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July 12, 2009 -- Sarasota Herald-Tribune (FL)

Editorial: Prescription For Abuse

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Florida's medical examiners recently released another report that shows another annual increase in the number of prescription-drug overdose deaths.

The report concluded that prescription medicines caused more deaths in 2008 than illicit drugs -- a multi-year trend.

The medical examiners also reported sharp increases in deaths caused by prescription tranquilizers and painkillers such as oxycodone and hydrocodone.

The results of the year-end report weren't surprising: An interim report covering the first six months of 2008 indicated that the upward trends in drug-caused and drug-related deaths would continue throughout the entire year. Since the middle of last year, responsible physicians, pharmacists and law enforcement officials have warned that a near-epidemic of deadly prescription-medicine abuse was continuing.

Annual Increases

In 2005, the Medical Examiners Commission began reporting the drugs discovered in bodies subject to autopsies. The percentage of decedents with at least one drug in their bodies has increased each year -- to 53 percent last year.

"The vast majority" (4,924) of the 8,556 drug-related deaths studied last year by the state's medical examiners involved the presence of more than one drug, according to the 2008 report. The presence of at least one prescription drug caused the death of 2,184 people last year, in the opinion of medical examiners conducting autopsies.

To put the scale of those numbers in perspective, consider: There were 2,983 deaths on Florida's roads last year; 1,169 of those fatalities were alcohol-related.

Framed another way: Prescription drugs caused more deaths than alcohol-related crashes in Florida.

In addition to identifying and reporting the drugs found during autopsies, the medical examiners determine how many deaths are directly caused by drugs -- including alcohol, heroin, cocaine, tranquilizers and narcotic painkillers.

The report for 2008 states:

The drugs found most frequently in decedents were alcohol (4,070 cases), sedatives classified as benzodiazepines (3,229), cocaine (1,791) and oxycodone (1,574).

Of particular concern: Death-related occurrences of both benzodiazepines and oxy-codone were up by more than 20 percent in 2008 compared with 2007.

Cocaine-related deaths, by contrast, were down almost 18 percent.

In the three-county district composed of Sarasota, Manatee and DeSoto, the painkillers hydrocodone and oxycodone were involved in 81 deaths last year alone.

The drugs that caused the most deaths in Florida: oxycodone (941), benzodiazepines (929), methadone (693), cocaine (648), alcohol (489), morphine (300), hydrocodone (270).

In comparison, medical examiners in Florida said 55 deaths were caused by propoxyphene -- a synthetic narcotic marketed under the trade name Darvon or Darvocet.

The U.S. Food and Drug Administration issued a special alert last week, saying it was "taking several actions" because of "data linking propoxyphene and fatal overdoses." The FDA ordered a new study of this drug and said the findings "could lead to additional regulatory action."

Considering the much-higher number of deaths in Florida linked to drugs other than propoxyphene, the FDA should reassess the safety -- and overuse or prescription -- of a wide range of painkillers and sedatives.

Painkillers and sedatives are essential to countless patients in Florida and the nation, so any efforts to control their prescription, sale and use must be carefully calibrated; ideally, a broad coalition of doctors, pharmacists, regulators and law enforcement officials would create model monitoring programs based on collaboration.

Unfortunately, the participants in the entire system -- from health care and medicine providers to medical examiners and regulators -- lag behind the trends.

It takes the medical examiners six months to compile and report their data publicly, so it's hard to tell how many drug-related deaths have occurred so far this year.

But a startling example of the potency and availability of drugs occurred recently, when a North Port teenager was found dead with drugs in his system; his parents were arrested for conspiring to sell oxycodone.

Portrait Of The Problem

An autopsy showed that 15-year-old Nicholas Block had opiates, cocaine and tranquilizers in his system when he died. Those findings are consistent with reports from witnesses and police that Block had snorted crushed oxycodone.

His mother and stepfather -- Linda and Billy Jack Courtright -- were later charged with conspiring to sell oxycodone. In an affidavit, a federal agent says the Courtrights filled two prescriptions for 250 oxycodone pills only days prior to their son's death.

The Herald-Tribune regularly contains lower-profile stories about arrests and deaths related to the overuse or illegal acquisition of prescription drugs. The problems are likely greater since autopsies aren't conducted in the majority of deaths.

This year, the Legislature finally passed a law that calls for creating an electronic database to monitor the prescription and sale of certain painkillers and tranquilizers. The database should help investigators track the worst offenders, but it won't be operational until late next year and even proponents of the law concede it was watered down.

In the meantime, the Sarasota County Sheriff's Office will create a special team aimed at pursuing violations of prescription-drug laws and building partnerships with responsible physicians and pharmacists.

Other initiatives, locally and statewide, are likely to be necessary because, unfortunately, the personal and societal problems associated with the misuse of prescription drugs aren't getting better.

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