WE NEED CASUALTY FIGURES IN THE WAR ON DRUGS

We need casualty figures in the war on drugs -- The story last week
was about a spike in deaths from heroin overdoses in tiny Newton,
N.H., population 4,500.

Nothing all that unusual. I've been reading stories like that every
few months for close to 40 years now. You think heroin is just in the
cities? Well, it's in the suburbs too.

But, it made me wonder how the war on drugs is going. It is, after
all, the really long war. Forget Iraq, Vietnam, World War II or even
the amorphous War on Terror. The endless one is the War on Drugs.

And how is it going? We don't know. We have a general idea that it is
bad and in spite of battles won here and there, slowly getting worse,
but we really don't know for sure.

And that is, demonstrably, because we don't want to know. More than
35 years after President Nixon announced the "War on Drugs," there is
still no law in Massachusetts that requires hospitals to report to
law enforcement when a patient is treated or dies from a drug overdose.

Yes, there are some statistics out there. The state Department of
Public Health says that between 2003 and 2005, the statewide death
rate from opiate overdoses was 8.1 per 100,000 people, or a bit less
than 500 people statewide. The rate here in the northeastern corner
of the state was worse, at 9.1 per 100,000.

But everybody on the front lines of this war says those numbers are
low - that admissions for nonlethal overdoses are vastly
underreported and even those that cause death are not always
documented or reported as such.

Indeed, the reporting of overdose admissions remains random at best.
Lawrence police Chief John Romero said there were three overdose
cases in one day brought to Lawrence General Hospital this past week,
"but we wouldn't have known about any of them if we hadn't been part
of an ambulance call for the third one. They just mentioned to us
that they'd had two others earlier in the day."

Dr. Wayne Pasanen, president of the Massachusetts Society of
Addiction Medicine and also medical director of methadone maintenance
programs in Lowell, Lawrence, Fitchburg and Lynn, says he thinks the
annual death toll from overdoses is more than 600.

"It's a couple hundred more than die in auto accidents in a year," he
says, noting the irony of extensive press coverage of fatal
accidents, especially involving young people, but when they die of a
drug overdose, "the cause is never described.

"That's understandable from the family point of view," he says. "It's
not something you want to be remembered for. But we've got a raging
epidemic here and it's largely just swept under the rug."

It's not just that the real cause of death doesn't make the obituary.
It is that too many times, it isn't even listed on the death
certificate, according to District Attorney Jonathan Blodgett.

"They list it as organ failure or heart attack," he says. "So we
don't get timely or accurate information."

State law requires hospitals to report to the state police anytime a
patient shows up with gunshot or knife wounds. But there is no
similar requirement regarding drug overdoses, even though that was
part of a proposed "action plan" by former U.S. Attorney Donald Stern
back in 1999.

That change, you see, required legislation. And while there have been
bills proposed to require hospitals to report opiate overdose
treatment during the past eight-plus years, none of them has become
law. Hospitals have opposed them, arguing that if they are forced to
turn over that information to law enforcement, those patients will no
longer come in for treatment, because they will fear being arrested
or prosecuted.

That fear should be gone, when it comes to the most recent bill now
pending in the House, because it protects patient confidentiality.

"Anonymity is fine," says Blodgett, who testified in favor of House
2277 recently. "This is not about handcuffing somebody to a gurney.
But we don't have accurate data right now, so we can't respond
effectively and we can't let the public know how bad this is."

Maybe, nearly a decade after the first attempts, this bill will have
a chance. The Massachusetts Hospital Association supports it,
according to spokesman Rich Copp.

Better data reporting will not win the war on drugs, of course. But
it is one logical step toward fighting it more effectively - one that
should have been taken long ago.

We all profess shock and horror every time yet another high-profile
life ends or is derailed by drugs. It will be interesting to see if
that shock and horror will be enough to motivate hospitals, law
enforcement and the Legislature to do something about it.

Taylor Armerding is a staff columnist.