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Study warns against more restrictions on painkillers




CHARLESTON, W.Va.

The widespread abuse of prescription painkillers in West Virginia is no secret, but a new study has prompted a leading medical journal to warn against the temptation to add more restrictions to the way such drugs are prescribed.

A study to be published Wednesday in the Journal of the American Medical Association examined unintentional overdose deaths related to pharmaceutical drugs in West Virginia in 2006.

The study found that of 295 such deaths, 275, or 93 percent, involved opioid painkillers like methadone, hydrocodone and oxycodone. Methadone was involved in 112 deaths, more than any other drug.

Overall, the study put West Virginia’s unintentional prescription drug related fatal overdose rate at roughly 16 deaths per 100,000 residents, more than twice the national average.

Some of the most striking information in the study concerns the methods the drugs involved in the fatal overdoses were obtained.

Among the 275 people whose death was linked to “prescribed opioids,” 56 percent were never prescribed those medications. About 20 percent of all fatal overdoses showed signs of illegal “doctor shopping” — that is, the person who died had visited five different doctors in the previous year trying to get prescriptions.

The findings suggest that drug “diversion” — acquiring the medication illegally, by lying to doctors, buying it from black market Internet pharmacies or outright theft — accounts for a significant majority of prescription drug misuse.

For that reason — and because the drugs are so effective in treating chronic pain — the journal and state experts say further restricting opioid painkillers is unlikely to improve the situation.

“How many people should be getting these drugs appropriately? A hell of a lot,” said Michael O’Neil, a University of Charleston pharmacy professor and the chairman of the new state Controlled Substance Advisory Board.

The first line of treatment for ailments like back pain are antiinflammatory drugs like ibuprofen. But for many people — with kidney problems, severe asthma or stomach ulcers, for example — those drugs may be dangerous. So opioids have become a boon to pain management.

“Pain is a very subjective issue, and that is very difficult to manage,” O’Neil said.

As a result, prescriptions for opioid painkillers have soared nationwide, but that growth has not been evenly distributed.

Records maintained by the federal Drug Enforcement Agency show phenomenal growth in the legal distribution of opioid painkillers in the last decade, especially in the Appalachian region.

In 2006, four of the five states where hydrocodone had the highest per capita distribution were in Appalachia — Tennessee, Kentucky, West Virginia and Alabama. Tennessee is also in the top five for oxycodone distribution, and Alabama ranks in the top 10 for methadone prescriptions.

“Opioid addiction is an absolute epidemic,” said Dr. Carl Sullivan, medical director of addiction programs at West Virginia University.

One of the major problems, Sullivan said, is a lack of treatment resources — beds at in-patient facilities, training for doctors and access for patients in rural areas.

“The treatment is so pathetically inadequate it’s embarrassing,” he said. “If you have diabetes, you can get treatment. If you have high blood pressure, you can get treatment. If you have opioid addiction, you’re out there on your own.”

The report leaves some questions about the problem unanswered. The association of methadone with 40 percent of all fatal overdoses would suggest that it’s far more common than other painkillers, but the opposite is true.

DEA figures show methadone was distributed in West Virginia in 2006 at a rate of 2,374 grams per 100,000 people — actually less than the national average. Oxycodone, meanwhile, was distributed at a rate of 17,384 grams per 100,000 people, and hydrocodone at 20,389 grams per 100,000 people.

“This suggests either that methadone is for unknown reasons favored by drug diverters or that methadone is more risky to users than other opioids,” the report concludes.

The report comes as the National Center for Injury Prevention and Control is soliciting applications for a $350,000 grant aimed at combatting unintentional overdoses.

The center said there were 23,618 such deaths in 2005, 95 percent of which were related to drugs — and more than half of those were linked to pharmaceuticals.

Despite a wave of publicity and attempts by both public and private groups to combat the problem, the center notes “there is no empiric evidence that any of these efforts have been successful in reducing drug overdose morbidity or mortality on a statewide or national level.”


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