A Plague of Pills
- By: Virginia Wright
For most of Paula Frost’s life, crime was practically unheard of in her hometown of Perry, a community of 850 people way Down East in Washington County. Then about five years ago, she started locking her doors. “I have deadbolts on both of them,” says Frost, who directs outpatient drug counseling at the Regional Medical Center in Lubec and heads Perry’s volunteer fire department. “And I always take my keys out of my vehicle. If addicts are not supporting their habit by selling pills, then they’re stealing. They will take anything that isn’t nailed down, quite literally, and they might even pull the nails out and take them and the hammer, too. Because of what I do, I have a pretty good idea of who is doing what out there, but the average person doesn’t. There is a huge amount of distrust in the community.”
The news over the past several months cannot have done much to raise anyone’s sense of security. Last fall a Lubec man was beaten and held at gunpoint in his own home by two men demanding money and prescription drugs. Three months later, two men assaulted a pregnant woman at her home in Steuben; they, too, took money and pills. Yet while Washington County’s problem has been especially stark, it is hardly the only area of Maine feeling the effects of the prescription drug abuse epidemic. Early this winter, federal law enforcement agencies headed by the U.S. Attorney’s Office stepped in to help investigate and prosecute a rash of pharmacy robberies, which jumped from seven in 2009 to twenty-one last year. Those robberies, along with ten burglaries, occurred in cities and small towns scattered across the state, from Biddeford to Stonington to Bethel to Jay.
Along with these very real crimes has come some unintended myth-making regarding Maine’s niche in what is truly a national scourge. In January, for example, several news outlets reported that Maine had the highest percentage of residents in the nation seeking treatment for addiction to prescription narcotics, drawing that conclusion from a federal Substance Abuse and Mental Health Services Administration (SAMHSA) report. But that interpretation is faulty, cautions Marcella Sorg, a forensic anthropologist at the University of Maine’s Margaret Chase Smith Policy Center. “States contribute data to SAMHSA only for programs that receive public funding,” Sorg explains. “So, for example, a state like Connecticut, which has many more private facilities providing this care, will have a lower rate in the SAMHSA report, but it has nothing whatsoever to do with the actual rate at which people are being admitted for substance abuse treatment. In addition, states have different ways of reporting data. Maine happens to have one of the best data systems in the country. It also happens to have the highest percentage of publicly funded treatment in the country.”
Sorg tracks epidemiological data on prescription and illicit drug abuse in Maine, and she serves on the Community Epidemiology Work Group, which monitors trends for the National Institute on Drug Abuse. She says the best way to measure the extent of the problem in Maine is “to compare it against itself over time.” By that measure, the state does indeed have a serious, and worsening, problem. The number of drug-related deaths has climbed more than 500 percent, from 34 in 1997 to 179 in 2009; more than 90 percent of the deaths involved at least one prescription drug. Treatment admissions related to opiate abuse (excluding heroin and morphine) have grown 60 percent since 2005, a trend driven by the synthetic opiate oxycodone, according to a report by the Maine Substance Abuse Commission. Crime has followed a similar track, says Roy McKinney, director of the Maine Drug Enforcement Agency (MDEA). Prescription drugs were implicated in 43 percent of MDEA’s arrests last year, compared to just 12 percent in 1997.
Although southern Maine was the first area to experience a rise in drug-related deaths, Washington County acquired early notoriety for the large number of people being treated for overdoses. The problem emerged soon after the painkiller OxyContin, Purdue Pharma’s time-release form of oxycodone, hit the market fifteen years ago. “You would hear stories about people who were using, and you would see people who appeared to be under the influence, but they were not coming in for treatment,” Paula Frost recalls. “For three to four years, individuals and families struggled to deal with it on their own. Then they started coming out of the woodwork.”
Those early cases of addiction, Frost says, were largely accidental — that is, people initially took medication for pain and “they didn’t know how to deal with it, so they started using more and more and more and more.” Now, Frost’s clients are just as likely to be people who sought pills for recreation right from the start. “They’ve found a wide variety of drugs they can abuse — opiates like oxycodone and methadone, or anti-anxiety medications like Xanax, Valium, and Klonopin, and even things like Ritalin [a stimulant used to treat attention deficit disorder in children].”
Heroin, cocaine, methamphetamine, and other illicit drugs have a grip in Maine, but our geography favors the prescription variety. Smuggled into the country, illicit drugs must travel the nation’s transportation infrastructure, McKinney says, and as a result, their use tends to be concentrated in metropolitan areas. “It may be more difficult for someone in a rural setting to make that connection with dealers of illicit drugs,” he says, “but the pharmacy is just down the street.” Prescription drugs are fast outstripping marijuana as the drugs most abused by teenagers, McKinney says, and most of them are getting the pills from their home medicine cabinets.
Frost observes a cultural facet to the phenomenon in Maine, combined with a misperception of the risks. “In Massachusetts, the opiate addiction is mostly heroin,” she notes. “Up here, the folks I work with will tell you they only use heroin if nothing else is available. They prefer OxyContin 80 because they know exactly what they are getting. They know they need three of them over the course of the day to not get sick, whereas with heroin they don’t know what they’re getting.”
There are other reasons that rural Maine is susceptible, according to Sorg. Its older population is likely to have more health problems, which in turn means more medicines being prescribed. Likewise, the blue-collar jobs that dominate in rural areas are associated with the kinds of injuries that may be treated with prescription narcotics.
The temptation to sell pills can be hard to resist for some people who live in economically depressed communities, says Washington County Sheriff Donnie Smith. “You’re sitting in your home and it’s freezing cold and someone calls you up and says, ‘You know those pills you’ve got are worth sixty dollars on the street today.’ Well, that’s sixty dollars worth of oil in your tank. That’s an easy source of money,” Smith says.
“We’ve seen people abusing and selling that you wouldn’t ever believe would be doing it. It’s not just one age group. It’s people in their teens to people in their sixties and seventies.”
Some of the drugs sold in Washington County have been smuggled across the Canadian border, but Smith calls overprescribing “the biggest problem we have.” He tells of one home invasion victim whose legally prescribed monthly supply of the narcotic painkiller Dilaudid would fetch $24,000 on the street. “That to me is unacceptable,” Smith says. “It’s unbelievable that one person would need that much medication and not need to be hospitalized. That’s what we’re up against. When someone starts out with a legal prescription and they’re selling a pill here and a pill there, that’s a very difficult thing to overcome. In cases like that, we usually go and talk to the physician. Sometimes it helps. Sometimes it doesn’t.”
Smith says the impact on his community has been profound. As a young officer, he patrolled the county’s roads during the early eighties, when “if you got someone for a usable amount of marijuana, you had a drug bust.” After a dozen years away from law enforcement, he returned in 1998 to find a rapidly changing social landscape.
“It’s a horrible, horrible addiction,” he says. “The drive to satisfy that need is putting people in some pretty desperate situations. It affects society at every level. I don’t think there’s a home in Washington County that hasn’t been affected one way or another. It affects job growth because if you don’t have a clean community, businesses aren’t going to come. It affects the economy because the workforce is not here. We’ve got one business in this county that was firing people ten to twelve at a time because they couldn’t get to work or they’d come in high. The company asked for surveillance because people were dealing drugs in the parking lot.”
The prescription drug epidemic in Maine and elsewhere is in part an unintended consequence of a shift in health-care providers’ approach to pain relief. “Doctors ask if you have pain, and they give you something for it,” says Sorg, a former nurse who remembers being unable to relieve the pain of post-surgery patients. “They expect to give you some treatment, and that’s a good thing.”
The prescription system, however, has weaknesses, Sorg says. Medicines intended for short-term use are dispensed thirty-, sixty-, and ninety-pills at a time. Pills build up in home medicine cabinets as new medications are substituted and leftovers are forgotten. “It’s a system that produces redundancy,” Sorg says, and that can lead to those pills being diverted to illegal uses.
Sorg believes one of Maine’s best preventive tools is a seven-year-old prescription drug monitoring program overseen by the Office of Substance Abuse in the Maine Department of Health and Human Services. The database tracks all prescriptions for controlled substances dispensed in the state. It is designed to identify patients who “doctor shop” — that is, seek painkillers from multiple prescribers — and to identify prescribers who write a lot of orders for opiates. Only about 35 percent of Maine’s 6,500 licensed prescribers participate in the voluntary program, but Maine Medical Association Director Gordon Smith says the MMA is making a push to get more doctors to enroll.
“For the past six to eight years, we’ve been aggressively involved in education and advocacy,” Smith says. The MMA has held roughly thirty programs to teach doctors about pain treatment and assessing patients for risk of addiction.
Meanwhile, Maine is doing a good job of addressing the issue of unused medicine disposal, according to Roy McKinney. MDEA receives an average of one hundred pounds of prescriptions weekly through the mail-back program it implemented three years ago, and some local police departments have placed collection boxes in their headquarters.
Last September, the state ranked first on a per capita basis in a national drug take-back program, with Mainers discarding 7,820 pounds of prescriptions at drop-off sites around the state. Another program is scheduled for April 30.
“It is a very, very complicated issue,” Sorg says. “Society has to recognize the problem. I don’t think we do. We have a culture that dictates that if you’ve got a little something wrong with you there’s a pill for that. We have a folk pharmacology where people feel they can figure stuff out and take what they need. We need public education. We need education in the therapeutic encounter. And we need to be vigilant.”
- By: Virginia Wright
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