The number of people abusing painkillers and other prescription medications in Maryland has risen sharply in recent years, and officials are looking to a new monitoring system, as well as increased awareness, to stem the tide.
Similar steps are being taken across the nation as prescription painkillers, stimulants and depressants have become the most widely abused drugs behind marijuana. More than 6,000 Americans a day now abuse a pain reliever for the first time. In Maryland, the number of people seeking treatment for addiction to prescription drugs jumped from more than 3,400 in 2007 to more than 7,000 in 2010.
The reasons aren't entirely clear, officials say. Easy availability, especially for teens and young adults, is likely fueling the abuse. There are more prescriptions being handed out for a host of medical needs, and online pharmacies make obtaining the medications easier.
"Abuse is a serious problem in Maryland, and it's one of the only states without one of the best tools to deal with the problem," said Dr. Joshua M. Sharfstein, secretary of the state's Department of Health and Mental Hygiene.
That tool is a monitoring system that would require pharmacies to log each filled prescription in a database, allowing prescribers in doctors' offices, emergency rooms or urgent care facilities to check before writing prescriptions for the same medications.
Officials expect the 2011 General Assembly to pass legislation to create the system, which would be funded by $344,000 in federal dollars in the next fiscal year and more after that. Just six other states and the District of Columbia lack a monitoring program, according to the National Alliance for Model State Drug Laws, a congressionally created commission that has helped states develop the systems since 2003. All other states have an operational program or are in the process of implementing one.
Last week, Senate President Thomas V. Mike Miller said the measure is "a very important bill" that should have been passed years ago. A similar measure passed by the House and Senate five years ago was vetoed by then-Gov. Robert L. Ehrlich Jr.
"We are behind the eight ball," Miller said. "It is an epidemic among young people."
A February assessment from the PMP Center of Excellence at Brandeis University concluded that prescribers in states with monitoring programs write fewer duplicate prescriptions, and that those states have lower treatment admission rates, less opiate abuse and more efficient law enforcement investigations. States without such programs have more drugs diverted for illegal use.
Sharfstein said a monitoring system in Maryland would not stop all abuse, but the state would benefit.
"If I came to you as a patient and I had a particular problem, you could see if I got seven other prescriptions from seven other doctors," he said. "The idea would be to help get people into treatment."
The most common prescription drug cited as a problem in Baltimore's treatment clinics is oxycodone, sold as OxyContin, said Dr. Michael Fingerhood, an associate professor of medicine at the Johns Hopkins University who treats addicts.
State public health officials report a 250 percent increase in poison control calls related to oxycodone from 2007-2010. More than half of the intoxication deaths in Maryland in 2010 involved such a prescription opiate.
Whether the drugs were legitimately prescribed or were stolen or purchased illegally, users can become addicted in a matter of weeks, Fingerhood said. The euphoria that comes from taking painkillers wanes, but users can't stop taking the drugs because they need them "just to feel normal. It starts to rule their lives."
But Fingerhood, who is also the director of the division of chemical dependence at Hopkins Bayview Medical Center, said trying to quit without help is tough. Withdrawal is not typically life-threatening but can bring aches, nausea and runny noses and eyes for the first 24 hours, and then more subtle symptoms such as trouble sleeping and focusing.
Treatment in a clinic might involve methadone and buprenorphine, but often other therapy is needed for underlying problems such as self-esteem issues, Fingerhood said. Overdoses can occur when addicts relapse but no longer have the same tolerance to the drug. That can cause respiratory troubles or death, particularly if the medications are mixed with other drugs or alcohol.
To cut down on addiction, Fingerhood said, doctors need to better evaluate whether prescriptions or refills for addictive drugs are needed in the first place. When they are prescribed, Hopkins keeps its own records in an attempt to control the number of prescriptions, he said.
A statewide monitoring system would be more comprehensive and would help reverse the surge of addicts that seem to get younger and younger and have no trouble getting their hands on the drugs, he said.
"We're definitely seeing more young people," Fingerhood said. "[Prescription drugs] are easily found on the street. But a lot of times the first pill comes from the family medicine cabinet."
Young people often think prescription drugs are no big deal, federal officials say. Nationally, an estimated 48 million people 12 and older have used prescription drugs for nonmedical reasons — or 20 percent of the U.S. population, according to the National Institute on Drug Abuse.
The U.S. Drug Enforcement Administration says 56 percent of teens believe that prescription drugs are easier to get than illicit drugs, and 40 percent believe that prescription drugs are safer. About a third of teens believe prescription pain relievers are not addictive.
Federal officials have pushed states to create monitoring programs and share information by offering to pay start-up and operating costs. Maj. Vernon Conoway, commander of the state police drug enforcement division, said the investment would be worth it in Maryland, where he sees more "doctor shopping" by abusers and distributors of all ages.
Doctor shopping occurs when patients go to multiple physicians in search of specific prescription drugs. They frequently get different pharmacies to fill the scripts, and they pay cash to keep insurers from denying refills. Sometimes they reproduce or copy the prescriptions.
In all, state police investigators seized about 30,000 prescription pills in 2010 compared with 7,000 in 2009, Conoway said. More were seized by patrol officers during traffic stops.
For example, Maryland troopers on Interstate 95 seized 34,000 oxycodone pills from a car headed from Florida to New York in 2009. In 2010, troopers seized 25 pounds of marijuana and 2,500 oxycodone pills in a car on I-95. He said officers recently discovered a ring in Cecil County in which 10 people were acquiring prescriptions for two others who sold the pills for $20 to $25 each.
State officials do not track arrests for prescription drugs separately, but Conoway believes they are rising. At the same time, arrests for illicit drugs overall are declining. In 2009, Maryland logged nearly 51,900 arrests for drug law violations, compared with about 57,700 the year before.
"People are clearly abusing the system we have now for prescription drugs," Conoway said. "We need to do something about the supply and the demand. People need to realize that oxycodone can kill you."
Baltimore Sun reporter Annie Linskey contributed to this article.
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