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In this
March 28, 2012, photo, Patricia Reynolds-Udell poses for a photo at her home in
Utica, N.Y. Reynolds has struggled to find treatment after becoming dependent
on hydrocodone pills originally prescribed for a broken tailbone. Sales of the
nation’s two most popular prescription painkillers have exploded in new parts
of the country, an Associated Press analysis shows, worrying experts who say
the push to relieve patients’ suffering is spawning an addiction epidemic. From
New York’s Staten Island to Santa Fe, N.M., Drug Enforcement Administration
figures show dramatic rises between 2000 and 2010 in the distribution of
oxycodone, the key ingredient in OxyContin, Percocet and Percodan. (AP
Photo/Mike Groll)
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NEW YORK
(AP) -- Sales of the nation's two most popular prescription painkillers have
exploded in new parts of the country, an Associated Press analysis shows,
worrying experts who say the push to relieve patients' suffering is spawning an
addiction epidemic.
From New
York's Staten Island to Santa Fe, N.M., Drug Enforcement Administration figures
show dramatic rises between 2000 and 2010 in the distribution of oxycodone, the
key ingredient in OxyContin, Percocet and Percodan. Some places saw sales
increase sixteenfold.
Meanwhile,
the distribution of hydrocodone, the key ingredient in Vicodin, Norco and
Lortab, is rising in Appalachia, the original epicenter of the painkiller
epidemic, as well as in the Midwest.
The
increases have coincided with a wave of overdose deaths, pharmacy robberies and
other problems in New Mexico, Nevada, Utah, Florida and other states. Opioid
pain relievers, the category that includes oxycodone and hydrocodone, caused
14,800 overdose deaths in 2008 alone, and the death toll is rising, the Centers
for Disease Control and Prevention says.
Nationwide,
pharmacies received and ultimately dispensed the equivalent of 69 tons of pure
oxycodone and 42 tons of pure hydrocodone in 2010, the last year for which
statistics are available. That's enough to give 40 5-mg Percocets and 24 5-mg
Vicodins to every person in the United States. The DEA data records shipments
from distributors to pharmacies, hospitals, practitioners and teaching
institutions. The drugs are eventually dispensed and sold to patients, but the
DEA does not keep track of how much individual patients receive.
The
increase is partly due to the aging U.S. population with pain issues and a
greater willingness by doctors to treat pain, said Gregory Bunt, medical
director at New York's Daytop Village chain of drug treatment clinics.
Sales are
also being driven by addiction, as users become physically dependent on
painkillers and begin "doctor shopping" to keep the prescriptions
coming, he said.
"Prescription
medications can provide enormous health and quality-of-life benefits to
patients," Gil Kerlikowske, the U.S. drug czar, told Congress in March.
"However, we all now recognize that these drugs can be just as dangerous
and deadly as illicit substances when misused or abused."
Opioids
like hydrocodone and oxycodone can release intense feelings of well-being. Some
abusers swallow the pills; others crush them, then smoke, snort or inject the
powder.
Unlike most
street drugs, the problem has its roots in two disparate parts of the country -
Appalachia and affluent suburbs, said Pete Jackson, president of Advocates for
the Reform of Prescription Opioids.
"Now
it's spreading from those two poles," Jackson said.
The AP
analysis used drug data collected quarterly by the DEA's Automation of Reports
and Consolidated Orders System. The DEA tracks shipments sent from distributors
to pharmacies, hospitals, practitioners and teaching institutions and then
compiles the data using three-digit ZIP codes. Every ZIP code starting with
100-, for example, is lumped together into one figure.
The AP
combined this data with census figures to determine effective sales per capita.
A few ZIP
codes that include military bases or Veterans Affairs hospitals have seen large
increases in painkiller use because of soldier patients injured in the Middle
East, law enforcement officials say. In addition, small areas around St. Louis,
Indianapolis, Las Vegas and Newark, N.J., have seen their totals affected
because mail-order pharmacies have shipping centers there, said Carmen
Catizone, executive director of the National Association of Boards of Pharmacy.
Many of the
sales trends stretch across bigger areas.
In 2000,
oxycodone sales were centered in coal-mining areas of West Virginia and eastern
Kentucky - places with high concentrations of people with back problems and
other chronic pain.
But by
2010, the strongest oxycodone sales had overtaken most of Tennessee and
Kentucky, stretching as far north as Columbus, Ohio and as far south as Macon,
Ga.
Per-capita
oxycodone sales increased five- or six-fold in most of Tennessee during the
decade.
"We've
got a problem. We've got to get a handle on it," said Tommy Farmer, a
counterdrug official with the Tennessee Bureau of Investigation.
Many buyers
began crossing into Tennessee to fill prescriptions after border states began
strengthening computer systems meant to monitor drug sales, Farmer said.
In 2006,
only 20 states had prescription drug monitoring programs aimed at tracking
patients. Now 40 do, but many aren't linked together, so abusers can simply go
to another state when they're flagged in one state's system. There is no
federal monitoring of prescription drugs at the patient level.
In Florida,
the AP analysis underscores the difficulty of the state's decade-long battle
against "pill mills," unscrupulous doctors who churn out dozens of
prescriptions a day.
In 2000,
Florida's oxycodone sales were centered around West Palm Beach. By 2010,
oxycodone was flowing to nearly every part of the state.
While still
not as high as in Appalachia or Florida, oxycodone sales also increased
dramatically in New York City and its suburbs. The borough of Staten Island saw
sales leap 1,200 percent.
New York's
Long Island has also seen huge increases. In Islip, N.Y., teenager Makenzie
Emerson says she started stealing oxycodone that her mother was prescribed in
2009 after a fall on ice. Soon Emerson was popping six pills at a time.
"When
I would go over to friends' houses I would raid their medicine cabinets because
I knew their parents were most likely taking something," said Emerson, now
19.
One day she
overdosed at the mall. Her mother, Phyllis Ferraro, tried to keep her daughter
breathing until the ambulance arrived.
"The
pills are everywhere," Ferraro said. "There aren't enough treatment
centers and yet there's a pharmacy on every corner."
The
American Southwest has emerged as another hot spot.
Parts of
New Mexico have seen tenfold increases in oxycodone sales per capita and
fivefold increases in hydrocodone. The state had the highest rate of opioid
painkiller overdoses in 2008, with 27 per 100,000 population.
Many parts
of eastern California received only modest amounts of oxycodone in 2010, but
the increase from 2000 was dramatic - more than 500 percent around Modesto and
Stockton.
Many
California addicts are switching from methamphetamine to prescription pills,
said John Harsany, medical director of Riverside County's substance abuse
program.
Hydrocodone
use has increased in some areas with large Indian reservations, including South
Dakota, northeastern Arizona and northern Minnesota and Wisconsin. Many of
these communities have battled substance abuse problems in the past.
Experts
worry painkiller sales are spreading quickly in areas where there are few
clinics to treat people who get hooked, Bunt said.
In Utica,
N.Y., Patricia Reynolds has struggled to find treatment after becoming
dependent on hydrocodone pills originally prescribed for a broken tailbone.
The nearest
clinics offering Suboxone, an anti-addiction drug, are an hour's drive away in
Cooperstown or Syracuse. And those programs are full and are not accepting new
patients, she said.
"You
can't have one clinic like that in the whole area," Reynolds said.
"It's a really sad epidemic. I want people to start talking about it
instead of pretending it's not a problem and hiding."
AP
Interactive Graphic: http://hosted.ap.org/interactives/2012/painkiller-nation/
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