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Narcotic overdose deaths and diversion in the U.S.
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A San Fernando physician over-prescribing opioids (from opium), such as Oxycotin, Vicodin, was arrested by DEA special agents in 2008. He accepted cash payments for writing narcotic prescriptions.
One of his patients informed federal agents he had paid the doctor cash for multiple narcotic prescriptions which he filled at regional pharmacies, selling the pills “on the streets” for profit.
A DEA review of regional pharmacies found 70,000 OxyContin tablets prescribed by the doctor in one year, making the top five OxyContin prescriber list in the federal region, including Los Angeles and Las Vegas.
DEA agents conducted undercover operations posing as drug-seeking patients making visits to the doctor’s office. After brief clinical encounters, the doctor wrote prescriptions in return for $200 per prescription.
Addictive narcotic pain medications were prescribed despite the covert agents’ statements that they had little pain, were taking the drugs for enjoyment, and/or wanted narcotics for others. The doctor discussed the street price of OxyContin with “patient.”
Three days before the arrest, a 23-year-old man was found dead of a drug a narcotic drug overdose prescribed for the victim by the doctor. http://www.lawfuel.com/show-release.asp?ID=17680
During 1999—2006, the number of poisoning deaths in the United States nearly doubled, from approximately 20,000 to 37,000, largely because of overdose deaths involving prescription opioid painkillers (1) http://www.cdc.gov/nchs/products/pubs/pubd/hestats/poisoning/poisoning.htm
This increase coincided with a nearly fourfold increase in the use of prescription opioids nationally (2) http://www.deadiversion.usdoj.gov/arcos/index.html
In the state of Washington, an in depth analysis of such deaths was reported October 30, 2009 in MMWR. Overdose deaths involving prescription opioids contained in the death “accidental” or “natural” as the manner of death, with contributing causes coded as “poisoning by narcotics” or a “mental and behavioral disorder due to use of opioids” by “overdose” of “oxycodone” or “methadone” and/or “hydrocodone.”
Opioid drugs are derived from the opium poppy, such as morphine>>heroin, and codeine, or are manufactured molecules eliciting opioid-like reactions in the brain and body.
Hydrocodone is a semi synthetic narcotic analgesic, found in Vicodin, and is prescribed as a DEA Schedule III controlled substance. It has potential to be abused and is sought by people with addiction disorders, and is subject to diversion (sale on the streets). Oxycodone (OxyContin) is a semi synthetic product of the opium alkaloid thebaine, and methadone is totally synthetic, causing its low cost, first synthesized in Germany in 1937 in anticipation of the coming conflagration.
Abusers of these substances have discovered multiple ways of drug ingestion, including oral, IV injection, snorting, inhalation, rectal and other routes. When these drugs are ingested, the dose may exceed the lethal level, leading to death from respiratory arrest.
The LD 50, the dose at which 50% of rats exposed will die, is not far above the dose needed to control symptoms of drug withdrawal, so severe suppression of CNS activity (respiratory, cardiovascular, mentation, etc.) is a risk for abusers. Use of these drugs with other CNS depressants, such as alcohol greatly increases the risk of a fatal outcome.
Alarming increases in accidental drug overdose deaths caused by methadone have recorded over the last 5 years, possibly due to the inexpensiveness of this manufactured drug, ranking it high on third party formularies now for treatment of chronic pain syndromes, such as low back pain. The drug comes in tablet and liquid form and made its way into American medicine via heroin addiction management clinics. However, the drug of treatment soon became the more powerful drug of abuse.
Municipal, state and federal units are attacking the problem of prescription narcotic abuse and poisoning on several fronts. The battle will be won only when each human mind and spirit says “No” to uncontrolled hedonistic desires and behavior.
References
1] Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999--2006. NCHS data brief, no. 22. Hyattsville, MD: National Center for Health Statistics; 2009. Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/poisoning/poisoning.htm. Accessed October 26, 2009.
2] US Department of Justice, Drug Enforcement Administration. ARCOS: Automation of Reports and Consolidated Orders System. Available at http://www.deadiversion.usdoj.gov/arcos/index.html. Accessed October 22, 2009.
