Deadly prescriptions

Deaths from prescription painkillers have soared in Spokane and across Washington during the past decade, according to new research that warns of danger as close as the bathroom medicine cabinet.

Popular drugs such as hydrocodone and methadone fueled an 800 percent increase in statewide deaths linked to prescription opiates, which jumped from 45 in 1995 to 411 in 2004, state health researchers found.

Spokane, which once saw almost no prescription-related deaths, logged 48 deaths in 2004, posting the highest rate per population of any county in the state. Unintended drug poisonings now account for almost as many deaths in Washington as car crashes – about 650 a year – primarily because of the spike in prescription-related fatalities, said Jennifer Sabel, an epidemiologist with the state Department of Health.

“Prescription drug overdose deaths have been climbing through the roof,” said Sabel. “Even doctors don’t really realize the magnitude of the deaths.”

While no detailed research has been conducted in Idaho, health officials there said, in general, accidental deaths caused by drug poisoning rose statewide by 94 percent between 2000 and 2004, jumping from 32 to 62. And Dr. Robert West, the Kootenai County coroner, said there’s no doubt the rise is tied to powerful legal prescriptions.

“I’m showing six, just off the top of my head, that are definite prescription drug overdoses apart from alcohol,” West said.

In West’s exam room, victims last year included an elderly woman who died after failing to remove used patches of time-released Fentanyl, a prescription opiate, before applying the new ones.

“There’s usually a 72-hour dose time on the patch, but at the end of 72 hours there’s still Fentanyl left in the patch,” West said. “She came in with eight or nine patches plastered on her body. … It caused a narcotic cessation of breathing.”

One addict seeking an extended high took long-acting prescription methadone pills, but didn’t wait for the effect to kick in. He added Benadryl, a cold medicine, plus alcohol – and then died from the effects of the toxic cocktail.

“In this case, the alcohol level was low, below intoxication level, but the methadone was the toxic drug,” West said. “It’s not likely that someone would die from a Benadryl overdose, but if the Benadryl is there, it adds up.”People seeking relief from pain – or those just looking to get high – are ingesting potent painkillers in greater variety and increased quantity, often without recognizing the hazard and often with fatal results, experts said.

“Users may be lulled into thinking prescription medications are safe as opposed to ‘street drugs,’ ” said Spokane County Medical Examiner Sally Aiken.

But the most detailed examination ever of opiate-related deaths in Washington reveals that legal opiates are killing more people than illicit substances, such as heroin.

Ann Lima, a state epidemiologist trained to study causes of death, said researchers began noticing a grim trend: more and more death certificates that named drugs prescribed by doctors.

“I’ve had to manually review all these death certificates and I’ve just seen it increase,” she said. “It’s incredible how much it’s gone up.”

Lima was part of the team of researchers who hand-examined more than 3,500 state death certificates from 1995 to 2004 that listed opiates as a cause. Among their findings:

“Overall opiate deaths – those linked to prescription drugs, illegal drugs or others that were unspecified – more than doubled between 1995 and 2004, rising from 260 to 555 a year.

“The number of deaths definitely caused by prescribed opiates such as methadone and hydrocodone rose tenfold, from 23 to 267, between 1995 and 2004. Deaths definitely or possibly tied to the drugs rose 800 percent, from 45 in 1995 to 411 in 2004.

“The highest death rates were among men ages 35 to 54.

“During the same period, deaths caused by illicit opiates, such as heroin, and those that were unspecified, actually fell by 33 percent, from 215 in 1995 to 144 in 2004. That’s a trend that echoed here, said Aiken, Spokane’s medical director.

“In Spokane County, it has become much less usual to list heroin, cocaine and methamphetamine as the cause of death, and more common to find a prescription medication,” Aiken said.

The huge jumps recorded by state researchers probably underestimate the extent of the problem, Aiken added. Better investigation techniques and a new emphasis on determining the cause of drug-related deaths will yield even more alarming results, predicted Aiken, who expects final tallies soon for 2006.

In Spokane, state researchers found no definite prescription opiate deaths in 1995, and only two possibly linked to the drugs. But by 2004, the numbers had jumped to 36 definite prescription deaths and a dozen more that were possibly tied to the drugs.

That left Spokane with a rate of 8.08 definite deaths per 100,000 people, far above larger population centers. In King County, for instance, with 55 definite deaths, the rate was 2.9 per 100,000 residents.

That only confirms what those who’ve long worried about the problem believe.

“When our own coroner is telling us that legal drugs are killing more people than illegal drugs, it’s time we got a clue,” said Troy Anderson, police chief in Chewelah, where citizens have started a grass-roots advocacy group aimed at stopping teenagers from using prescription drugs.

Mark Selle, a Chewelah-area school district superintendent who helped form the group “Prescriptions for Life,” said public awareness needs to catch up with reality.

“I’m familiar with people close to me who have hydrocodone, OxyContin and Percocet,” said Selle, citing common painkillers. “They think, ‘I can’t sleep, I’ll just pop one of those.’ ”

The new Washington data offers the first detailed glimpse into what health advocates say is a growing problem nationwide. Researchers tracking death certificates followed a hunch about what seemed to be a disturbing trend, said Dr. Kim Thorburn, former health director for the Spokane Regional Health District.

“It was that kind of red flag that sparked our early discussion,” said Thorburn, who championed injury prevention during her nine-year tenure, including more than a year as the head of the state Board of Health. “We thought, ‘We need to look at this.’ ”

Only a few states have reviewed deaths specifically related to prescription opiates, but those that did found exponential increases. A national study drafted last year for the federal Centers for Disease Control and Prevention showed an increase of more than 91 percent in narcotic painkiller poisonings listed on death certificates between 1999 and 2002.

“This is a national problem,” said Dr. Gary Franklin, medical director for Washington’s Department of Labor and Industries, who has studied prescription opiate deaths.

Experts familiar with the drugs and their effects said vastly increased supplies of prescription painkillers have combined with growing demand and a cavalier attitude about the potential for toxicity.

“If they take two or three Ambiens and they still have pain, they end up taking 10 or so oxycodone just to see if that works,” noted West, the Kootenai County coroner.

“Or someone who’s been used to taking eight Percodan will switch over to OxyContin, and it will result in an overdose.”

Users fail to recognize the drugs’ most dangerous effect: suppressing the respiratory system, doctors said. If too much of the drug is taken, or if a long-acting drug is taken in combination with other potent medications – or even with less lethal substances such as antidepressants, cold medicines or alcohol – the combination can override even the most basic bodily function.

“In some of the acute cases, they’ll simply stop breathing,” West said. “The narcotic depresses the brain stem that causes the breathing.”

Statistics don’t distinguish between mistakes in drug prescriptions or dosing and intentional misuse of drugs, researchers said. Users seeking a high may induce a euphoric effect by ingesting large quantities of a drug, or by injecting, snorting or smoking it, but the result is the same – death by overdose.

“You have a kid who comes over after school and starts rummaging through the medicine cabinet,” West said. “They will take anything they can to get a buzz.”