. Friends and family often see things that physicians and other health care providers cannot and can help identify and confront those who may be addicted, and people need to know that addiction is a potential with certain prescription medications. We need to support such programs as Celebrate Recovery and Alcoholics Anonymous/Narcotics Anonymous to help address the underlying issues that lead to the abuse and support patients in their efforts to overcome the addiction.”