CDC studies prescription overdose deaths in West Virginia Two-thirds of drugs involved had no valid prescription By Scott Finn Studio lead: It’s not every day that the federal Centers for Disease Control comes into a state to study the outbreak of a disease. And that disease is usually something like e-coli that’s spread through contamination. But the CDC has teamed up with state researchers to study another killer: overdoses caused by prescription drugs. West Virginia leads the nation in its rate of overdose deaths, and researchers are gathering clues about just who is dying, and why. Scott Finn reports. Finn: Three-hundred and thirty two people died in West Virginia from accidental drug overdoses in 2006. A young woman from Mingo County, who we’ll call “Kelly,” says she almost became number 333. Kelly: They called the ambulance to come get me. I was blue. Five more minutes and I’d have been dead. I remember waking up in the hospital and I couldn’t open my eyes, but I could hear people talking around me. And I felt a tube in my chest, it was awful. And I could feel them bring it out, you know how they has those little ripples on them? I could feel it like bumping on my chest. Oh, it was so painful. I could hear my dad, “She took methadone and Xanax. She took methadone and Xanax.” And they had given me a shot to reverse it. Finn: But an increasing number of young people are not so lucky. Drug overdoses are now the leading cause of death for young adults in West Virginia – more so than cancer, heart attacks, and car accidents. It’s gotten bad enough for the federal Centers for Disease Control to notice. They’re helping state officials to figure out just what’s behind this epidemic. They looked death certificates to find out who is dying. The average victim was a man in his thirties, living in southern West Virginia. More than half the victims had a history of chronic pain, mental illness or substance abuse. And most of them did not have a prescription for the drugs that killed them, according to Dr. Aron Hall, the CDC’s Epidemic Intelligence Service Officer for West Virginia. Hall: Approximately a third the drugs that killed individuals were valid prescriptions, were validly prescribed products, which means that most of the folks that are dying from prescription drug overdose are obtaining those drugs through non-sanctioned means. Finn: The researchers ran the victims names through the state’s prescription drug database. They found strong evidence of “doctor shopping” among some of the victims. That’s where patients get multiple prescriptions from several different doctors. The average victim had been to three doctors and three pharmacies in the last year. Some went to a lot more. Hall: So there were some individuals out there that sought and got prescription controlled drugs from 22 different providers in the one year prior to death, which is just alarming. Finn: And that’s not even counting patients who crossed into a neighboring state to doctor shop. More than 90 percent of the victims died from prescription drugs, mostly narcotic painkillers with names like OxyContin, Vicodin…and especially, methadone. Hall: Well methadone specifically was the number one drug contributory to these overdose deaths. And we found that overall in 2006, about one-third of the unintentional overdose deaths involved methadone. Finn: Unlike these other drugs, methadone has a dual purpose. It can be used in drug treatment, or it can be prescribed for pain. Of the more than 100 methadone overdose victims, only 10 were involved in drug treatment. Hall says that tells him that the main problem isn’t the methadone clinics – it’s methadone prescribed for pain. One question the researchers are looking at is why the problem is worse in West Virginia than in some other states. Hall says we have a surplus of both poverty and painkillers. Hall: Unfortunately, West Virginia is a relatively poor state, has overall relatively low level of education in our population. In addition, we have industries present that can be associated with high levels of injury, certainly our coal mines and other types of blue collar industries that may be associated with work-related injuries that can lead someone to develop pain problems and eventually down this path to using prescription narcotics. Finn: Still, West Virginia has always been poor and injuries have been high for decades. But this epidemic of overdoses didn’t start here until about ten years ago. That’s when a national movement started to treat pain more aggressively, says Dr. Dee Bixler, director of infectious disease epidemiology for the West Virginia Bureau for Public Health. Bixler: It’s pretty clear it’s a national problem that began about the same time as expert societies were recommending that physicians do a better job, appropriately so, of managing patients with chronic pain. There was a lot of publicity about inadequate treatment of chronic pain. The next thing that happens is a tremendous increase in distribution of opioid medications through legitimate channels, to pharmacies, to hospitals. However at the same time, there is also an increase in illicit distribution or diversion, as it’s called. Then we start seeing increased emergency room visits, and most alarming, increased deaths. So it’s really quite a remarkable and startling history that unfolded in the last ten years. Finn: Bixler and Hall plan to continue their study. But they say it’s not too early to educate the public about how to prevent these deaths. Bixler: We don’t understand this problem as well as we would like, but we have enough information now that physicians need to be talking to patients about this, and parents need to be talking to children. The word needs to get out. Hall: Most folks tend to get these drugs from people they know, and not necessarily paying for them, which really speaks to the potential utility of keeping your prescription drugs under lock and key, or just more closely guarded at the very least. Now that prescription drug deaths or poisonings in general have surpassed drug deaths, perhaps we should be keeping our prescription drugs under lock and key, just as we would a firearm. Finn: In southern West Virginia, more adults in the prime of their lives are showing up in the obituary pages of local newspapers. Kelly, the young woman who nearly died from a methadone overdose, says she thinks she knows why. Kelly: I know they do die at home. That’s why when I read in the newspaper and I read obituaries and I see, such and such, 30 years old, died at home, that’s what you immediately think is, that was probably an overdose. Because people don’t usually die at home. There’s something wrong with them. They go to the hospital. Unless it’s an overdose. Finn: For West Virginia Public Broadcasting, I’m Scott Finn in Charleston. Outcue: You can find more information about this story in the Charleston Gazette, at wvgazette.com. Or you can find those links on our website: wvpubcast.org.