PRESCRIPTION DRUG DEATH TOLL RISING, AGAIN

Fatal overdoses from prescription drug abuse in Western Virginia
continue unabated.

The death toll from prescription drug abuse in Western Virginia is on
the rise again.

Following a year in which fatal overdoses declined slightly, the
total for 2005 is nearing another record, according to figures
compiled by the state medical examiner's office in Roanoke.

Autopsies have confirmed that 174 people in the western half of the
state died in the first nine months of 2005 from drug overdoses,
usually after abusing prescription painkillers. Because lab tests
needed to complete an autopsy can take several months, final numbers
will not be known for some time.

But if the last three months of 2005 follow the same pattern -- and
assistant chief medical examiner William Massello expects that they
will -- the annual tally of drug deaths could exceed 230.

That's more than twice the number in 2000, and three times the level
from a decade ago.

"It is absolutely devastating to the community and the families,"
said Martha Wunsch, an associate professor and chairwoman of the
addiction studies program at the Edward Via Virginia College of
Osteopathic Medicine in Blacksburg.

Fatal drug overdoses are claiming more people in the mountains and
valleys of Southwest Virginia than on the streets of the state's more
urban areas, Wunsch said.

With drugs such as cocaine and heroin harder to find in the state's
rural reaches, pills are more popular. At the same time, a high rate
of injuries from industries such as coal mining, logging and farming
means there's more pain medication available.

"Until they come up with an alternative management for pain, another
wonder drug to replace the opioids, I think we're going to keep
seeing this," Massello said of the high overdose numbers.

Continuing a prior trend, methadone was the leading killer last year,
accounting for 55 of the 174 deaths through September.

Methadone is a double-edged narcotic. It can ease pain when
prescribed by physicians as an analgesic, and curb addiction to
opium-based drugs when dispensed at methadone clinics. But it can
just as quickly put people who abuse the drug into a deep sleep from
which they never wake up.

Through a grant from the National Institute on Drug Abuse, Wunsch is
researching the region's fatal overdoses in an effort to explain the
escalating numbers.

She hopes to determine why methadone is so lethal. One theory is that
abusers often mix the pill form of the drug prescribed by doctors
with benzodiazepines, or tranquilizers such as Valium and Xanax. The
result may be a mix far more deadly than benzodiazepines combined
with other drugs, such as OxyContin or Lortab.

That's because methadone stays in the blood system longer and can
build up over time to a toxic level. In other words, abusers can take
the same amount of methadone on a Friday and Saturday with no ill
effects, only to die on Sunday from the same-size dose.

Another reason for methadone's high death rate may be its rising
popularity in the wake of negative publicity about OxyContin and the
high-profile prosecutions of a few physicians who heavily prescribed it.

"With all of the gnashing of teeth and concern about OxyContin, many
doctors have switched from OxyContin to methadone for the treatment
of pain," Wunsch said.

Virtually all of the deaths from methadone have been from the pill or
wafer form prescribed by doctors and not the liquid form dispensed by
drug treatment clinics, said Massello, who is joining Wunsch and
toxicologist George Behonick in the research grant.

Although final conclusions are a long way off, the researchers have
found some early trends:

n The victims are predominantly white and young, many in their 20s.

n Most of them die with two or three different drugs in their bloodstream.

n Women are dying in greater numbers from prescription drug overdoses
than from street drugs such as cocaine and heroin.

In Tazewell County, one of the parts of Southwest Virginia hardest
hit by the problem, Commonwealth's Attorney Dennis Lee was not
surprised by the latest overdose numbers.

Hardly a month goes by that he doesn't hear about another drug
fatality in the county, Lee said. And it seems more and more that the
victims are in their 20s or teens.

That doesn't necessarily mean young people are dying the first time
they try a new drug, though.

"OxyContin has really changed the entire landscape," Lee said. "We're
seeing people who go from experimenting to hard-core IV drug use
within a matter of months."

But in a county where masked women have robbed retirement homes of
their medications, and where some pharmacies have stopped stocking
the drugs most sought after by armed robbers, Lee said crime related
to prescription drug abuse may finally be leveling off.

He attributed that in part to doctors being more cautious about who
they prescribe to. In the past, prescription drugs have found their
way onto the black market through doctor shoppers, abusers who feign
ailments or go to multiple physicians to accumulate a cache of pills.

The potential backlash is that legitimate patients may be deprived
access to their medicine, Wunsch said.

According to a survey conducted by Virginia Commonwealth University,
36 percent of the doctors questioned said they have prescribed fewer
Schedule II drugs, which include methadone and OxyContin, either
because of intense media coverage or increased criminal prosecutions.

Yet at the same time, Drug Enforcement Administration data show the
volume of such drugs being prescribed increasing steadily.

In September 2003, Virginia began a prescription monitoring program
to reduce doctor shopping. Under the pilot program, every
prescription for a Schedule II drug filled in Southwest Virginia is
entered into a database.

The information can be accessed by doctors and police to make sure
someone is not receiving too many drugs from multiple sources. As of
Jan. 27, the database maintained by the Department of Health
Professions contained 1.5 million prescriptions, according to program
manager Ralph Orr.

But the number of inquiries -- 1,773 last year, compared with 1,238
the year before -- is still relatively small when compared with
similar systems in other states.

"We feel there is still a good chance there are people who could
benefit from the program who are not using it," Orr said.

Officials expect the system to see greater use once changes approved
by the General Assembly go into effect. The system will soon be
operating statewide, and will include not just Schedule II drugs but
other categories of prescription medicine, such as hydrocodone, that
are widely abused.

Meanwhile, the deaths show no signs of subsiding.