PRESCRIPTION DRUG ABUSE DEADLY PROBLEM IN SW VA.

As late as mid-August 2004, it appeared that the tidal wave of drug
overdoses in Southwest Virginia had finally begun to subside. Dr. William
Massello of the state medical examiner's office told reporters that he had
identified 136 cases in the region, compared to 223 the previous year.

Unfortunately, Dr. Massello's optimistic forecast was not borne out by
subsequent events. As 2004 came to an end, the number of drug overdose
deaths - primarily from methadone, hydrocodone and oxycodone - reached 217.

To be sure, that was a drop from the previous year, but the decline was
pitifully small. More significant by far is the deeply disturbing upward
trend in such deaths, which have increased more than 300 percent in the
region in just 10 years.

According to a report from the Virginia Department of Health, the number of
drug fatalities has grown enormously since 1993, when just 66 deaths in
that category were recorded. Prescription drugs figured prominently in the
deaths, accounting for 211 of the 217 deaths examined. Autopsies determined
that approximately 80 percent of the deaths were accidental.

In Southwest Virginia, particularly in the rural counties traditionally
dominated by coal mining, fatal overdose rates outpace urban areas like the
state capital in Richmond by as much as 600 percent. Massello speculates
that the abnormally high injury rates associated with mining and other
labor-intensive jobs in Southwest Virginia may account for the higher
prescription and drug overdose rates as compared to more urban areas of the
state.

By far, Massello says, methadone is the primary culprit in most drug
overdose deaths.

The synthetic opiate was developed by the Nazis during World War II and
subsequently embraced by U.S. medical researchers who saw it as a
non-addictive cure for morphine and heroin dependency.

But today, nearly 60 years after its development as a wartime necessity,
methadone's cachet as a Cinderella drug has dimmed considerably.
Uncritically celebrated in the beginning, it is now universally recognized
as a highly addictive Schedule II drug. For all the hope and hype initially
surrounding it, it's now abundantly clear that methadone is often more
dangerous than the pain it seeks to mitigate.

The drug, which usually comes in pill form, was initially used almost
exclusively as a means to rehabilitate drug addicts, although that
treatment has become increasingly controversial. Since the widely
publicized deaths and addiction associated with OxyContin, methadone is
increasingly being used as an alternative to manage chronic pain. And,
increasingly, its presence is turning up in state autopsies.

Prescription drug abuse, in one form or another, has long been a problem in
many states, and steps have been taken in Virginia to help law enforcement
and health officials to combat it. But more help is needed.

Virginia's prescription-monitoring program, which was mandated by the
General Assembly in 2002, has gathered hundreds of thousands of
prescription records so far and generated close to a thousand requests from
law enforcement and health officials. But the pilot program, funded by
grants, is scheduled to expire this year if the General Assembly doesn't
vote to extend it.

Virginia lawmakers should do just that - and more. The current program
tracks the prescription and dispensing of addictive painkillers, such as
methadone, OxyContin, Percocet, Ritalin and other drugs. But the program
has fundamental flaws that have always limited its effectiveness. There are
still doctors who are unfamiliar with the database and how to use it to
their advantage. The program doesn't cover all of Virginia, and it only
provides the most basic information, compared to many other states'
programs, which offer a greater range of helpful data.

Virginia lawmakers should not only move to preserve this program but expand
it, so that its scope and effectiveness are maximized.

In medicine, the first law is to do no harm. While every drug can and has
been misused to one extent or another, abuse of prescription painkillers,
particularly methadone, is clearly a crisis in Southwest Virginia.
Legislation that would expand the state's current monitoring program, along
with a plan of public education targeted at what appear to be this region's
especially vulnerable population, is a critical health concern that we
cannot afford to ignore.