Prescribed doses of opiate pain medication have dropped significantly since Kentucky House Bill 1 went into effect last summer.
Lawmakers passed the bill during the 2012 legislative session in response to Kentucky’s prescription pill problem, which was blamed for about 80 drug overdose deaths a month.
From teenagers stealing pills from their parents’ and grandparents’ medicine cabinets to medical professionals addicted to pills they prescribe to their patients to babies born addicted as a result of their mothers’ pill abuse in the womb, drug addiction doesn’t discriminate. It crosses all gender, social, racial and economic barriers.
House Bill 1, which was approved in April 2012, mandated that Kentucky prescribers who write prescriptions for controlled substances run a Kentucky All Schedule Prescription Electronic Reporting report on their patients to try to prevent doctor shopping from occurring and to deter prescription pill abusers from obtaining and/or diverting controlled substances such as powerful narcotic painkillers. KASPER is an electronic prescription drug monitoring database that allows prescribers to find out if their patients have obtained a controlled substance from another Kentucky prescriber. Prior to House Bill 1, prescribers’ participation in the program was not mandatory.
”I had many prescribers tell me since mandatory KASPER scans (were implemented), they recognized doctor shopping among patients,” said Kentucky Office of Drug Control Policy Executive Director Van Ingram. “Part of the reason we wanted expanded KASPER usage was so we can recognize this earlier. ... Opiate addiction is a disease and it should be recognized in the medical field.”
Gov. Steve Beshear signed House Bill 1 last April, calling it “a critical bill for the health and safety of Kentuckians.” Since the bill took effect last summer, the governor’s office reported that, within just six months, total doses of all controlled substances had dropped by 10.4 percent compared to the same time period the previous year, a news release said.
Prescribed doses of some of the most abused drugs such as hydrocodone and oxycodone – both typically used to treat pain – have fallen by 11.8 percent. Oxymorphone (Opana) – used to treat moderate to severe pain – is reported to have fallen by 45.5 percent compared to the same time period the previous year. Prescribed doses of Alprazolam, also known as Xanax, which is used to treat anxiety but also diverted by drug abusers, have decreased by 14.5 percent.
The legislature revised House Bill 1 last month with another bill, House Bill 217, that’s scheduled to go into effect this summer and will “carve out some common-sense exceptions” to the KASPER report, Ingram said. Those exceptions include doctors providing pain medicine prescriptions to people immediately following surgery and other exceptions for people receiving long-term cancer care or end-of-life care.
“What we wanted to accomplish was, when an opiate is prescribed, that it’s a conscious, measured decision between patient and provider,” Ingram said, adding that HB 217’s modification still allows for cancer patients to receive the medication that they need but prevents noncancer patients from obtaining such strong medication for longer periods of time.
TriStar Greenview Regional Hospital pharmacy director Jim Morris said the bill has increased physician awareness. “The requirement for physicians to do (KASPER reports) has really opened their eyes,” Morris said.
While there was some initial concern about patient accessibility to necessary pain medicine, Morris said that does not appear to be a problem. “No, it has not stopped any legitimate patients from getting any medication,” Morris said.
Wide range of groups affected
“We were seeing overdose deaths increase, and we were seeing infants being born addicted” to opiates, Ingram said.
In 2000, Kentucky reported 29 infants who were born addicted to opiates. By 2011, that number had jumped to 730 babies born to mothers addicted to opiates, Ingram said.
“You can see in the numbers the opiate abuse has skyrocketed,” said Beth Crace Fisher, Cabinet for Health and Family Services public information officer.
Research compiled by Kids Plus Now, a program that helps expectant mothers give birth to healthy babies, shows there has been a dramatic rise in babies exposed to maternal opiate use. Many babies born to mothers addicted to drugs suffer from neonatal abstinence syndrome, Fisher said.
The range of problems affiliated with neonatal abstinence syndrome includes babies being born prematurely, withdrawal symptoms for the infant, discomfort, high-pitched crying, diarrhea, hyperactivity and other health problems, Fisher said. The problems can also follow the child into adolescence, increasing their chances of having problems at school.
“There are numerous dangers,” Fisher said. “Anything from preterm birth to increasing risks of infant mortality. ... It can cause problems later in life. Studies have shown even if a child is born without complications, they may develop problems in adolescence.”
The increasing number of infants born to opiate-drug using mothers was one of the major driving forces behind House Bill 1, along with the increasing number of overdose deaths linked to prescription pills, Ingram said.
Since the bill was passed last year, Ingram said numbers of infants born addicted to opiates and prescription pill related overdose deaths have decreased. With about a “decade of rates going up each quarter, it’s nice to see numbers go the other way,” Ingram said.
Warren County Coroner Kevin Kirby said that within the past several years there has been an increase in prescription pill-related overdoses.
“It can happen in any neighborhood and in any home,” Kirby said. “From young people to old people – there’s no age limit to the problem.”
The Warren County coroner reported a total of 18 drug overdoses in 2011 in Warren County, with that number falling to 13 in 2012. About 99 percent of those drug overdoses can be attributed to prescription pill abuse, said Deputy Coroner Dwayne Lawrence, who helps run the reports annually.
Prescription pill-related overdoses aren’t always linked to a person looking for a way to end his or her life, but instead are accidental and frequently caused by a lethal combination of drugs and alcohol. “I’d say a great percentage (of overdoses) are accidental,” Kirby said. “That wasn’t on their agenda that night.”
Kirby said people need to be mindful of how many pills they are prescribed to take, and make an effort not to exceed that limit.
When mixing certain prescription drugs with one another, it can cause the body to react a certain way, which sometimes can lead to death, he said. “When they take these (pills), they do not know what it will do to their bodies,” Kirby said, adding that overdose chances increase when adding alcohol to the pill equation.
With people’s judgment impaired, they may pull out too many pills, which could subsequently lead to death, he said.
Questhouse patients mostly pill addicts
Questhouse Inc. rehabilitation treatment center founder and executive director Russ Hopper said no one sets out to become addicted.
“It is not about lack of willpower. In fact, addicts have more will power than anyone in the world. Having worked with 6,000 addicted people, I’ve never met a single one that’s chosen to be addicted. ... We’ve all tried not to be addicted. We just couldn’t do it.”
Hopper started Questhouse Inc. at 2349 Russellville Road in 2003 and has provided recovery treatment to more than 1,600 people at the facility after being inspired by circumstances in his own life where he decided to seek out professional treatment for his alcohol addiction.
“I was just sick and tired of being sick and tired,” he said about his addiction, adding that others who get treatment at rehab facilities are either ordered by a judge to do so because of legal issues or are influenced by a family member, spouse or a boyfriend or girlfriend.
“We have a lot of opiate narcotic-addicted people here,” he said about the facility. “About 75 percent of people are here for prescription pill treatment.”
Addiction knows no gender, age or class-ranking, with about 30 percent of people admitted to Questhouse being professionals who work in the medical field, who are doctors, pharmacists, lawyers and teachers, he said.
“The main reason that people use is because it feels good,” he said. “It relieves pain and it feels good. It releases dopamine in the brain. Dopamine is a natural substance that the brain manufactures itself.”
Those getting high on prescription pills typically release about 200 percent of baseline dopamine, which compares to the same effects people get when having sex.
“Females seem to be more likely to be addicted than males to opiates and narcotics,” Hopper said. “I know that it’s becoming more acceptable to use pills, say, than it is alcohol or cocaine ... that would be one reason I think.”
Tenth-graders in southcentral region using pills
Along with mothers who abuse prescription pills during pregnancy and professionals and women who become addicted to the pills, there have also been reports of a high number of 10th-graders taking prescription pills from their grandparents’ and parents’ medicine cabinets, according to LifeSkills regional prevention center director Joy Ford.
“The kids are under the impression that prescription drug use – because the pills are prescribed by a doctor and filled by a pharmacist – that they are a safer form of drug use,” Ford said. “They don’t understand misuse and abuse.”
Ford said misuse is when pills are prescribed to a patient by a doctor and later given to a family member or friend without consulting with a doctor. “We’re trying to get that concept across to not save the pills for someone else who gets sick,” she said.
Lifeskills’ prevention treatment was selected to receive a grant from the state to help raise awareness in southcentral Kentucky on prescription pill abuse, and to educate communities on how to keep prescription pills away from teenagers, she said, adding that a survey taken by 10th-graders in the region in 2010 indicated a strong need.
“They won’t take the whole bottle,” Ford said. “They will take two or three pills out of the bottle, and most of us as adults don’t count our pills.”
With easy accessibility to pills through medicine cabinets and parents and grandparents leaving them out in plain view, it’s important to inform the community about how to monitor, educate, dispose and secure prescription pills, Ford said.
It’s important to follow these guidelines and educate people, because most kids who abuse prescription drugs get them from their home medicine cabinets or from friends, she said.
“One of the things that they’re identifying through the federal government ... is that prescription drugs are considered a gateway drug,” Ford said. “Before it was tobacco, alcohol and marijuana and then there was a pretty big gap there ... prescription drugs is that jump off, because of the accessability of it.”
Black market demand for pills is up
With such a wide range of people affected by prescription pill abuse, the black market demand for prescription pills is inevitable.
Although the Bowling Green-Warren County Drug Task Force reports a slight decrease in prescription-pill related trafficking cases this year, there is still a high demand in Warren County for Dilaudid, the brand name for hydromorphone, which are pain pills typically used to treat cancer patients, according to Bowling Green-Warren County Drug Task Force Director Tommy Loving.
“The unique thing about Dilaudids is most areas in Kentucky don’t deal with Dilaudids,” Loving said. “But in this area that’s a prescription drug that’s trafficked fairly heavily.”
Dilaudids typically make their way up to Warren County from black-market traffickers who come from the Nashville area, Loving said. The local drug task force has worked with Tennessee police agencies on cases in the past, he said.
In 2011, there was a 45 percent increase in prescription pill trafficking and prescription drug cases in Warren County compared to the previous year, he said. In 2012, that number remained about the same, he said.
“Right now for this year in the first couple of months we appear to be trending down slightly,” Loving said. “I want to think that House Bill 1 that dealt with the availability of prescription drugs has certainly helped with that.”
Lawmakers remain hopeful that the enforcement of House Bill 1 and recent revision of House Bill 217 will help keep the overall numbers of people addicted to prescription pills down, Ingram said.
“We have to get our patients better educated, our providers better educated, and get treatment to those who are already addicted,” Ingram said. “There’s a lot of work to be done, but I’m excited to do it.”
For more information on prescription drug misuse/abuse, contact LifeSkills Regional Prevention Center at 270-901-5000 ext. 1277.