Nevada Loves the Vicodin Part 2

July 22, 2008

In my post on the interactive map of US prescription opiate use trends provided by the Las Vegas Sun I initially missed the association with a three-part series on “The New Addiction”. This explains why the Sun came up with the map in the first place which I should have thought about a bit more. Bad DM!
At any rate there’s all kinds of interesting stuff in here such as a reader poll with only 53% of respondents (as of 7/22/08) saying it is “difficult” to persuade a doctor to provide a prescription for narcotics:

Jennifer Hilton says that after she had a tooth filled, her dentist handed her a prescription for Vicodin even though she was not complaining about pain. She bristled at the unsolicited prescription because she’s a program coordinator for an inpatient drug addiction program for adolescent girls that’s run by Westcare, a Las Vegas nonprofit that specializes in substance abuse treatment.

and a suggestion that the rising trend is all the fault of the American Pain Society in cahoots with BigPharma.

The New Addiction Part 1: The painful truth about Nevada
As reader jamie indicated on a prior post, “I know from my own field of narcotics research that drug use is not decreasing but in fact steadily increasing and becoming more mainstream from things such as oxy abuse, but I figured hey, maybe narcotics are an outlier”. Prescription narcotic misuse/abuse is indeed increasing in the recently past years and to some reads of the epidemiology for all illicit drug use, this does represent a currently unusual case. The Sun thinks it knows why:

The use of narcotics to treat pain got a tremendous boost in 1995 from the American Pain Society. Its corporate members include the pharmaceutical companies Purdue, maker of OxyContin; Abbott, maker of Vicodin and UCB, and Watson, maker of the hydrocodone drugs Lortab and Norco.

The advent of direct-to-consumer marketing by pharmaceutical companies has also contributed to the rise of prescription narcotics. In 1997, the Food and Drug Administration allowed drug companies to hype their brand-name medicines directly to consumers, which has helped remove any stigma attached to their use. Doctors say patients are now demanding drugs by name.

No worries, they spread the blame around. Go read.
The New Addiction Part 2: Rising use of painkillers taking a deadly toll
A comment from becca on a prior post pinpoints the issue- “Dying of a oxycontin overdose sure strikes me as what any sane War on Drugs should be aiming to minimize”. Agreed. Acute death is a major concern and whether or not someone is addicted can be a pertinent concern.

Fatal overdoses involving prescription painkillers more than quadrupled in a decade and now exceed those involving illicit drugs, according to data compiled by the Clark County coroner’s office.
In 1997, there were 57 fatal overdoses in Clark County in which prescription narcotics were a contributing factor, a rate of about five per 100,000 people. In 2007, 258 people died in Clark County from overdoses of prescription narcotics, a rate of 13 per 100,000 people.
In contrast, the number of deaths caused by illicit drugs has plateaued. Street drugs such as cocaine, methamphetamine and heroin were involved in a combined 197 fatal overdoses in 2007.

Of course, non prescription use of prescription opiates is still illicit drug use. Just sayin’. A handy graphical representation is here.

Prescription narcotics deaths accounted for 56 percent of poisoning deaths nationally in 2005, according to the Centers for Disease Control and Prevention, and their absolute number increased by 84 percent from 1999 to 2005.

Half? Ok, that sounds kinda bad to me. I mean, perhaps there aren’t actually that many poisoning deaths but still…
One last bit that struck me a little funny and illustrates the difficulty of collapsed data.

No prescribed narcotic is involved in more deaths among Nevadans than methadone. The long-acting painkiller was named in a third of the 1,771 prescription drug overdoses in Clark County from 1991 to 2007, according to the Clark County coroner’s office. The number of deaths involving methadone climbed from three in 1993 to 20 in 1998 and 105 in 2007. (Cocaine was a factor in 116 Clark County deaths in 2007.)

So the article goes on to mention methadone as the therapy for heroin addiction and also alleges that insurance companies push this as a cheap pain med. Hmm. Without numbers one wonders what populations we are talking about here and the relative risk across prescription opiates.
This section also has a bit of detail on diversionary practices that get these drugs into the hands of users.
The New Addiction Part 3: Officials urge action on painkiller abuse
This deals mostly with local political responses to the issue.

“Definitely Nevada is overusing narcotics,” said Assemblywoman Sheila Leslie, D-Reno, who leads the legislative committee on health care. “How could you not come to that conclusion?”
Leslie said she will work with Nevada Attorney General Catherine Cortez Masto to draft legislation to address the issue during the 2009 legislative session.

Expected. Well, I’m sure the drug policy watchdogs will be following this case to see if Nevada breaks new ground in drug penalties, restrictions and interdiction, or if this is just temporary political posturing.
[h/t: Drug Law Blog pointed me to an AP story which took me back to the LV Sun series]

No Responses Yet to “Nevada Loves the Vicodin Part 2”

  1. juniorprof Says:

    So the article goes on to mention methadone as the therapy for heroin addiction and also alleges that insurance companies push this as a cheap pain med. Hmm. Without numbers one wonders what populations we are talking about here and the relative risk across prescription opiates.
    Not sure about relative risks but I can guess the population… When a heroine addict or heroine on methadone maintenance shows up in the doctor office (or more likely the ER) they are going to be complaining about pain. The staff is going to suspect that they are an abuser and they are going to ask for something strong… what is the staff supposed to do? They are likely in pain (as we discussed in a previous post — opiate-induced paradoxical pain) and they are likely desperate for some opiate. Methadone would be a good compromise, no? I have no numbers but I am completely unaware of instances of methadone prescriptions for non-addicts in the US.
    I’ll have to consider the American Pain Society assertions a bit before spouting off on that one.


  2. juniorprof Says:

    After some digging it appears that I am wrong about methadone. Methadone is prescribed mainly for cancer pain treatment (as the article alludes to — I didn’t believe it) largely because it gives a longer duration of pain relief and because it is less expensive than other options. On the other hand, methadone has a great liability for side effects, including a strong possibility of respiratory depression, so most of the clinical trials I found indicate caution in prescribing methadone in situations where monitoring is not possible.


  3. kenny Says:

    Methadone is one of the drug treatment for cancer patients.
    Nevada Drug Addiction


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