PAINKILLER PRESCRIPTIONS UP SIGNIFICANTLY IN REGION

"There Seems To Be A Definite Correlation Between High Availability And High
Abuse," A Lee County Physician Wrote.

As fatal overdoses from prescription drugs have risen sharply in
Western Virginia, so has the amount of painkillers prescribed by the
region's doctors.

From 1998 to 2002, when methadone deaths went from six to 62, the
volume of the drug prescribed increased by 500 percent, according to
Drug Enforcement Administration figures that track the flow of
controlled substances from the point of manufacture to retail
distribution.

The amount of methadone prescribed as a painkiller - 24,083 grams in
2002 for the western half of the state - does not include the liquid
form of the drug that is dispensed at drug treatment centers.

Oxycodone prescriptions for the region leveled off at about 140,000
grams a year after increasing by about 210 percent from 1998 to 2000.
A Schedule II drug, meaning it has a high potential for abuse, oxy-
codone is the active ingredient in opioids such as OxyContin and Percocet.

Prescriptions of hydro-codone, which as Schedule III drug is less
potent and not as closely regulated, increased by 107 percent over
five years. Hydrocodone, which includes painkillers such as Lortab and
Vicodan, was the most-prescribed of the three drug classes in 2002,
the most recent year for which numbers were available.

The figures, compiled by the state Department of Health Professions,
are subject to interpretation.

Pain-management advocates cite them as evidence that doctors are
finally providing relief to people who have suffered needlessly for
years; critics say the numbers show a need to rethink the escalating
use of opium-based analgesics.

"There seems to be a definite correlation between high availability
and high abuse," Lee County physician Art Van Zee wrote in a letter
earlier this year to the General Accounting Office, the investigative
arm of Congress.

In the letter, Van Zee took issue with a recent GAO report that failed
to establish a link between the aggressive marketing and promotion of
OxyContin and abuse of the prescription painkiller.

Others say a number of factors are behind the increases, and that
concentrating on a relatively small group of abusers is unfair to the
patients who take their drugs responsibly to control life-altering
pain. At the same time the medical community realized that pain had
been undertreated for years, other developments contributed to an
increased need for opioids, according to Dr. Marc Swanson, a
pain-management specialist in Roanoke.

Under increased pressure from insurance companies to reduce their
patients' time in the hospital, doctors have found themselves
prescribing more take-home medication after major surgeries, Swanson
said.

And as advancing medical technology has kept more people alive, that
doesn't mean their extended lives will be pain-free. The advent of air
bags in automobiles has meant that more accident survivors, who might
have died 10 years ago, now require pain medicine, Swanson said.

With the White House announcing a crackdown on prescription drug abuse
this month, and with federal prosecutors across the country charging
more doctors with overprescribing, some say physicians have become
more reluctant to prescribe potent opioids.

"Certainly the impression among some doctors seems to be, right or
wrong, that if you're writing [prescriptions] for OxyContin, you're
going to be earmarked for some kind of investigation," said Tim Lucas,
a Botetourt County pharmacist who heads the Roanoke Valley Pharmacists
Association.

The DEA numbers for Western Virginia appear to bear that out: After
rising steadily for several years, OxyContin prescriptions began to
level off about the time rampant abuse of the painkiller was getting
widespread attention. At the same time, pain specialists such as
Swanson began to receive more referrals.

"I understand why the primary doctors don't want to get into this
quagmire," Swanson said.

Yet the distribution of OxyContin in Virginia - 4,208 grams per
100,000 residents - is still well above the national average of 3,750
grams, according to DEA figures cited by Van Zee. In the counties of
far Southwest Virginia, where the hard physical labor of coal mining
and farming leads to a higher incidence of injuries, OxyContin
prescriptions are generally 500 percent above the national average.

It's no surprise, Van Zee argues, that those counties have been the
hardest hit by prescription drug abuse.