Generation Rx
Are Americans ready for a ‘Generation Rx’?
We consume more than 70% of the world’s opiates and are dying of overdoses at epidemic rates. Where is the oversight?
By LISE OLSEN. HOUSTON CHRONICLE. Feb. 7, 2011, 5:22AM
A decade after Congress began dramatically increasing imports into the United States, Americans are consuming more than 70 percent of the world’s legal medicinal supply of opiates — poppy-based pain drugs related to heroin, a Chronicle analysis of the Congressional Record and international treaty data shows.
The resulting wave of accidental prescription drug overdoses has been called a national epidemic, but the same federal agencies that license drugmakers and oversee imports and doctors have been slow to react to exponential increases in deaths reported in states like Texas, Florida, West Virginia and others from coast to coast.
“The truth is this is killing people and there are things that can be done,” says A. Thomas McLellan, a prominent addiction researcher who until September served as assistant director of the Office of National Drug Policy in Washington, D.C., better known as the office of the drug czar. “In 2008, there were 28,000 deaths and one of them was my son. It was one of the reasons that I took this job.”
Prescription drug overdoses nationwide have doubled in the past five years, according to the latest reports from emergency room doctors who participate in the government’s Drug Awareness Warning Network. Some hard-hit metro areas have seen even bigger increases in both nonfatal overdoses and deaths, Texas and national data shows.
McLellan was among a prominent group of health specialists who met last July in a summit organized by the Food and Drug Administration. A majority of that group urged the FDA to collaborate with other regulatory bodies to require specialized training on the dangers of pain drugs for all doctors who must get federal licenses to prescribe opioid medications, such as Vicodin (hydrocodone) and OxyContin (oxycodone).
McLellan considered the meeting historic. But so far, nothing has happened.
Too slow to react?
Dr. Sidney Wolfe, an expert with the nonprofit Public Citizen and a member of the FDA Drug Safety and Risk Management Advisory Committee, said the FDA has become too weak, overdependent on big pharma for funding and too slow to react to strong evidence of public health threats posed by pain drugs and other medicines.
In January, the FDA rejected a ban on the powerful opioid Vicodin and Percocet proposed by another panel of its own medical experts in 2009. The panel suggested banning the drugs because of concerns over deaths linked to popular and addictive pain pills that also contain acetaminophen (sold over the counter as Tylenol) and can cause liver failure or death in large doses.
Instead, the agency gave drug companies three years to gradually reduce acetaminophen content of pain pills – a step that Wolfe and others criticized as weak.
The FDA did not respond to requests for comment.
Houston’s Bari Brochstein-Ruggeri lost her 28-year-old daughter, Jennifer, eight months ago to an accidental overdose of Vicodin. A mix of pills prescribed by physicians based at the same hospital effectively shut down her liver and induced a fatal coma, medical records, drug and death records produced by Brochstein-Ruggeri show.
“She was too good just to be swallowed up in that way,” Brochstein-Ruggeri said.
Dr. Amitava Dasgupta, an expert in toxicology and clinical chemistry based at the University of Texas Health Science Center at Houston, said he and many other experts fear that the nation’s over-prescription problem is creating a “Generation Rx.”
In Harris County, more than 1,200 people have died of accidental overdoses since 2006, mostly after taking pain drugs often in combination with other prescriptions, like the anti-anxiety drug Xanax or alcohol. In many cities, the rate of death by overdose has surpassed traffic accidents.
Dasgupta argues the federal government has the power to stop the epidemic: It controls imports, regulates controlled substance licenses and oversees medical safety.
But the drug companies’ clout and profits from the sales of opioids and other popular medicines impair response, he and others say.
“If you stop this growth of pain medicines, drug companies will face a serious crisis because these are the most-prescribed drugs in this country,” Dasgupta said, adding that companies are looking for profit margins and “we’re concerned that we’re going to create an entire generation that is dependent on drugs.”
‘A grave problem’
U.S. Sen. John Cornyn, R-Texas, called the epidemic “a grave problem facing our nation, and unfortunately, instances of accidental death by prescription drug overdose in Texas are increasing at an alarming rate.”
Cornyn co-sponsored a law passed last year that provides more ways for consumers and for long-term care facilities to dispose of surplus medications that otherwise can end up on the black market or in the hands of teenagers or other users: “While it is just one part of the prescription drug abuse problem, the failure to properly dispose of unused medications increases the chance they will be used for unintended purposes.”
Houston – along with Fort Lauderdale and Palm Beach – are among the biggest centers in the country for illicit pill mills, according to the U.S. drug czar and others. Some doctors and organized crime figures have made millions off clinics that serve as fronts for medical drug dealing.
High-profile deaths
Similarly, Houston doctors have been traced to high-profile celebrity prescription drug deaths – both Michael Jackson and Heath Ledger got at least one of their prescriptions from a Houston-based physician, according to the Drug Enforcement Administration and the Texas Medical Board.
Ironically, doubling or even tripling of reports of prescription drug overdose emerged in the last decade as many of the same communities reported huge drops in illegal drug deaths.
“We were all giddy about declines in cocaine use, but all the while we had this big growth in prescription drug abuse,” one veteran Miami-based federal drug enforcement official said.
Today, in almost every major American city, the number of overdoses blamed on prescription drugs are double, triple or even quadruple the number of those tied to illegal drugs like cocaine or heroin, emergency room data from the Drug Awareness Warning Network shows.
Yet Congressman John Garamendi, a San Francisco Bay area Democrat who has worked on prescription drug issues for decades, told the Chronicle that many federal lawmakers remain unaware of the scope of the prescription drug overdose problem and the role federal regulators play in overseeing drugs.
lise.olsen@chron.com
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