Deadly medicineState autopsy data shows the most prolific killers are the painkillers hydrocodone and oxycodone, often in combination with the anti-anxiety drug alprazolam. In 2010, hydrocodone was a factor in 153 overdose deaths in Oklahoma, followed by oxycodone at 144 deaths, according to the Bureau of Narcotics and Dangerous Drugs Control. Both are opioid painkillers, chemical cousins of heroin and morphine. Pain meds containing hydrocodone are marketed under the brand names Lortab and Vicodin. Oxycodone is the main ingredient in Percocet and OxyContin. Alprazolam, marketed as Xanax, contributed to 139 overdose deaths. Other prescription painkillers accounted for significant numbers of deaths. Methadone, used to help wean addicts off other narcotics, as well as to treat chronic pain, contributed to 99 overdoses. Morphine contributed to 85 and fentanyl to 53. Nonprescription street drugs were noted in the deaths of 147 Oklahomans. Meth was present in 99 overdose victims and cocaine in 48. The number of fatal drug overdoses in Oklahoma more than doubled in the past 10 years, climbing to 739 in 2010, according to the state medical examiner’s office. The number of drug overdose deaths was higher than the number of motor vehicle fatalities, which totaled 683.
Lethal cocktailsNationwide, sales of opioid pain relievers quadrupled between 1999 and 2010, according to the Centers for Disease Control and Prevention. More than half of all fatal overdoses involved a “cocktail” of several prescription drugs. Vorse said the combination of opioid painkillers with benzodiazepine tranquilizers such as Xanax and Valium is particularly deadly. Add alcohol to the mix, and it’s even more lethal. “People need to know that if you mix benzos and opiates, you’re going to die,” Vorse said. “If that was general knowledge, we might save 100, 200 lives a year from that information alone.” Darrell Weaver, director of the Bureau of Narcotics and Dangerous Drugs Control, said statistics suggest much of the medication shipped into the state is being diverted to abusers. “I’m of the opinion that no Oklahoman should be in pain,” Weaver said. “But common sense dictates that some of this is not about pain, it’s about addiction.” Nearly 240,000 Oklahomans — 8 percent of the population above age 11 — took prescription painkillers for nonmedical reasons over a 12-month period ending in 2009, according to a federal survey. Oklahoma’s rate of prescription painkiller abuse was the highest in the nation. The state also ranks in the top 10 states for the number of overdose deaths per 10,000 people in the state and the per capita volume of prescription painkillers sold. The survey determined that 55 percent of Americans who abused prescription painkillers got them from a friend or relative at no cost. It said 17 percent had been prescribed painkillers by a single doctor. Only 4 percent got them from a drug dealer or other stranger.
Doctor shoppingWeaver’s agency tracks the legal narcotics trade in Oklahoma with an online Prescription Monitoring Program. Under a provision that took effect Jan. 1, pharmacists must enter data for every controlled drug prescription within five minutes of filling it. Doctors, dentists and other health practitioners are not required to check the database before prescribing controlled medications, but they are encouraged to do so. About 70 percent of the state’s 17,000 prescribers and pharmacies currently participate, the bureau said. The system is designed to flag patients who engage in “doctor shopping” by seeking multiple prescriptions from more than one physician. The most brazen doctor shopper snagged so far is Keith Knox Simmons. In 2009, prosecutors accused the 28-year-old Blanchard man of obtaining 4,533 doses of prescription painkillers, mainly hydrocodone, from 195 different health care professionals and 105 pharmacies. He entered blind guilty pleas to eight counts of obtaining a controlled dangerous substance by fraud on July 1, 2010, in McClain County District Court.
Improvements?Some state lawmakers say the Prescription Monitoring Program is not as effective as it could be. On Feb. 21, the House Public Health Committee endorsed a bill that would require Oklahoma physicians to check the database before prescribing controlled substances to new patients. The legislation, House Bill 2468, also would place Lortab, Vicodin and other medications containing hydrocodone in a category of prescription narcotics subject to stricter controls. If the bill becomes law, physicians would no longer be able to phone in hydrocodone prescriptions. Patients would be required to get a paper prescription from the doctor. “Hydrocodone is the key. If you limit hydrocodone, the overdose deaths will go down, I guarantee it,” said the bill’s author, Rep. Richard Morrissette, D-Oklahoma City. “I’ve seen it in my law practice,” Morrissette said. “Most of my clients that got addicted to hydrocodone had back problems. Once they’re addicted to the relief … it’s just overwhelming. They’ll do anything to get it.” Not all lawmakers are convinced it’s a good idea. Rep. Mike Ritze, R-Broken Arrow, a family practice doctor, voted against the bill. He said the benefits of stricter oversight need to be weighed against the legitimate needs of pain sufferers and the heavy workloads of physicians. “The doctors know their practices. The doctors know who they’re treating,” he said. “I don’t think we need another regulation to tell us how to treat our patients.”
Sad conclusionCarwithin, the Oklahoma City overdose victim, tested positive for several drugs, including alprazolam. She had a degenerative disk condition in her lower spine, authorities said, and she had been prescribed hydrocodone to help with the pain. Her stepbrother, Hoye, said that before their elderly mother died in 2008, Carwithin frequently paid for her prescriptions with her mother’s charge card. “I don’t know how she was getting her scripts,” Hoye said. “I don’t know if she was conning doctors into giving her scripts or getting refills or what.” Carwithin was pronounced dead of an accidental overdose on Jan. 20, 2010. She was cremated. Patches was sent to the animal shelter.
Fatal Rx overdoses
A sampling of fatal prescription drug overdoses investigated by the state medical examiner's office illustrates the danger of combining opioid painkillers with other narcotics or alcohol. The case studies, culled from data compiled over a four-week period in 2010, include:
• A 53-year-old Broken Bow woman with a history of back pain and prescription drug abuse. A family member told the medical examiner she sometimes purchased drugs on the street when her Xanax prescription ran out. She tested positive for the painkiller hydrocodone, the muscle relaxer carisoprodol and the tranquilizer meprobamate.