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State of Addiction: Oklahoma ranked No. 1 state in prescription painkiller abuse

Prescription drugs factor into numerous overdose deaths in Oklahoma, experts say.
BY WARREN VIETH Published: March 11, 2012
Sherri Carwithin was lying on the hardwood floor of her south Oklahoma City home when police found her body, clad in pajama bottoms and a T-shirt. Perched on her chest was her small dog, Patches, who growled at the arriving officers.

The 51-year-old woman, who had a history of chronic back pain and prescription drug abuse, last was seen alive four days earlier, when she asked a neighbor to give her a ride to the pharmacy.

“She’d been doing prescription drugs for a long time,” said her stepbrother, Virgil Hoye. “She’d take a pill to wake up and take a pill to go to sleep. It was a constant thing. She was never in her right mind.”

Oklahoma’s drug scourge is shifting from the street corner to the medicine cabinet.

Drug overdoses now kill more Oklahomans than motor vehicle accidents — an average of two per day.

Four of five victims overdose on widely prescribed medications found in tens of thousands of Oklahoma households.

The grim statistics help explain why Oklahoma was ranked the No. 1 state in the nation in prescription painkiller abuse last year. They underscore a new reality for law enforcement authorities, health care professionals and public policymakers.

The casualties of drug abuse are not just hard-core addicts who buy bootlegged meth, crack and heroin from street dealers.

They’re middle-aged and middle-class Oklahomans who start taking pain pills for bad backs and other injuries, never dreaming they could wind up tumbling down the slippery slope of addiction, or worse yet, dying from an overdose.

They’re suburban kids passing around pills they find in their parents’ medicine cabinets.

They’re veterans returning from Iraq and Afghanistan who turn to narcotics to tame the demons of post-traumatic stress.

They’re people like Austin Box, the University of Oklahoma linebacker whose promising football career was cut short by a fatal prescription drug overdose in May 2011.

“Meth, it’s a problem, sure,” said Hal Vorse, an addiction treatment physician in Oklahoma City. “But the fact is, you’ve got five times as many people dying from prescription drugs as are dying from methamphetamine.”

Deadly medicine

State 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 cocktails

Nationwide, 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. Oklahoma comes in ninth place for prescription drug sales... Oklahomans abuse prescription painkillers more than any... Number of Oklahomans who die from drug overdoses higher...

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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.

• A 51-year-old Spiro man who died after drinking for several hours with his roommate. The roommate told investigators he left the residence to pick up a friend; when he returned, he found the victim sprawled on the floor. The roommate had been prescribed 100 oxycodone pills four days earlier; he said the bottle was empty when he returned home. The victim tested positive for oxycodone and the antihistamine sedative diphenhydramine.

• A 23-year-old Comanche woman whose boyfriend told authorities the two had been partying the night before. He said the woman had applied two patches containing the painkiller fentanyl, ingested “a few” Lortab and drunk some vodka. Investigators found a bottle containing several Xanax and a small bag of marijuana at her residence. She tested positive for fentanyl, alprazolam and the painkiller propoxyphene.

• A 32-year-old Wagoner man with a history of substance abuse. An examining doctor told the medical examiner it appeared the man had been taking morphine pills on the night he died. A family member said the man's death was not a surprise because of his drug history. The victim tested positive for morphine and alprazolam.

• A 40-year-old Oklahoma City woman who died after arguing with her boyfriend about her drug use, the boyfriend told authorities. The man said he spent the night on the couch and found the woman's body in her bed the next morning. Family members told investigators the woman had been in rehab twice and had a history of drug abuse. She tested positive for oxycodone, alprazolam and the anti-anxiety drug lorazepam.

• A 55-year-old Norman woman who had received a Lortab prescription for a painful case of shingles. Her husband told the examiner he found his wife in bed, her face buried in the mattress. Two pill bottles were on a desk by her computer, a nearly empty glass of wine on the floor. She tested positive for hydrocodone, the sleep aid zolpidem and the antidepressant citalopram.

• A 41-year-old Anadarko woman with a history of back pain. Her son told investigators he found his mother on the living room sofa, her body slumped to one side. She had filled a prescription for morphine three days earlier; only three pills were left the day she died. Her blood tested positive for morphine, citalopram, propoxyphene, the tranquilizer diazepam and the muscle relaxer cyclobenzaprine.

• A 57-year-old Holdenville man described by his doctor as a chronic alcoholic. His sister found his body on the couch covered with blankets. The medical examiner said several liquor bottles were nearby. Several weeks earlier, he had been given a painkiller prescription after cracking two ribs in a fall. He tested positive for hydrocodone.

Warren Vieth, Oklahoma Watch


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