Tag Archives: prescription drug abuse

LA Times: While board investigates, doctors’ ‘reckless prescribing’ kills

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

By zeroing in on one particular type of dangerous physician behavior, known as “reckless prescribing,” Los Angeles Times reporters Lisa Girion and Scott Glover were able to draw a powerful link between the state medical board’s inaction and patient death in an investigation titled “Dying for Relief.”

For the piece, reporters reviewed state medical board records and coroner’s files, assembling evidence that “At least 30 patients in Southern California have died of drug overdoses or related causes while their doctors were under investigation for reckless prescribing. The board ultimately sanctioned all but one of those 12 doctors, and some were criminally charged – too late to prevent the deaths.”

For its part, the board has been hit hard by state budget cuts and, the reporters write, is hamstrung because “Unlike medical regulators in other states, it cannot suspend a doctor’s license or prescribing privileges on its own, even to prevent imminent harm.” The resulting lack of oversight has led to pervasive overprescribing and uneven enforcement. For more details and a powerful narrative hook, I strongly recommend reviewing the paper’s brilliantly produced online package.

Fla. database intended to stop prescription drug abuse is largely unused

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

After years of increasing scrutiny as it sat at what appeared to the epicenter of the national prescription painkiller abuse epidemic, Florida implemented a law requiring that every prescription filed for controlled substances such as prescription painkillers be recorded in a statewide database. A year later, Tampa Bay Times reporter John Woodrow Cox has followed up to see what difference the law has made.

The answer appears to be “hardly any.” Because there is no requirement to use the system when writing prescriptions, Cox writes, “the vast majority of medical practitioners have never touched the much-touted database.” He has assembled some damning numbers to back that observation up.

  • Since the system’s inception on Sept. 1, 2011, more than 48 million prescriptions have been written in Florida for controlled substances — that’s about 2.5 for every man, woman and child in the state. Prescribers, however, checked the database before writing just 2 percent of them.
  • Among physicians in the Tampa Bay area permitted by the federal government to prescribe these potent drugs, fewer than one in 12 has ever used the database.
  • A Times reporter surveyed all 91 local pain-management clinics registered with the state and that appeared to be in business. Fewer than half reported using the program. Employees at 46 of the clinics declined to answer questions or did not respond to calls. One acknowledged never using the program.

Cox digs pretty deep into the issue, but in the end it comes down to a simple observation: When it comes to enforcement, there is neither carrot nor stick. Scrupulous voluntary use of the database would only mean less business for the “pill mills” which account for so many of the state’s prescriptions, so they have no incentive to check it and face no punishment for not doing so. The experience of other states indicates that requiring prescribers to reference the database would make it more effective, but such a mandate appears impossible given Florida’s current political climate.

OxyContin’s early poster children: Where are they now?

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

More than a decade into America’s new age of opiates, the long-term effects of the ubiquitous prescription painkillers are starting to be felt on a real, measurable scale. As part of an evolving investigation for the Milwaukee Journal Sentinel and MedPage Today, John Fauber and Ellen Gabler drive this home by following up on seven patients – and one physician – featured in an early promotional video for OxyContin maker Purdue Pharma.

Originally conceived as a teaching aid, the video was ultimately used in a marketing campaign in which Purdue sent it to about 15,000 doctors. A Purdue subsidiary has since paid $634 million in penalties for misbranding OxyContin in its various promotional campaigns but, as the reporters found, the patients who used the drug sometimes paid an even steeper price, as demonstrated by the subsequent lives of the seven “poster children” featured in that video. I’ll let Fauber and Gabler take it from here.

The subjects who spoke glowingly of their experiences with OxyContin in the video 14 years ago offer a case history of sorts.

Two of the seven patients were active opioid abusers when they died. A third became addicted, suffered greatly, and quit after realizing she was headed for an overdose. Three patients still say the drug helped them cope with their pain and improved their quality of life. A seventh patient declined to answer questions.

The doctor who enlisted his patients for the video and played a starring role, now says some of the statements went too far.

Within this broad sketch, the reporters find much room for story and nuance, touching upon everything from the impact of the drug on patients with a history of addiction to the legitimate success stories of patients who had their lives changed by the powerful narcotic. It’s a well-drawn, big-picture portrait of the swath opiates have cut through modern American, told through the lens of a unique and fascinating narrative device.

AP puts numbers on the prescription drug epidemic

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Associated Press’ Chris Hawley has worked through the latest numbers on the prescription painkiller boom, helping to illustrate the ongoing toll the opiod abuse epidemic is taking on traditional hotspots like Appalachia and emerging ones like the American Southwest and parts of New York City. Nationally, numbers continue to hit new heights.

Nationwide, pharmacies received and ultimately dispensed the equivalent of 69 tons of pure oxycodone and 42 tons of pure hydrocodone in 2010, the last year for which statistics are available. That’s enough to give 40 5-mg Percocets and 24 5-mg Vicodins to every person in the United States.

Hawley writes the numbers can be distorted by things like clinics for returning servicemembers, whose ranks have greatly increased in the past decade, as well as by mail-order clinics, but they still paint a detailed picture of where the opiods are going. Absent federal regulation, there is currently only a patchwork of state prescription drug tracking systems, many of which are not fully interoperable, but Hawley’s federal numbers help fill in the gaps.

The AP analysis used drug data collected quarterly by the DEA’s Automation of Reports and Consolidated Orders System. The DEA tracks shipments sent from distributors to pharmacies, hospitals, practitioners and teaching institutions and then compiles the data using three-digit ZIP codes. Every ZIP code starting with 100-, for example, is lumped together into one figure.

Investigation delves into Wash.’s prescription drug problem

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Everything time we think prescription drug abuse stories have peaked, something comes along to push the story further. This time, InvestigateWest’s Carol Smith sets herself apart by starting from square one and clearly explaining the origins and dimensions of Washington’s particularly nasty drug issues, tracing back each facet of the problem to its source and spotlighting what makes the Evergreen State unique.prescription-drugs

Washington has been one of the hardest hit states in the country, in part because of aggressive prescribing practices. That, coupled with lack of oversight of doctors who over-prescribe, has led to the spectacular run-up in the number of deaths from prescription overdoses.

The backdrop for her work is an epidemic that shows no signs of abating, despite a recently implemented state law Smith calls “a bold attempt to reduce overdose deaths by launching the first-ever dosing limits for doctors and others who prescribe these medicines.”

Prescription drug abuse is at epidemic levels throughout the state, and elsewhere in the country, despite lawmakers’ attempts to get a grip on it. Washington now has one of the highest death rates in the nation. Deaths from prescription drug overdoses in this state have skyrocketed nearly twenty-fold since the mid-1990s, and now outstrip those from traffic accidents.

Why caused it to leap so quickly? Smith tracks down several key tipping points. “There’s plenty of blame to go around for what caused the epidemic,” she writes. “Aggressive marketing of opiates by drug companies, nonexistent tracking of overprescribing, lack of insurance coverage for alternative treatments for pain, and demand by patients for quick fixes, to name a few.”

She drills down into many of those causes, with my personal favorites being two key origin stories:

  • How marketing by OxyContin maker Purdue Pharma led to relaxed guidelines for chronic pain treatment and a “1999 law specified ‘No disciplinary action will be taken against a practitioner based solely on the quantity and/or frequency of opiates prescribed,’” both of which helped cause a jump in prescriptions.
  • How “the rise in the death rates of Medicaid patients tracks along with the state’s cost-saving decision to move many of its poorest residents to the cheapest, most potent pain reliever available: Methadone.”

See the upper right-hand sidebar for more stories from the six-month investigation.

Web outlet pumps out dozens of stories on prescription drug abuse

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In partnership with USC’s Annenberg School for Communication & Journalism and a number of other organizations, Santa Barbara online news outfit Noozhawk (about), put together “Prescription for Abuse,” an exploration of the misuse and abuse of prescription drugs in the Santa Barbara area.screen-shot-2012-01-17-at-100653-pm In the extensive, online-only series, the reporters take a look at the problem and its underlying causes, then go a step further by exploring possible solutions as well.

In a uniquely meta twist, the series even looks at how journalism such is advancing public health goals and explains how the project came together. The series features at least 36 individual articles, by my count, and every health journalist who takes the time to browse the full catalog will come across at least a few easily localizable ideas, but in this space I’ll just highlight those stories that deal directly with the series itself:

Thieves target pharma cargo, cause shortages

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Reporting for WBBH-Fort Myers, Fla., Andy Pierotti reports that highly specialized thieves have made an art form  of snatching shipping containers in the state, slipping in like ninjas and getting away with the massive haul in fewer than 90 seconds. They’ll take anything they can get, Pierotti writes, but the big prize is a shipment full of pharmaceuticals.

An intercepted shipment, especially one loaded with rare drugs with tight supply chains, can cause nationwide shortages and price hikes, experts say. And, no matter how esoteric the product, the criminals seem to be able to find buyers.

An NBC2 investigation discovered over the last four years in Florida, thieves stole at least 24 cargo containers full of pharmaceuticals. From dialysis products to eye medicine, they were valued at $5.6 million.

Erik Hoffer, an expert in pharmaceutical cargo crime, says the evidence disappears fast.

“Those pills can be blended into real and fake, there’s no way to trace it anymore and you’ve eaten the evidence,” said Hoffer.

Local hospital administrators say they can feel the pinch when a shipment goes missing, and that the problem has worsened in recent years. There are possible solutions, but their implementation would likely spell more price increases.

Possible remedies to the problem include putting tracking devices on individual pill bottles or cartons, and a consumer interactive tool on the pill box that allows them find out [if] it was reported stolen.

The problem is, that’s expensive and the cost would likely be passed down on the customer.

The stolen drugs pose a health risk, as well. One expert says the stolen drugs can be blended with other drugs and resold, with consumers none the wiser.

Series, inquest illuminate Canada’s pill problem

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Writing for the reader-funded site rabble.ca with the help of a Canadian Institutes for Health journalism award, Ann Silversides is devoting a four-part series to Canada’s prescription drug problem, declaring the country to be a “world leader in prescription drug abuse.” Canada’s pill problem hasn’t hit the headlines with the vehemence it has in the states, but Silversides says evidence points to Canadian drug abuse that’s every bit as damaging as what’s happening south of their border.

medsPhoto by jypsygen via Flickr.

In the U.S., prescription opioids have been the leading cause of unintentional overdose deaths — far surpassing cocaine and heroin — since about 2001. The same is true in Canada, if the statistics from Ontario hold true for the rest of the country. (There is a striking lack of research in the area of prescription drug misuse in Canada, especially about the progression from use to abuse of these drugs.)

Yet in 2008, Canada had the highest rate per capita consumption of oxycodone in the world, surpassing even the United States, according figures from the International Narcotics Control Board.

The second installment in the series zeroes in on a specific Ontario inquest into two opiate overdose deaths, one which promises to shine a bright light on the nation’s broader struggle with the prescription drug abuse epidemic. Other articles in the series:

Fla. juvenile justice system relies on heavy antipsychotic use

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In looking into the state Department of Juvenile Justice’s use of powerful prescription antipsychotics, The Palm Beach Post‘s Michael LaForgia “analyzed department drug purchasing information and state Medicaid billing data and reviewed thousands of pages of DJJ inspection reports, drug company disclosure records and court documents.” It shows, as he surfaces with some powerful numbers and equally alarming anecdotes (Part 1, Part 2, Infographic).

…in state-run jails and residential programs, antipsychotics were among the top drugs bought for kids – and they routinely were doled out for reasons that never were approved by federal regulators, a Palm Beach Post investigation has found.

A key concern is that the prescriptions may be driven by their improper use as chemical restraints, or by the hefty speaker (and related) fees being paid from pharmaceutical companies to the most prolific prescription writers. Unfortunately, specifics are hard to come by as most homes are run by private contractors and the state doesn’t have the resources for close monitoring. For this story, the reporters were only able to obtain two years worth of data for 25 jails and three programs – a fraction of the statewide total. Those data still paint what LaForgia calls a “startling story.”

A look at the sheer numbers of drugs purchased … suggests a startling story is unfolding in state homes for wayward kids.

In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081 tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails and homes for children.

That’s enough to hand out 446 pills a day, seven days a week, for two years in a row, to kids in jails and programs that can hold no more than 2,300 boys and girls on a given day.

Veteran journalists speak from front lines of prescription drug epidemic

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In a subject area increasingly defined by its steady drumbeat of alarming numbers and increasingly dire statistics, the opening to a recent episode of WBUR’s On Point with Tom Ashbrook still manages to make even the most jaded readers sit up and take notice.

Prescription drug abuse is sky-rocketing in the United States as accidental overdose deaths now exceed crack deaths in the 1980s. Overdose from prescription painkillers like Oxycontin and Xanax is now the leading cause of accidental death in 17 states.

The show touches upon every point of the prescription drug epidemic, from the pill mills of Florida to the devastated counties of rural Appalachia, where entire generations have been lost. The show is driven by the expertise of guests like Louisville Courier Journal reporter Laura Ungar and The Charleston Gazette‘s Alison Knezevich, both of whom will be speaking at the June 3 lunch session of AHCJ’s upcoming Rural Health Journalism Workshop in St. Louis. The thoughts of these veteran journalists are also supplemented by a unique interactive element, thanks to On Point‘s national reach and call-in format. One example:

On Point caller Michelle in Carter County, Ky., grew up with her mother addicted to prescription medications.

“We would wake up in middle night and have to put her to bed because she was like a zombie,” Michelle said. “It was like no one was there.” Michelle is now going to school to be a drug abuse therapist.

A summary of the show is available online, as is an MP3 of the entire broadcast.