Rx-related deaths go unchecked

Analysis in Wyo. shows state lacks oversight

Ben Neary, Associated Press

Tuesday, August 21, 2007

CHEYENNE - In common with the rest of the nation, Wyoming has seen a sharp increase in the volume of some prescription painkillers consumed by its residents over the past decade.

But despite national trends that show increases in deaths associated with the abuse of some prescription painkillers, Wyoming state government doesn't track whether any such drug abuse is killing people.

An analysis by The Associated Press shows that the percentage of people nationwide using five major painkillers increased 90 percent between 1997 and 2005. Prescriptions in Wyoming generally follow that trend.

Measured by the grams of painkiller prescribed per 100,000 population, Wyoming has seen the amount of oxycodone - the active ingredient in the popular painkiller OxyContin - increase more than 500 percent, the analysis found.

The volume of hydrocodone prescribed in the state has increased 207 percent; morphine is up 219 percent. Meperidine, the active drug in the popular painkiller Demerol, is down 10 percent, and codeine was down by 30 percent.

James T. Carder, executive director of the Wyoming Board of Pharmacy, last fall reviewed the federal records compiled by The Associated Press showing trends in painkiller prescriptions for Wyoming from 1997 through 2004. The 2005 information became available more recently, but continues the same trend.

"It looks like what's happening in Wyoming is what's happening in the country," Carder said. But he emphasized that such increases in prescriptions for certain painkillers in Wyoming does not mean that they're being abused.

"I think you can't really look at the numbers and say, 'Obviously we've got a problem with doctors over-prescribing, or people abusing the drugs,' " Carder said.

Instead, Carder said, "I think society has changed. I think the courts have changed; I think the boards have changed. I think there's been an awakening that we've been too hard on people who have real pain."

As recently as 15 years ago, Carder said the only patients who received large doses of opiates for control of their pain were those dying slowly from cancer.

"The way society is now - and I don't think it's necessarily wrong at all - is if you have pain, and there's a way that they can try to improve your quality of life, then that should be accomplished," Carder said.

OxyContin was introduced in 1996 and sales took off. According to federal figures, the number of prescriptions issued for it nationwide increased twentyfold, to about 6 million in 2000.

However, OxyContin also proved easy to abuse. Tablets are designed to be swallowed whole, but people soon found out they could achieve a heroinlike high by crushing the tabs.

Last month, a federal judge in Virginia ordered OxyContin producer Purdue Pharma L.P. and three of its executives to pay a $634.5 million fine for misleading the public about the painkiller's risk of addiction.

According to a report from the U.S. Drug Enforcement Administration, the number of OxyContin deaths increased fivefold from 1996 to 2001. The agency reported that the drug caused 146 deaths in 2002 and contributed to another 318.

But if Wyoming residents are dying from OxyContin abuse, nobody in state government is keeping track. Coroners are elected in Wyoming's 23 counties; only one - Natrona County's James Thorpen - is a medical doctor.

Autopsies generally must be contracted out to pathologists.

Even in cases where autopsies are performed, Wyoming maintains no central repository of specific cause-of-death information that could show how many people are dying from prescription drug abuse.

Thorpen has been an outspoken proponent of creating a state medical examiner's office to handle all autopsies of suspicious deaths in the state and keep records of what's causing them. But while such offices are common in other states, he says he's run into opposition from the state's elected county coroners.

Carder, director of the state's pharmacy board, said it would be useful to his office to be able to look at records of deaths around the state associated with prescription drugs.

"To me, there ought to be a central repository, so you can find out cause of death or see what's going on," Carder said. He said that would allow his office to look for any problem areas, to see if there are places in Wyoming where prescriptions are causing deaths.

Gov. Dave Freudenthal said there have been proposals to deal with the levels of training required for coroners as well as the role of medical examiners.

The Wyoming Board of Pharmacy started its own monitoring program in July 2004 that keeps track of individual patients, monitoring how many different doctors and pharmacies they visit and what drugs they get.

From the start of the monitoring program through July this year, Carder said it has collected information on over 2 million prescriptions for controlled substances. He said the program has responded to more than 9,000 requests for patient profiles from prescribing physicians or pharmacists.