Oklahoma Says Prescription Pills are the New Gate Way Drug, Not Marijuana

Use of pain pills shoots up in Oklahoma

City doctor says there is a new `gateway drug' in Oklahoma,
nation

BY VALLERY BROWN
Published: September 20, 2009

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Supplies of prescription pain medication in Oklahoma more than doubled
over a four-year period ending in 2006 — enough in one year to give
every state resident about 60 painkillers.

More than 2.2 million grams — the equivalent of about 200 million,
10 milligram pills — was shipped to the state in 2006. A report
released by the U.S. Drug Enforcement Administration shows most of those
drugs went to pharmacies.

Controlled pain pill use and abuse has been escalating in Oklahoma since
2004, said Mark Woodward, spokesman for the Oklahoma Bureau of Narcotics
and Dangerous Drugs. Doctors are prescribing pain medications more often
and more patients are asking for them, he said.

"There's really nothing showing the use is going down," Woodward
said.

The most recent federal data shows Tulsa and Oklahoma counties ranked
nationally among the top 15 areas of highest prescription pain pill
misuse. Oklahoma is the only state to have two regions in the top 15.

In fact, information from the state's Prescription Monitoring
Program show a nearly 40 percent increase in the number of doses of
hydrocodone dispensed by pharmacies between Sept. 2007 and June 2009.
Oxycodone increased by about 30 percent over that same time period. This
doesn't include drugs in a liquid form like cough syrup.

Dr. Charles Shaw, an Oklahoma City-based specialist with more than 20
years of experience in treating addiction, said painkillers have
replaced marijuana as the "gateway drug."

"Many young people experiment with pain medications and become
hooked," he said. "Most of the ones I see are in their 20s and have
lost everything."

Woodward said in 2008 there were more than 600 prescription drug-related
deaths in the state.

"Sometimes people just don't become aware it is a problem until
someone close dies or becomes addicted," said Chris Smith, agent in
charge of diversion for the state narcotics bureau.

Where is it coming from?

The majority of the controlled prescription pain medications in the
state are ordered by pharmacies, according to a 2008 federal report.

Pharmacies bought about 2 million grams of codeine, oxycodone,
hydrocodone, meperdine, morphine and fentanyl to sell in the state in
2006. Oxycodone, hydrocodone and morphine were bought in the highest
amounts.

Hydrocodone is commonly sold under the brand names Lortab and Vicodin.
The stronger oxycodone is sold as OxyContin and Percocet. Meperdine is
sold under the brand name Demerol.

Comparatively, hospitals bought about 200,000 grams of pain medications,
the report states. In hospitals, codeine, meperdine and morphine were
bought in higher amounts compared to other controlled pain medications.

"Pharmacies are ordering these quantities because someone is prescribing
them," Smith said. "Maybe there needs to be a change in philosophy
in the prescribing of the medicines."

Who's taking them?

During the period from 2002 to 2006, The National Survey on Drug Use and
Health reported more Oklahomans used painkillers for nonmedical purposes
than nearly any other state. Only areas in West Virginia and Utah ranked
higher.

The report defines nonmedical use as using drugs without a prescription
or simply for the feeling caused by taking them.

According to the report, 6.3 percent of Oklahomans took pain pills for
reasons other than treating pain each year between 2004 and 2006.

"It's a national trend," Woodward said.

Shaw said doctors began approaching pain management differently in the
late 1980s and early 1990s. Where there was apprehension in prescribing
some of these medications before, many started prescribing more
liberally to help keep patients comfortable and out of pain.

"And now it's a cash cow for pharmaceutical companies," Shaw
said. "And I don't see that slowing anytime soon."

Doctors started prescribing less codeine and more oxycodone and
hydrocodone around 2004, Woodward said. Amounts have been on the rise
ever since.

He said once pills leave the pharmacy they are difficult to track, but
one way to stop their spread illegally is for people who are caught
selling them to tell investigators how they got the pills.

"Sometimes they spill everything," he said.

Drug sources

The latest survey from the National Centers for Drug Use and Health
stated more than half of those surveyed said painkillers they took
nonmedically were given to them by a friend or relative for free. About
20 percent said they obtained medications from one doctor.

The remainder reported they paid for the drugs from a dealer and a
fraction said they bought them on the Internet.

"Once it gets out of the pharmacy, it's too late," Shaw said.
"You have to go back to the source to slow this."

CONTRIBUTING: PAUL MONIES, DATABASE EDITOR

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From legitimate to illegitimate

Chris Smith, agent in charge of diversion at the state narcotics
bureau's Lawton district, said there are several ways drugs are
being shuffled from legitimate to illegitimate uses.

->Doctor shoppers: Not all of the doctors are using the
prescription monitoring program or they aren't reading it correctly.
Patients will jump around from doctor to doctor until they get what they
want.

->Professionals: Doctors, nurses and pharmacists are writing
unnecessary prescriptions or helping people obtain the drugs for
nonmedical use.

->Acquaintances: Giving drugs away to friends or family.

->Thefts: Those who steal the drugs from a friend or relative.

->Dealers: People who obtain the drug from any number of sources
and then sell it on the street.

BY THE NUMBERS

Increases in supply of federally regulated prescription pain pills in
Oklahoma 2002-2006:

->Morphine: More than 120 percent

->Oxycodone: 90 percent

->Hydrocodone: 70 percent

->Meperidine (brand name is Demerol): 10 percent.

->Codeine: Down 20 percent statewide

Source: U.S. Drug Enforcement Administration Automation of Reports and
Consolidated Orders System

Using drugs illegally

200,000: Number of Oklahomans 12 years and older who used prescription
painkillers without a prescription or just for the feeling or
experience.

Source: 2008 National Survey on Drug Use and Health

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