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AP: Pain medicine use has nearly doubled
By Frank Bass
Associated Press
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MYRTLE BEACH, S.C. -- People in the United States are living in a world of pain and they are popping pills at an alarming rate to cope with it.

The amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005, according to an Associated Press analysis of statistics from the Drug Enforcement Administration.

More than 200,000 pounds of codeine, morphine, oxycodone, hydrocodone and meperidine were purchased at retail stores during the most recent year represented in the data. That total is enough to give more than 300 milligrams of painkillers to every person in the country.

Oxycodone, the chemical used in OxyContin, is responsible for most of the increase. Oxycodone use jumped nearly six-fold between 1997 and 2005. The drug gained notoriety as "hillbilly heroin," often bought and sold illegally in Appalachia. But its highest rates of sale now occur in places such as suburban St. Louis, Columbus, Ohio, and Fort Lauderdale, Fla.

The world of pain extends beyond big cities and involves more than oxycodone.

In Appalachia, retail sales of hydrocodone - sold mostly as Vicodin - are the highest in the nation. Nine of the 10 areas with the highest per-capita sales are in mostly rural parts of West Virginia, Kentucky or Tennessee.

Suburbs are not immune to the explosion.

While retail sales of codeine have fallen by one-quarter since 1997, some of the highest rates of sales are in communities around Kansas City, Mo., and Nashville, Tenn., and on New York's Long Island.

The DEA figures analyzed by the AP include nationwide sales and distribution of drugs by hospitals, retail pharmacies, doctors and teaching institutions. Federal investigators study the same data trying to identify illegal prescription patterns.

An AP investigation found these reasons for the increase:

-The population is getting older. As age increases, so does the need for pain medications. In 2000, there were 35 million people older than 65. By 2020, the Census Bureau estimates the number of elderly in the U.S. will reach 54 million.

-Drugmakers have embarked on unprecedented marketing campaigns. Spending on drug marketing has gone from $11 billion in 1997 to nearly $30 billion in 2005, congressional investigators found. Profit margins among the leading companies routinely have been three and four times higher than in other Fortune 500 industries.

-A major change in pain management philosophy is now in its third decade. Doctors who once advised patients that pain is part of the healing process began reversing course in the early 1980s; most now see pain management as an important ingredient in overcoming illness.

Retired Staff Sgt. James Fernandez, 54, of Fredericksburg, Va., survived two helicopter crashes and Gulf War Syndrome over 20 years in the Marine Corps. He remains disabled from his service-related injuries and takes the equivalent of nine painkillers containing oxycodone every day.

"It's made a difference," he said. "I still have bad days, but it's under control."

Such stories should hearten longtime advocates of wider painkiller use, such as Russell Portenoy, head of New York's Beth Israel pain management department. But they have not.

"I'm concerned and many people are concerned," he said, "that the pendulum is swinging too far back."

Consider:

-More people are abusing prescription painkillers because the medications are more available. The vast majority of people with prescriptions use the drugs safely. But the number of emergency room visits from painkiller abuse has increased more than 160 percent since 1995, according to the government.

-Spooked by high-profile arrests and prosecutions by state and federal authorities, many pain-management specialists now say they offer guidance and support to patients but will not write prescriptions, even for the sickest people. The increase in painkiller retail sales continues to rise, but only barely. There was a 150 percent increase in volume in 2001. Four years later, the year-to-year increase was barely 2 percent.

-People who desperately need strong painkillers are forced to drive a long way - often to a different state - to find doctors willing to prescribe high doses of medicine. Siobhan Reynolds, the widow of a New Mexico patient who needed large amounts of painkillers for a connective tissue disorder, said she routinely drove her late husband to see an accommodating doctor in Oklahoma.

Perhaps no place illustrates the trends and consequences for the world of pain better than Myrtle Beach, a sprawling community of strip malls, hotels and bars perched along a 60-mile strip of sand on the Atlantic Ocean. The metro area, which includes three counties, is home to 350,000 people but sees more than 14 million tourists annually, drawn to its warm water, golf courses and shopping.

During the eight-year period reflected in government figures, oxycodone distribution increased 800 percent in the area of Myrtle Beach, partly due to a campaign by Purdue Pharmaceuticals of Stamford, Conn. The privately held company has pleaded guilty to lying to patients, physicians and federal regulators about the addictive nature of the drug.

Use of other drugs soared in the area, too: Hydrocodone use increased 217 percent; morphine distribution went up 180 percent; even meperidine, most commonly sold as Demerol, jumped 20 percent.

It is no small wonder that federal authorities suspected the area was home to a notorious "pill mill," or a clinic that dispenses prescription medication without verifying that it's needed.

The U.S. attorney for South Carolina secured a 58-count indictment in June 2002 against seven physicians and one employee of the Comprehensive Care and Pain Management Center, a nondescript storefront on Myrtle Beach's main drag.

Tipped off by local pharmacists concerned about an increase in the volume of painkiller prescriptions, the federal investigation created a furor in the medical profession. The owner, D. Michael Woodward, was sentenced to 15 years in the case and has relinquished his license.

A second physician, Deborah Bordeaux, had worked at the clinic less than two months before quitting in disgust. Bordeaux, now serving a two-year prison term, was threatened with a 100-year sentence if she did not help the prosecution.

Officials with the Justice Department and the DEA would not discuss what some activists say is a "war on doctors."

Reynolds, the widow who drove her late husband hundreds of miles for his pills, became an activist after the Myrtle Beach indictments. She contributed money to appeal some of the criminal convictions in South Carolina and started the Pain Relief Network, an advocacy organization for people living in pain. She believes the doctors sent to prison were railroaded.

"It was a witch hunt," she said.

Bordeaux's husband, Edworth Swaim, agrees. A retired U.S. Postal Service employee, Swaim believes his wife was sentenced to two years because she would not turn on her former colleagues. Even though Bordeaux had worked at the clinic less than two months and eventually sued over what she alleged was rampant Medicare fraud, he said she did not stand a chance of avoiding prison.

"She wasn't guilty of anything, so she wasn't going to plead to anything," Swaim said. "She was absolutely railroaded, made an example of. I can't tell you how angry I am."

Myrtle Beach physicians are not convinced that the "Myrtle Beach Eight," as they became known, were innocent.

A Myrtle Beach internist who also works in addiction medicine, Brian Adler, said physicians were flooded with patients seeking pain medicine after the clinic was shut down.

The community has a slightly higher-than-average number of older people and relatively high numbers of people between 21 and 64 who describe themselves as disabled.

"There's a significant problem with narcotics in this area," Adler said. After the pain management clinic closed, "all those folks were like rats, scurrying from a burning building, trying to get their fix."

Other physicians were concerned about patients with legitimate needs for painkillers. The federal bust raised the stakes.

When radio commentator Rush Limbaugh settled a federal case charging him with illegally obtaining painkillers, he did not get prison time. Neither did NFL star Brett Favre, who publicly acknowledged an addiction to Vicodin that he obtained legally.

To pain management specialists, they were being blamed for everyone's addiction.

The DEA cites 108 prosecutions of physicians during the past four years; 83 pleaded guilty or no contest, while 16 others were convicted by juries. Eight cases are pending, and one physician is being sought as a fugitive.

In congressional testimony, the agency's deputy assistant administrator, Joseph T. Rannazzisi, estimated that fewer than 1 percent of the nation's physicians - under 9,000 - illegally provide prescription drugs to patients. He told lawmakers it is far more common for people to illegally obtain prescription drugs from friends and family members.

"It is not merely illegal but could feed or lead to an addiction and place that loved one in a life-threatening situation," Rannazzisi said.

It is impossible to reliably measure painkiller abuse.

A 2004 government study estimated between 2 million and 3 million doses of codeine, hydrocodone and oxycodone are stolen annually from pharmacies, distributors and drug manufacturers. The AP's analysis only included retail sales and did not include estimates of diverted pharmaceuticals.

John Charles, director of medical affairs at the Grand Strand Regional Medical Center in Myrtle Beach, practices pain management. A few years ago, Charles said, he took a drastic step to reduce his potential legal risks: He stopped prescribing painkillers.

The decision gave him peace of mind, but he does not expect there to be less of a need for painkillers or physicians who prescribe them.

"People with cancer are surviving longer, elderly people are living longer," Charles said. "So, physicians are walking a fairly fine line. We're walking a narrow path. And I think we'll continue to see it for a while."

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Reader comments on this story - 16 total

Note: All views and opinions expressed in reader comments are solely those of the individual submitting the comment, and not those of the Pantagraph or its staff.

Why don't you try~~ wrote on Aug 21, 2007 3:38 PM:

" being in pain and see how it feels to not have anything to at least dull the pain. I'm in pain everyday and let me tell you it's horrible. Some days aren't worth living, but I go on. If my doctor didn't give me pain meds I don't know what I would do. Yes, I do, but that's another story. Some people have problems that can't be corrected and need help with pain so I don't slight anyone in pain. I HATE TAKING PAIN MEDS, but don't have a choice when phsyical therapy, hot water, massage therapy etc. doesn't work. Pain meds are the last resort. As long as I'm in pain and can get relief from meds, I'm taking them as long as the doctor will let me have them. "

Dr. John Charles should be wrote on Aug 21, 2007 9:43 AM:

" stripped of his medical license. Doctors are supposed to look out for the needs of their patients FIRST, not their own. It is morally wrong to refuse pain relief due to fear of getting in trouble. Wake up doctors! If you are legitimately prescribing medicine then you have nothing to fear. If this doctor is sleeping okay at night, then he must be a robot with no heart. How can he sleep knowing he has patients that are in so much pain and he refuses to help them? Severe pain will make a person feel like they would do anything to make it go away, whether that means trying to obtain relief illegally, or just shooting yourself in the head so you never have to feel that pain again. This doctor shouldn't be allowed to practice medicine, as it is clear he does not have his patients' best interests in mind. "

To: Common Sense wrote on Aug 21, 2007 9:08 AM:

" That is simply not true. At least not when it comes to pain killers. Did you even read the article? You could be bent over and in tears in total misery, and most doctors will still refuse to prescribe pain meds because they are afraid they will get in trouble. When in fact, if doctors would actually research federal and state laws, they would find that as long as the doctor is prescribing the medication for legitimate and documented medical reasons, the DEA has no interest in prosecuting them. DEA is only after physicians who routinely prescribe narcotics to people who don't need them, if it's found that a person died of an overdose of narcotics that were prescribed for no apparent reason, and also those doctors that sell narcotic prescriptions for profit. Now, if you had a friend or family member that was dying of cancer and in unimaginable pain, would you still criticize a doctor for prescribing pain meds? Or would you be begging a doctor to do so? "

To: Woodford Pundit wrote on Aug 21, 2007 9:02 AM:

" That's a good question, one that I cannot answer. However I can tell you, being a legitimate patient on a pain prescription, that when taken correctly you won't get a "high" feeling that many people are after. The medication I'm on is for long-term pain management. It stores in the tissues and has a long half life. The purpose of this is so the patient can build up a tolerable level of pain control, and after the first couple of days on the medication, there is no "high" or euphoric feeling, making it possible to live everyday life without pain and without being stoned. I agree with whomever said that people who are after prescription meds without legitimate purpose will get them illegally and it's not that hard to catch these people, what with all the regulations there are in place nowadays. As long as legitimate pain patients follow the rules, the patient and the doctor are doing nothing wrong. When a patient takes the medication exactly as prescribed, after the first few days they won't get high when the meds are taken. "

MRS. wrote on Aug 20, 2007 6:28 PM:

" TO:Woodford Pundit: I've thought about that too. Believe me, you take SOMA you won't be running around. In fact my DR told me to take the med while sitting on the bed. I also have wondered why schools say they have zero tolerance for drugs yet at the firt sign of a kid that might actually require extra instruction the first thing they want to do is drug them up. "

Woodford Pundit wrote on Aug 20, 2007 5:05 PM:

" How come the police don't have the equivalent of a breathalizer for prescription drugs? How come it's "you drink, you drive, you get arrested" when everyone's running around on painkillers and "mood enhancers"? How come High Schools have "no tolerance" for drugs but don't test the teachers, administrators, and school boards. I often wonder how whacked out folks that I meet are (on prescription drugs), making important decisions, and no one cares - because it's acceptable - the have scripts. "

MRS. wrote on Aug 20, 2007 4:15 PM:

" I'm with you JO, that helps me when I need it. I had broken vertabra in my C-spine and I only use pain meds when I have too but that is a good one. "

This is so wrong wrote on Aug 20, 2007 4:07 PM:

" It is morally and ethically wrong, not to mention horribly reckless to just stop prescribing pain medication just because a doctor is afraid he might get into trouble for it. I have lived in pain for years due to a chronic condition that is incurable. I completely understand that people will try to obtain drugs illegally or become abusers, however that should not stop a doctor from treating a patient appropriately. The people that are going to abuse prescription meds are more than likely going to go about getting their drugs in an illegal fashion. Those people should be prosecuted to fullest extent of the law. But people with legitimate pain who follow all the rules (no doctor shopping, use the same pharmacy, never run out early or try to get more when it is too soon, etc) shouldn't have to be punished for it. In fact, doesn't the hypocratic (sp?) oath say something like "First do no harm?" If a patient is clearly in pain, and narcotic pain reliever is the only thing that will make them a little more comfortable, NOT giving it to them is more harmful "

There is... wrote on Aug 20, 2007 1:49 PM:

" one drug out there that will cure the overusage of inferior products which cause addiction and NASTY side effects. Unfortunatley due to political reasons the Federal Government has continued it's unlawful "WAR ON DRUGS!" Yet due to political contributions, these harmful drugs are not only legal, they are smiled upon by our "elected" officials. "

Common sense wrote on Aug 20, 2007 1:36 PM:

" As a culture, we now prevent nothing with our health. We simply react to diseases that we contract. The "popping of pills" is a perfect example of my point. Today's M.D.s are not taught preventative medicine, they are simply taught to throw a prescription at the problem. "

FYI wrote on Aug 20, 2007 1:07 PM:

" Yet they still ignore the benefits of marijuana. On a side note, marijuana is the largest cash crop in the USA. At over $35billion dollars/year, it is more than corn and wheat combined. The best and worst part of it all is that it's tax-free, because uncle sam is so stupid...w/an outfit like that, it's obvious sammy used a little too much. "

User wrote on Aug 20, 2007 12:24 PM:

" So far this year, I've been prescribed Codiene, Morphine, Percoet, 5MG Vicodin and 10MG vicodin. I had a motorcycle accident, and thank chemists for these drugs! You know you're in pain if morphine isn't cutting it. "

Gov's, Muppet's wrote on Aug 20, 2007 12:01 PM:

" Yes I agree with you, S. Carter, Well said... I believe this nations drug crisis starts with the fact that the American diet is high in fat. Drug company's have said hey here is a pill for everything instead of rehabilitation by exercise and rest. The real problem with having drugs that are illegal is that the human brain processes this as an encouragement to use them in the first place, reverse psychology that is known for a fact to effect the human mind. As our atmosphere becomes more polluted our bodies are going to ache and be riddled with diseases, and drug usage even legal ones are a contributing factor to the rise of obesity, loss of life, and the dumbing of America. "

s. carter wrote on Aug 20, 2007 10:53 AM:

" I believe drug companies should not be allowed to advertise.the reason is they say if you feeling a ceartain way you should take this drug.Why should they not be looked upon as drug dealers and doctors as there pushers?They basically tell you there drugs cause heart,liver and other complications .Why are young men thrown in jail everyday for a drug never found to harm anyone.(Pot) Drug companies target children (ridlin)who should be in jail? "

J O wrote on Aug 20, 2007 10:39 AM:

" Soma, please. The human race, like capitalism's race, causes me great pains. "

Consider this wrote on Aug 20, 2007 10:12 AM:

" The more you weigh, the stronger the dose! "
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