Feature

Thursday, Dec. 20, 07

Prescription for Death

Prescription drugs claim more lives than cocaine and heroin combined

By Angie Hargot

Photo illustration by James Wilkins

Florida corpses are telling a disturbing tale — and they’re using terms like blow, smack or meth less often than harder-to-pronounce, and more deadly, prescription drugs.

Prescription drug use isn’t just increasing in Florida — it’s killing nearly three times more people than cocaine, heroin and methamphetamines combined, in part because of a growing supply of street pharmaceuticals.

In the first six months of this year, cocaine, heroin and methylated amphetamines caused the deaths of 470 people statewide, while the five most commonly prescribed painkillers and tranquilizers caused 1,324 deaths, according to a Florida Department of Law Enforcement report detailing drug use identified by state medical examiners during autopsies.

Cocaine, the state’s deadliest substance, killed 398 people statewide, while heroin killed 38 and methylated amphetamines killed 34, according to the report.

However, during the same time period, methadone, a drug often prescribed to heroin addicts, killed 392 people; benzodiazepines, which include widely prescribed tranquilizers such as Valium and Xanax, 353; oxycodone, commonly sold as OxyContin, 323; hydrocodone, a painkiller often prescribed as Vicodin and Lortab, 134; and morphine, 122.

“We’ve become a medicated society,” said Howard Lerner, clinical director of South Miami Hospital’s substance abuse treatment program. “Ten years ago, we never saw drugs marketed on TV. Now they’re selling them like McDonald’s hamburgers. The availability is a progression of the numbers. Many more people are attracted to it.”

‘Lethal Levels’

Of the 87,500 people who died in Florida between January and June, medical examiners detected drugs in the systems of 3,980 corpses at the time of autopsy — nearly 5 percent more than in the second half of 2006, according to the Dec. 4 report.

Yet prescription drugs, which “dominate at lethal levels when compared to illicit drugs,” accounted for 69 percent of all the drugs found at autopsy — 2 percent more than in the previous six-month period, according to the report.

“In general, there is certainly an increase across the board” in prescription drug use and abuse, Lerner said. “Because of an increase in marketing, there’s a lot more usage. “Younger people are selling them on the streets.”

That doesn’t mean illicit street drugs more commonly associated with overdoses aren’t still killing plenty of Floridians, either directly or indirectly.

Take cocaine, for example. Medical examiners detected various amounts of cocaine in 1,008 corpses statewide, of which it killed 398. Yet, 13 percent of the 610 who died with nonlethal levels of cocaine in their systems were homicide victims.

In Miami-Dade County, the narcotic was found during 84 autopsies and caused 16 deaths.

“The leading causes of death in this country are all drug-related — alcohol, murder …,” said Jay M. Holder, a board-certified addictionologist who runs the Exodus Treatment Center in Miami. 

In fact, 57 percent of the 59,000 people arrested by the Miami-Dade County Narcotics Bureau in the last year had records of violent crimes and robberies. Even more had theft and burglary records, said Major Charles Nanney, whose bureau polices everything from marijuana grow houses to a burgeoning MySpace market for MDMA, more commonly known as ecstasy.

“There is a crime-drug nexus,” Nanney said. “The main use is still cocaine and heroin. Twenty-five years ago a kilo of coke was $50,000. Now the price is lower.”

Rx Factor

Still, the growing number of prescription-related deaths has garnered much concern among government and law enforcement officials, as well as substance abuse counselors. The problem, according to Nanney, “comes down to availability.”

There’s no doubt the findings are troubling.

“We have seen an increase in prescription drug deaths in recent years,” FDLE spokesperson Kristin Perelluha said.

Although heroin, which killed 84 percent of the 45 people with the drug in their systems, topped the list of the state’s most lethal drugs — those that caused death in more than 50 percent of people in which it was found — methadone, oxycodone and fentanyl followed closely behind.

Methadone, which is often prescribed to treat the pain associated with heroin withdrawal, caused the deaths of 354 more people than heroin statewide. It killed 392 — nearly 74 percent — of the 533 people in whom the substance was found. Methadone was found in eight Miami-Dade decedents, of which it killed three.

The report also noted a 5 percent increase in the use of benzodiazepines, the most widely prescribed and detected prescription drug. Benzodiazepines killed 353 — 30 percent — of the 1,167 people in whom it was found, including 260 from alprazolam alone, which is often sold under the trade names Xanax and Niravam.

“What we’re seeing is the same individuals with cocaine and heroin addiction, now also with a whole litany of prescription drugs,” Holder said, adding that time-released medications are particularly dangerous when mixed with alcohol. “OxyContin is very powerful. An addict will chew that, and it’s 100 percent absorbed immediately, bypassing the time-release.”

Use of oxycodone, the painkiller often marketed under the brand name OxyContin, increased 9 percent from last year, killing 323 — about 57 percent — of the 568 people in whom the substance was found, including six of nine in Miami-Dade. The pills sell for $20 to $30 each on the street, said Nanney, who, in his 20 years of service, has arrested several doctors for selling OxyContin prescriptions.

“There has been a crackdown on oxycodone and OxyContin,” Lerner said, adding that prescriptions often fall into the hands of some abusers who go “doctor shopping,” frequenting different doctors and getting prescriptions for pain medications from each of them. That tactic can also lead to overdoses even for those prescribed the medication for genuine ailments. Taking them with alcohol can cause respiratory failure, for example.

The street pharmaceutical market also carries a unique problem: dosing. “It’s not logical,” Nanney said. “Someone might know ‘I can take this much cocaine,’ for example, but the same size pill could be 20 mg or 40 mg. It’s easy to overdose.”

Hydrocodone, a painkiller prescribed under the brand names Vicodin and Lortab, caused the deaths of 134 users statewide, though it was found in 380 bodies. It killed one of two deceased Miami-Dade users.

Morphine, another painkiller, killed 122, or nearly half of the 280 deceased users statewide, and half of the 10 users in Miami-Dade.

Fentanyl, a pain reliever sold under the name Actiq, which is 80 times more potent than morphine and often administered via a mouth swab or lollipop to facilitate speed of absorption, killed more than half of the 103 people who had it in their systems.

Many hospitals have recently pushed to better control the prescription of opiates, Lerner said, the use of which continues to increase. Medical examiners detected a 27 percent increase in one opiate-based painkiller, hydromorphone, which is two to eight times stronger than morphine and marketed under the trade name Dilaudid.

Some of these drugs, Lerner said, are sold by unethical doctors who “open clinics to distribute meds to anyone who has the money to pay for them.”

Both Holder and Lerner, who mostly counsel patients for cocaine and alcohol problems, said that they also see patients with addictions who are taking prescription drugs according to their doctor’s instructions, who prescribed them without asking enough questions about the indicators of a possible addiction.

Behind the Eight Ball

Still, Florida is one of few states that does not track prescriptions. So far, 35 states have passed legislation to create prescription monitoring systems, with at least 24 of them already in use. The Florida Legislature has routinely rejected similar efforts for the last six years, citing privacy issues.

However, some state lawmakers now want to implement a pilot program that would create a $1.6 million computerized monitoring system to track painkiller prescriptions in Broward County. The proposed system, which would be funded with private money and federal grants, would keep patient medication records that could be accessed by doctors, pharmacists, patients, law-enforcement agencies and the Agency for Health Care Administration.

“If you open the New Times and look at the local ads, a significant percentage are pain management clinics that even specifically say ‘OxyContin’ in their ads,” Holder said. “Basically they are saying, ‘Come get your prescription.’ What’s killing people may not be the drugs, but the doctors that give patients the drugs.”

Comments? E-mail angie@miamisunpost.com.