Handle with care
by MARK ST.J. COUHIG
The death by overdose of Lillian Star Taylor has brought the subject of prescription drug abuse to the forefront on the peninsula.
The 13-year-old Port Angeles girl was found dead while camping in August. She died of a methadone overdose.
Sgt. Lyman Moores of the Clallam County Sheriff's Office says the report indicated Taylor took about 10 pills.
How she got the pills is still unknown, Moores said.
Many news reports noted methadone often is used by those who are hoping to break the heroin habit. Less well known is its use as a treatment for chronic pain.
A 2009 study by the Washington State Department of Health showed methadone was involved in 64 percent of the state's fatal overdoses on prescription opiate drugs, more than double the rate of overdoses on oxycodone or hydrocodone.
Dr. Ronald J. Bergman, MD, MPH, a family practice/occupational medicine physician practicing at the Lower Elwha Health Clinic, says that properly administered, "Methadone is an excellent medicine for pain."
Bergman, who specializes in pain management, is also one of the leaders of a new effort to keep these drugs out of the hands of youths and to ensure they aren't abused by adults - including patients who have been prescribed the drugs.
State Attorney General Rob McKenna says accidental overdoses from narcotic pills account for more deaths than all other illegal drugs combined, including methamphetamine.
Bergman puts a slightly different spin on the statistics, saying, "They're called overdoses, but who knows?"
Sequim Police Officer Maris Turner confirms there is a problem with prescription drug abuse.
"It's very common. They buy it on the street. Or kids can get it from Mom and Dad. That's why there's a big push for the prescription drug take-back program."
The drug take-back program formerly was handled in Sequim by Frick Drug, but with the sale of its pharmacy operations to Walgreens, Frick's no longer is taking back prescription drugs. Left-over drugs can be brought to the Sequim Police Station in Sequim Village Center.
The University of Washington's Alcohol and Drug Abuse Institute provides statistics supporting the need for such a program, saying more than 30 percent of the 10th-graders who used prescription painkillers as a recreational drug in 2008 got them from a friend. Another 21 percent had their own prescription from a doctor or dentist. Fifteen percent said they took the drugs from their own home or another home without permission.
Solving the problem
Bergman says the nature of his job helped him "morph" into advocacy for reducing prescription drug abuse. "I prescribe opiates. That's what I do," he said.
He's now working on solving the problem "from the top down" by serving as an advisor to McKenna's prescription drug abuse reduction efforts and by working to support new legislation. He's working from "the bottom up" through his work at the Elwha clinic and in concert with Dr. Jane Pryne, superintendent of the Port Angeles School District. The two are part of an effort to "see how we can communicate with young people."
Their message, he said, concerns nutrition, exercise and other healthful choices. Bergman also said they're trying to make the point that "it's OK to graduate. It's OK to do well in school."
Bergman is working to reduce the supply of drugs but he also believes if you have a demand, "someone's going to fill it."
Sgt. Sean Madison of the Sequim Police Department says the street price of OxyContin is now about a dollar a milligram, with 80-mg tablets the most popular. OxyContin is highly prized, Madison said, because it can be easily crushed and smoked. "That's how they take it," he said.
Lock it up
Bergman is blunt: "I'm worried about the kids."
He said the drugs of choice are "alcohol, marijuana and prescription drugs - in that order."
"When you put those together with driving, you have a potentially deadly combination. Most of the young people get (prescription drugs) from the family's medicine cabinets. One or two go missing but aren't missed."
Bergman says Vicodin, Percocet and OxyContin are the most likely to be abused. He also said younger people are abusing codeine-laced cough syrups.
"If you don't need these, get them out of your cabinet," he said. "If you do need them, get a lock box."
Bergman noted a lock box provides privacy, reduces the opportunity to steal your medications and keeps them away from children, "who may think they're candy."
Lock boxes are available at pharmacies for about $18, Bergman said.
He said it's also important to get across to youths a simple message: Prescription drugs aren't safe.
"In the past they didn't think they were dangerous. The dentist gives out Vicodin ... the FDA has approved them. But they are dangerous, especially in combination with alcohol and other drugs."
Bergman ties the prescription drug abuse issue to larger social concerns about today's younger generation. "We're squandering a great resource and we don't know why."
Parents who grew up in the 1960s should take no comfort from their experience, he said, noting the issue is greater now than in the days of sex, drugs and rock 'n' roll.
Many of those who are now abusing drugs will recover, he said, but many won't.
Doctors play a role
Bergman said his fellow chronic pain physicians
sometimes have contributed to the abuse of prescription drugs.
"We as health care providers are probably prescribing more than is needed to control pain. We're looking at backing down."
He also says the current system lacks proper controls. "There's generally no way for a doctor to know what another doctor has prescribed," he noted. He's working with McKenna to secure funding for a prescription monitoring program, a "real-time" system that will allow all the stakeholders to know "when Mr. Jones has a prescription filled at one pharmacy, then goes to another."
"It needs to go to all 50 states," he said.
He also is supporting the work of a Washington Department of Health committee that is formulating new guidelines for physicians involved in pain management. Under the new rules, doctors would be required to explain to patients the risks and benefits of the various treatment options. Doctors also would have to explain that "other treatment modalities may be necessary."
Bergman wants to see greater use of complementary treatments, including acupuncture, massage and pain management support groups.
"Let's look at other modalities," he said, noting "they have established records of effectiveness."
The rules also would put greater responsibility in the hands of the patient, especially those at special risk of medicine abuse. That might include agreeing to provide blood or urine samples for screening, as requested, and signing a written release allowing authorities to report any abuse.
Bergman said he's working with Dr. Scott Kennedy, Olympic Medical Center's chief medical officer, to incorporate the new protocols into their treatment choices.
Reach Mark Couhig at firstname.lastname@example.org.