In Southwest Florida the deadliest drugs are legal

Over-the-counter medications like Advil or Tylenol are easy to get for your aches and pains. If that doesn't do the trick, prescription drugs called opoids are available from your doctor or pharmacy. Heroin's an opoid, but so are painkilling pills with brand names such as Vicodin and OxyContin.

And for stress there is benzodiazepine, in drugs like Xanax or Valium.

They are all commonly prescribed but now cause nearly three times the number of deaths in Florida than all illegal drugs combined, according to a Florida Medical Examiners report released this summer.

Southwest Florida Addiction Services CEO Kevin Lewis called the statistics, "pretty stunning data."

Records show the popularity of opiate-based pain medication has grown steadily over the last 10 years to surpass cocaine and all legal and illegal drugs as patients' drug of choice in the region.

In 1997, more than half the patients landed in local detox facilities because they were alcoholics. Now, more than half are there because of an addiction to opoids, mostly pain medications.

"People are addicted to opoids because, more and more, the pills are prescribed at pain clinics," said Dr. Washington Baquero, SWFAS medical director. "It's the main problem with addiction in this community."

Opoids led to the most deaths, the Medical Examiners report said (2,328); and of the opoids, Methadone caused the most deaths (785), followed by Oxycodone (705) and Hydrocodone (264).

Opoids can create a feeling of euphoria for a few hours and in many cases, are prescribed by doctors after only a quick walk-in appointment.

Local law enforcement, physicians and addiction specialists say Florida is out of control when it comes to legal, prescribed pain medication. And, there are no centralized records to keep track of who prescribes what and to whom.

Baquero said physicians are caught in a conundrum as a result — there is often only the patient's word, to know if he/she has genuine physical pain. Some people doctor-shop to find one who will give a prescription or they'll try to get drugs at more than one clinic.

"Many times patients come to the office and they lie about that," Baquero said. "They're taking medication from somebody else and they want more and there's no way for you to find out about that.

"Let's say you come to my office; I don't know you from anything. I take whatever information you give me as the truth. Let's say you're a drug addict looking for Vicodin. They know exactly what to say, and when to say 'ouch' when you examine them."

Thirty-eight other states have passed laws that allow doctors to know if you've been elsewhere looking for such drugs; or if you are a doctor who prescribes them indiscriminately, but not Florida.

Lawmakers considered a statewide database recording prescriptions, but ended up saying no, because of fear that it could violate patients' privacy rights.

"Each year it's brought up in the legislature," CEO Lewis said. "And it's defeated on a civil libertarian basis. It's a privacy issue."

Some say the time it would take to create a centralized database, if it is only to help keep addicts clean, might be better spent on other areas of pharmaceutical mismanagement.

Local law enforcement, physicians and addiction specialists say Florida is out of control when it comes to prescribed pain medication...

Doug Hepler, professor emeritus in the College of Pharmacy, the University of Florida, wrote a book about how prescription drugs are mismanaged by doctors and pharmacists. But he said opoid medications are a small, over-publicized part of how prescription drugs can be misused.

 

"We're just sort of preoccupied from preventing some junky from getting Vicodin," he said.

He also added, "I would be in favor of a system that would allow pharmacists and patients to know a patient's drug regimen if it improved therapy. But those are a couple of big Ifs…if that was all one big network, then people could see that was happening and prevent (drugs being prescribed to addicts)."

Hepler surmises that in an effort to keep costs down in a burdened economy, doctors, patients and pharmacists communicate less, and it leads to the misuse of opoids and many other types of drugs, especially those that treat asthma.

"Cost containment pressure sometimes has the effect of reducing doctor or pharmacy encounters, thereby removing some opportunities for frequent follow-up and monitoring of the effects of therapy," he wrote in an e-mail. "The professions need tougher standards or regulations encouraging them to work cooperatively in the management of drug therapy."

Pill law

 

However unethical, doctors who write any prescription might benefit by getting kickbacks from drug companies; or they might make a good living at charging patients $50 for an examination, Dr. Baquero said. Those practices are called "pill mills."

"There's a certain amount of people using prescriptions for ulterior motives and there's a certain amount (of doctors) that write them," Lewis said.

The Lee County Sheriffs Office didn't point fingers directly, but officials said they are aware that pill mills exist in Lee County. The Florida Department of Health sometimes works with law enforcement to find doctors who prescribe inappropriately.

Lewis

"Not every doctor or pain clinic is bad," said Sgt. Mark Shelly, with the Lee County Sheriff's Pharmaceutical Investigations Law Enforcement Strategy, which has made 200 arrests so far this year. "But just like everywhere, a few are bad."

Investigators like Shelly work with databases from pharmacies at Walgreen's, CVS and Publix.

 

"The pharmacies are working alongside us pretty closely right now," Shelly said.

This fall, the sheriff's office is planning to ask Lee County residents to bring all their unused prescription drugs to local Wal-Marts instead of leaving them in their cabinets where kids might find them. And Sheriff Mike Scott started the PILS unit two years ago due to the widespread illicit sale and use of prescription drugs.

"Among youths, (prescription drugs) are the most sought-after drugs after marijuana," said Shelly.

Between 2003 and 2007, 119 Florida doctors were disciplined for inappropriate prescribing and faced consequences such as having their medical licenses revoked or suspended; and getting more education, fines and community service, according to the Florida Department of Health.

Baquero

A few have faced prison terms.

For selling the prescription pills on the street, patients also face strict consequences. Selling opoids illegally can come with a mandatory three years in jail, said Shelly. (Sentencing is less strict for benzodiazepines such as Xanax, which caused 743 deaths last year, according to the Medical Examiner's report.)

Opoids sell on the street for about $7 to $25 each. Roxy Codon, or "blues," the 30-milligram pill, is the most popular variety in Lee County now.

"We're taking thousands of pills off the street," Shelly said. "It's not one part of town; it's everywhere."

Lewis agreed that the pills are popular across every socio-economic boundary.

"It's not a 'them' thing," he said. Undercover cops buy about 50 pills off the street each day, Shelly said.

Drug culture

 

Lewis said some of the increase in pills prescribed points to a more general change in the philosophy of pain management.

"This becomes a part of that culture where all answers come to pills," he

said. Access to the drugs has played a part: there are simply more prescription pills out there — in medicine cabinets or wherever. Lewis said he was prescribed an opoid about a year ago after surgery; 40 pills. He took one and still has 39 at home.

Also, as more people become addicted, their desire for the drug doubles and triples as they build up a tolerance and need increasingly larger doses. Lewis said advertisers tout drugs in general more than ever.

"We continue to promote the belief that no one has to feel any discomfort, whether emotional or physical," he said. "I keep hoping for that world, but it hasn't happened yet."

Is our society simply overmedicated?

 

"In general, yes," Lewis said.

Ironically, a new opiate based medication called Suboxone is helping SWFAS detox patients get off another opiatebased med, OxyContin. The success rate for withdrawal went up by about 30 percent when Suboxone was introduced in 2005.

It is trading one addiction for a lesser one, like using a nicotine patch instead of smoking a cigarette. Suboxone must be dissolved under the tongue for it to have any effect.

The most dangerous drugs

 

Dr. Baquero said Methadone is especially lethal. Although the effects of one pill wear off in four hours, the drug stays in your body for 48 hours. Patients often overdose by taking too many pills over the course of a few days, not realizing the drug is building up in their system and may ultimately cause their heart to stop.

Drugs with benzodiazepine, such as Xanax, Lithium and Valium, which are used to treat anxiety, caused 743 deaths.

They can be especially dangerous when paired with alcohol, because the two drugs multiply each other's effects.

"Two benzodiazepines and two Bud Lights don't equal four," Lewis said. "They equal eight."

Cocaine caused 843 deaths, inhalants 11 and marijuana none.