Tuesday, March 11, 2014
First of six parts
A pharmacist counts out Vicodin pills at a pharmacy in Portland last week. Maine was one of the first states to see an explosion of painkiller addiction and it remains among the worst states in the nation for pill abuse. The human and societal costs associated with the epidemic – almost 1,400 Maine people have died from pharmaceutical drug overdoses in the past decade and thousands more need treatment for addiction – are staggering, experts say.
Gregory Rec/Staff Photographer
PAINKILLERS IN MAINE: Stories, video interviews and links to resources.
Ten years ago, Maine’s former U.S. attorney called prescription pain-pill abuse “the greatest criminal problem and possibly the greatest social problem facing Maine.”
The problem, as it turns out, was just getting started.
Maine was one of the first states to witness the explosion of prescription painkiller addiction, and its pill habit, still out of control, is among the worst in the nation. The damage continues to pile up.
Nearly 1,400 Mainers have died from pharmaceutical drug overdoses in the past decade. And all residents bear the costs of the abuse. They pay for the pills, police the crime and care for and treat the addicts.
Substance abuse in Maine is now estimated to cost $1.18 billion a year, or $900 for every man, woman and child, and much of that comes from misuse of prescription drugs.
“It’s extraordinary how deep this epidemic has gone,” said Dr. Mark Publicker, an addiction specialist in Westbrook. “It was eating its way through the culture, and it was diagnosed too late.”
Now human and social costs are at historic highs, leading to a renewed urgency to fight back.
• Overdose deaths from pharmaceuticals in Maine set a new record in 2009 – 165 – and for the first time exceeded the number of Mainers killed in motor vehicle accidents. One hundred and sixty-two Mainers died from the drugs in 2010, the second-highest year on record.
• Pill abuse continues to rise among teens, according to experts. Nearly one in four high school seniors in 2009 – 23.6 percent – said they have used prescription drugs that were not prescribed to them.
• A record number of Maine babies – 572 – were born last year to mothers who were known to have used painkillers or other drugs during pregnancy, more than triple the number in 2005. Most of the babies experienced painful opiate withdrawal and spent their first two weeks in the hospital.
• Crimes driven by pill addiction – especially pharmacy robberies and home invasions – are becoming more common and more dangerous, according to police statewide. These crimes have turned county jails into busy detox centers.
• Prescription pain pill addicts are seeking treatment in record numbers – nearly 4,000 last year. Maine has more people per capita in state-funded treatment than any other state, eight times the national average, according to federal and state data.
After a decade of efforts to contain the abuse, Maine’s Legislature and the Attorney General’s Office are among those calling for a more aggressive, coordinated response. A seven-year-old effort to track opiate prescriptions statewide, for example, has never been put to full use because of limited resources and participation.
“I think there’s enough fault to go around for everybody,” said Jay McCloskey, who sounded the alarm as Maine’s U.S. attorney a decade ago and is now in private practice.
The 10-year toll and Maine’s inability to contain the epidemic come as little surprise to those who have experienced addiction.
“It just really quickly takes control. And then it takes and takes,” said Daryl Blums, a 27-year-old recovering addict from the Sanford area.
Painkiller abuse is the side effect of powerful new pain relievers introduced more than a decade ago.
Drug makers targeted Maine physicians with promises that the pills were safe and effective. And doctors who took an oath to relieve suffering felt they could no longer allow pain to go untreated, at least not without violating their oath and losing patients.
Maine’s fishermen, loggers and other physical laborers provided plenty of demand for the new pain medications, and the prescriptions flowed. Maine has been a consistent leader in the prescribing of narcotic painkillers such as oxycodone.
Teens and others quickly figured out how to crush the pills and snort the powder to get the full euphoric rush of the synthetic opiates, which are as powerful and addictive as heroin and morphine.
As a rural state at the end of the distribution network, Maine didn’t have a lot of experience with hard drugs such as heroin and cocaine.
But now, here was a drug delivered to every community in pure, pharmaceutical-grade, precisely measured doses.
Experienced drug users loved the pills because they could trust them to work. The inexperienced considered them safer than street drugs.
And there was a ready appetite for the pills, especially among teens and among adults wanting to wash away depression or escape the stress of unemployment and financial insecurity.
Police, meanwhile, were all but powerless to keep the pills out of the wrong hands.
“Drugs used to come from foreign countries and people would smuggle them in,” said Penobscot County Sheriff Glenn Ross. “Today, they are in the medicine cabinets of our homes.”
At first, prescription opiates – also called opioids – give a warm, on-top-of-the-world feeling, users say. Pretty soon you need larger amounts to get high.
Then one day you feel like you have a horrible flu – pain, vomiting, sweats and chills – and you realize it’s because you missed a dose.
Opiate receptors in your brain, spine and intestines have gone into a kind of shock.
Opiate withdrawal doesn’t kill you, but addicts say you wish it would.
“You don’t have a care in the world when you’re on it. And when you can’t get it, it’s the worst experience in the world,” said Chuck Lawson, a recovering addict in Portland.
Some addicts say it took them as little as two weeks of regular use to get hooked.
The extreme highs and lows physically change an addict’s brain. Getting the next dose becomes the first thing – and sometimes the only thing – on an addict’s mind.
Some addicts, chasing the high and trying to avoid withdrawal, mix painkillers with Xanax or other anti-anxiety pills or dissolve the pills and inject them directly into their veins. Both push addicts closer to a potentially fatal overdose.
“Once you got past a certain point, there is no going back,” said 31-year-old Nicole Martin, a recovering addict who injected the drugs and used heroin when she couldn’t get pills. “Anything you say you haven’t done yet, you will do eventually.”
Finding the drugs is rarely a problem, addicts say.
Users share them, buy them, steal them, forge prescriptions for them and, if desperate enough, trade sex for them. Some go out of state to get the drugs, including to Florida’s so-called “pill mills” – clinics that offer painkiller prescriptions for cash.
Many addicts get prescriptions from their local doctors – sometimes for real pain and often not.
Some are even bold enough to file false police reports of pill theft so they can convince their doctors to give them more.
Those with their own prescriptions get their pills on the cheap – MaineCare and private insurance cover most of the cost.
And they quickly learn they can sell their pills for as much as $30 to $100 apiece depending on the type and strength. Addicts buying their pills on the street can spend $100 to $400 a day to feed their habits.
That gets very expensive, said Blake Carver of Portland.
Carver, now 24, was a teenager when he started breaking into houses looking for money to buy “Oxys,” he said. And he always cleaned out the medicine cabinets in the homes he robbed.
“Even if there wasn’t something I wanted, I knew somebody who would,” he said.
‘NO FAMILY IS IMMUNE’
The epidemic has affected Mainers of all ages and backgrounds – middle schoolers and senior citizens, clam diggers and doctors.
“No family is immune from this particular issue,” said Troy Morton, chief deputy of the Penobscot County Sheriff’s Office. “They are the youngest of kids, in their early teens, and people in their 70s. They are the poorest of the poor and the richest. There are no boundaries.”
Abuse often starts among teens, who don’t understand the danger and are more vulnerable to addiction. Addiction, meanwhile, is most common among young adults who were in their teens when the pills first flooded into Maine communities.
Thirteen percent of Mainers age 18 to 25 said they abused painkillers in the past year, according to the 2009 National Survey on Drug Use and Health, the most recent available. The rate is 6 percent of 12- to 17-year-olds and 4.7 percent of all Mainers over 12 – a total of 52,000 people.
The overall cost of painkiller abuse in Maine is not known. Through taxes, health insurance premiums and higher medical costs, Mainers are helping to supply the pills, pay for emergency room visits, investigate crimes, lock addicts in jails and provide the treatments to help them get sober.
Opiate addiction treatment alone costs Maine taxpayers millions of dollars a year. The state spends about $12 million a year on substance abuse treatment programs, not including its share of MaineCare coverage for treatment services. Painkiller addiction accounts for about one-third of substance abuse treatment admissions.
However, every dollar spent on treatment saves as much as $12 in medical care and crime-related costs, according to Maine’s Office of Substance Abuse.
Opiate abuse – including both heroin and prescription painkillers – was responsible for 30,451 emergency and outpatient hospital visits in Maine in 2008, a 28 percent increase from the year before, according to a May report.
Pharmacies have banklike security, with surveillance cameras and tracking devices, and still get robbed repeatedly in some cases.
County jails and state prisons are straining financially to hold and care for all the addicts arrested for drug-related crimes.
State government, the medical community, law enforcement, drug makers and others have all taken action to try to contain the problem. There are new prescribing guidelines, tamper-proof prescription sheets, overdose prevention campaigns and collection drives for unused drugs.
Experts say many of the efforts have helped keep the abuse from doing even more damage.
But frustration is clearly peaking after a decade of watching the problem steadily worsen.
“It just seems that if we’re leading the way with this problem, we ought to show some leadership in dealing with it,” said Rep. Jon Hinck, D-Portland.
Hinck proposed a bill in the Legislature earlier this year that would have established new rules for doctors, including a requirement that they check patients’ medication records before prescribing them painkillers. The proposal failed, but lawmakers instead created a study group that is due to propose policy changes by Dec. 1.
McCloskey, the former U.S. attorney, said the state and federal governments have not devoted enough resources to educating kids about the dangers of abuse. “It hasn’t been a priority,” he said.
McCloskey, meanwhile, took criticism himself after leaving the federal government in 2001 and working as a consultant for the maker of OxyContin. McCloskey still maintains the pharmaceutical industry is not to blame for the abuse. “If we don’t reduce the demand for drugs we’ll never be successful.”
Most now agree that pill abuse is so entrenched in Maine’s culture it will take more than doctors or state agencies or police alone to control it.
“People want to point a finger. Let’s blame the pharmaceutical companies. Let’s blame the physicians. Let’s blame the druggies. (Some) people still think it’s a problem of will power,” said Marcella Sorg, a forensic anthropologist at the University of Maine’s Margaret Chase Smith Policy Center. “The reason we haven’t been able to tackle it is because it’s so darn complicated.”
Maine Attorney General William Schneider has invited leaders in government, law enforcement, medicine, education and addiction treatment to attend a one-day summit Oct. 25 and come up with a coordinated action plan.
“It’s staggering,” Schneider said. “I don’t think it’s going to be solved by any one particular tactic, but I think if we choose several different tactics we can make a difference.”
Those who have experienced addiction first-hand have no easy answers, either.
The pills are too easy to get and too powerful, said James Cox, a 31-year-old recovering addict in Jonesboro.
“I don’t think they’ll ever get rid of it,” he said.
Staff Writer John Richardson can be contacted at 791-6324 or at:
click image to enlarge
“It’s extraordinary how deep this epidemic has gone,” Dr. Mark Publicker, an addiction specialist in Westbrook, says of prescription pain-pill abuse. “It was eating its way through the culture, and it was diagnosed too late.”
Gregory Rec/Staff Photographer