In a period of nine months, a tiny Kentucky county of fewer than 12,000 people sees a 53-year-old mother, her 35-year-old son, and seven others die by overdosing on pain medications obtained from pain clinics in Florida.1 In Utah, a 13-year-old fatally overdoses on oxycodone pills taken from a friend’s grandmother.2 A 20-year-old Boston man dies from an overdose of methadone, only a year after his friend also died from a prescription drug overdose.3
These are not isolated events. Drug overdose death rates in the United States have more than tripled since 1990 and have never been higher. In 2008, more than 36,000 people died from drug overdoses, and most of these deaths were caused by prescription drugs.4
100 people die from drug overdoses every day in the United States.4
What Do We Know?
The role of prescription painkillers
Although many types of prescription drugs are abused, there is currently a growing, deadly epidemic of prescription painkiller abuse. Nearly three out of four prescription drug overdoses are caused by prescription painkillers—also called opioid pain relievers. The unprecedented rise in overdose deaths in the US parallels a 300% increase since 1999 in the sale of these strong painkillers.4 These drugs were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined.4
The misuse and abuse of prescription painkillers was responsible for more than 475,000 emergency department visits in 2009, a number that nearly doubled in just five years.6
More than 12 million people reported using prescription painkillers nonmedically in 2010, that is, using them without a prescription or for the feeling they cause.7
The role of alcohol and other drugs
About one-half of prescription painkiller deaths involve at least one other drug, including benzodiazepines, cocaine, and heroin. Alcohol is also involved in many overdose deaths.8
In 2008, there were 14,800 prescription painkiller deaths.4
How Prescription Painkiller Deaths Occur
Prescription painkillers work by binding to receptors in the brain to decrease the perception of pain. These powerful drugs can create a feeling of euphoria, cause physical dependence, and, in some people, lead to addiction. Prescription painkillers also cause sedation and slow down a person’s breathing.
A person who is abusing prescription painkillers might take larger doses to achieve a euphoric effect and reduce withdrawal symptoms. These larger doses can cause breathing to slow down so much that breathing stops, resulting in a fatal overdose.
In 2010, 2 million people reported using prescription painkillers nonmedically for the first time within the last year—nearly 5,500 a day.7
Where the drugs come from
Almost all prescription drugs involved in overdoses come from prescriptions originally; very few come from pharmacy theft. However, once they are prescribed and dispensed, prescription drugs are frequently diverted to people using them without prescriptions. More than three out of four people who misuse prescription painkillers use drugs prescribed to someone else.7
Most prescription painkillers are prescribed by primary care and internal medicine doctors and dentists, not specialists.10 Roughly 20% of prescribers prescribe 80% of all prescription painkillers.11,12,13
Who is most at risk
Understanding the groups at highest risk for overdose can help states target interventions. Research shows that some groups are particularly vulnerable to prescription drug overdose:
People who obtain multiple controlled substance prescriptions from multiple providers—a practice known as “doctor shopping.”14,15
People who take high daily dosages of prescription painkillers and those who misuse multiple abuse-prone prescription drugs.15,16,17,18,19
Low-income people and those living in rural areas.
People on Medicaid are prescribed painkillers at twice the rate of non-Medicaid patients and are at six times the risk of prescription painkillers overdose.20,21 One Washington State study found that 45% of people who died from prescription painkiller overdoses were Medicaid enrollees.20
People with mental illness and those with a history of substance abuse.19
Where overdose deaths are the highest
The drug overdose epidemic is most severe in the Southwest and Appalachian region, and rates vary substantially between states. The highest drug overdose death rates in 2008 were found in New Mexico and West Virginia, which had rates nearly five times that of the state with the lowest rate, Nebraska.4
There are many different points of intervention to prevent prescription drug overdoses. States play a central role in protecting the public health and regulating health care and the practice of the health professions. As such, states are especially critical to reversing the prescription drug overdose epidemic.
The following state policies show promise in reducing prescription drug abuse while ensuring patients have access to safe, effective pain treatment.
Prescription Drug Monitoring Programs
Thirty-six states have operational Prescription Drug Monitoring Programs.22
Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients. They are designed to monitor this information for suspected abuse or diversion—that is, the channeling of the drug into an illegal use—and can give a prescriber or pharmacist critical information regarding a patient’s controlled substance prescription history. This information can help prescribers and pharmacists identify high-risk patients who would benefit from early interventions.
CDC recommends that PDMPs focus their resources on
patients at highest risk in terms of prescription painkiller dosage, numbers of controlled substance prescriptions, and numbers of prescribers; and
prescribers who clearly deviate from accepted medical practice in terms of prescription painkiller dosage, numbers of prescriptions for controlled substances, and proportion of doctor shoppers among their patients.
CDC also recommends that PDMPs link to electronic health records systems so that PDMP information is better integrated into health care providers’ day-to-day practices.
Patient review and restriction programs
State benefits programs (like Medicaid) and workers’ compensation programs should consider monitoring prescription claims information and PDMP data (where applicable) for signs of inappropriate use of controlled prescription drugs. For patients whose use of multiple providers cannot be justified on medical grounds, such programs should consider reimbursing claims for controlled prescription drugs from a single designated physician and a single designated pharmacy. This can improve the coordination of care and use of medical services, as well as ensure appropriate access, for patients who are at high risk for overdose.
Health care provider accountability
States should ensure that providers follow evidence-based guidelines for the safe and effective use of prescription painkillers. Swift regulatory action taken against health care providers acting outside the limits of accepted medical practice can decrease provider behaviors that contribute to prescription painkiller abuse, diversion, and overdose.
Laws to prevent prescription drug abuse and diversion
States can enact and enforce laws to prevent doctor shopping, the operation of rogue pain clinics or “pill mills,” and other laws to reduce prescription painkiller diversion and abuse while safeguarding legitimate access to pain management services. These laws should also be rigorously evaluated for their effectiveness. View your state’s prescription drug laws.
Better access to substance abuse treatment
Effective, accessible substance abuse treatment programs could reduce overdose among people struggling with dependence and addiction. States should increase access to these important programs.
These recommendations are based on promising interventions and expert opinion. Additional research is needed to understand the impact of these interventions on reducing prescription drug overdose deaths.
The amount of prescription painkillers sold in states varies.4
The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices was 4 times larger in 2010 than in 1999. Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for one month.
Nearly 15,000 people die every year of overdoses involving prescription painkillers. In 2010, 1 in 20 people in the US (age 12 or older) reported using prescription painkillers for nonmedical reasons in the past year. Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month.
Prescription Medication and Drug Abuse in NJ – What You Should Know [AUDIO]
Jim spoke about this topic at great length yesterday (7/11). It started out as a discussion on the drug problem in NJ and morphed into a “what you need to know” segment regarding prescription medication.
The entire segment started yesterday with Jim discussing the plight of a caller named Linda, who has frequented the show. Linda has a son who has been in trouble in the past due a bad dug problem and actually got assistance for her son by calling in to Jim’s show and the Ask the Governor program.
The following is the audio of Jim beginning the discussion:
Right after Jim started discussing the topic, Linda called in to give an update on her son and the feedback she has received from other parents since reaching out for assistance for her son.
You can listen to Linda’s segment with Jim below.
Jim went on after the discussion with Linda to discuss the addiction so many have to prescription drugs. Below are some articles to educate yourself about prescription meds and places where you can drop off expired or unwanted medication locally in NJ.
This is Roxy. As you know she is our mascot. Roxy was sent to us from heaven.
Justin always wanted a bulldog named Rocco. He would talk about this dog and how much he loved it when in fact, he never had it. Well. I made a promise to Justin that I would get a bullie for him. So in September of 2011, Dan Justin’s oldest brother, worked in a pet store. He called me and said that they had a bullie that they were placing up for adoption because of some surgery that was needed and that we could have it. WOW!!! I almost fell on the floor. This didnt happen! A bulldog for free? Crazy enough, this cute little bullie was around in May of 2011. Dan actually sent Justin pictures of her showing her how adorable she was. For some reason, nobody bought her!!! This almost never happens with these dogs. But in this case it did. Why you ask? Well because she was waiting to come to us. So with a little help, from heaven and her angel, Justin, Roxy has joined our family. Its not a Rocco, but Roxy will do.
Every summer since I can remember, my husband’s family has gathered at the New Jersey shore, where he and his three siblings grew up. All together, we were a group of eighteen, ten adults and eight cousins. These yearly reunions were a wonderful time for the kids to reconnect after the long school year. There was nothing quite as beautiful as watching them ride the waves together. The picture to the right, taken in July 2010, shows the smiling faces of cousin Bobby (16, from Houston, TX) and cousin Justin (20, from Freehold, NJ).
The two boys couldn’t have been more different. Justin was outgoing and boisterous, and had the ability to captivate an entire room with his big personality, humor and generosity. When he was in high school, Justin was a state-ranked weight lifter, an all-county football player and captain of the football team. Bobby, on the other hand, was a quiet observer with tremendous wit and charm. He was a gifted academic with a scientific mind, likely of genius intelligence, earning a nearly perfect grade point average as well as a nearly perfect SAT and advanced SAT scores.
Yet, despite their differences, they had one thing in common: An addiction to prescription medications that ultimately resulted in their deaths. Justin was 21 years old when he died. Bobby was just 17.
Justin started using marijuana when he was 14. By the time he was a senior in high school, he also started to use prescription pain medications recreationally. Once in college, his recreational use turned to addiction, and after one semester, he failed out and returned home. His parents had absolutely no idea that he was using prescription pills and thought his return was because he was home sick. In 2009, while attending community college, Justin ‘totaled’ his car. Admitting marijuana abuse, Justin wanted help so in 2010, his parents found him intensive outpatient treatment. But then in 2011, expensive items in the house went missing, yet the theft was a mystery. Justin’s parents did not learn of his addiction to prescription medications and heroin until he was stopped for a traffic violation and police found a needle and a pill in his car. Justin willingly entered a 30-day rehab program and soon thereafter, moved to a sober living facility. On July 13th, 2011, just days after a family gathering, Justin was found dead in a hotel room; the cause of death was drug overdose.
Bobby’s path to addiction was the same as Justin’s. He too started using marijuana heavily when he was 14. At 15, his recreational drug use escalated significantly. His mother’s pain medication, prescribed as part of her breast cancer treatment, went missing. Initial thoughts of Bobby’s involvement in the theft were disregarded, as it seemed preposterous that this high-achieving student would take drugs. Despite the lock that was then used to safeguard the medication, it continued to disappear. Bobby’s mother lost her 9-year battle with cancer on March 1, 2011, just three months prior to Justin’s death. Bobby, now 17, vowed to use his gifted mind to help find a cure for the deadly disease that took his mother so early.
In late October 2011, my husband and I went to Houston to visit with the family. During our stay, Bobby and I planned to work together to finalize his college application; he had his heart set on Princeton. Just moments after we arrived, my brother-in-law informed us that Bobby had recently confessed to being a prescription drug addict and asked for help. He had recently stolen $8K from his dad’s account to buy medications on-line; but now that the money was gone, he was out of options. We were stunned and devastated to say the least.
We had no idea what to do. Justin’s father, Bobby’s uncle in New Jersey, begged us to take him to the hospital or call the police, as he wished he would have done for his son. Bobby refused to go to the hospital and foolishly, we worried that a police record could interfere with college acceptance. Instead, we took him for an evaluation at an out-patient rehab center. The evaluation took half the day. Because of HIPPA laws, the addiction specialist could not tell us what she learned from Bobby about his use, but did tell us that he was one of the heaviest users she had ever encountered and was already far down the road of addiction. He would need, at minimum, 30-day residential (in-patient) treatment.
Although Bobby told us he was an addict, we had absolutely no idea how serious the problem was until that moment. Yes, in retrospect, there were signs of drug abuse that we attributed to teen behavior, but it was impossible to reconcile this expert opinion with the person we thought we knew. Unlike Justin, whose world fell apart because of addiction, Bobby was functioning almost as usual.
By 8pm that evening, we completed all the paper work for his admission to the residential facility which was to take place at 8am the next day. Tragically, Bobby didn’t make it through those 12 hours.
On October 25th, at 6am, his sister and I found him dead in his bed. He took heaping doses of some of his father’s accessible medication and sent a text to a friend. He couldn’t imagine loving anything more than his drugs. Bobby died just a little over three months after Justin.
These young deaths have devastated and forever-altered every member in our family as well as members of Justin’s New Jersey community, Bobby’s Texas community and our own community here in Maryland. Prior to these events, I had absolutely no idea that prescription drug abuse was an epidemic in our country. Even though I have a master’s degree in Public Health from Johns Hopkins and worked in psychiatric drug development for over 10 years, I had no understanding of the dangers of prescription drugs, how addictive they are, and how, even with one dose, they can kill. I had no comprehension of how different and dangerous the ‘drug landscape’ is today as compared to when I was a teenager in the 80s.
In an effort to help save other families and communities from this horror, I am committed to raising awareness among both adults and children, because knowledge is the best form of prevention. I now know that prescription drug abuse is everyone’s problem because it doesn’t discriminate by race or socioeconomic status; everyone is at risk. I work voluntarily as a Parent Partner with The Partnership at Drugfree.org, a national non-profit organization whose mission is to help solve the problem of teen substance abuse. As a Parent Partner, I have access to scientific information, educational programs, and professional assistance. Please help me honor Justin and Bobby by allowing me to share these resources with you.