New Project: The Prescription Epidemic

Today we’re publishing The Prescription Epidemic, a set of reports on the human cost of prescription drug addiction in Washington State. The project is the result of a six-month investigation led by InvestigateWest's Carol Smith into the origins of the epidemic, the challenges it poses for communities going forward, and what lessons other states might learn.

You can read the resulting work this morning in The Spokesman-Review and on Crosscut.com, as well as here on our website. This project also marks our fourth collaboration with PBS affiliate KCTS-9. Monday, Jan. 30 at 9 p.m., KCTS is airing a documentary we co-produced on the faces of this addiction.

Prescription pain medications kill more Americans than heroin and cocaine combined, and in a pill-happy culture, the trend shows few signs of reversing.

Washington State has been at the epicenter. The state’s residents are among the highest consumers of prescription pain meds in the country. They are also dying from prescription overdoses at a rate of two people a day, one of the highest rates in the nation.

At the beginning of this month, the strictest prescribing law in the country went into effect. But many loopholes in the system remain. Public health experts around the country are watching what happens, and tracking other innovative pilot programs here aimed at cutting abuse.

Let us know what you think. Share your own stories on our Facebook page. And stay tuned this week as we release more documents, maps, data, and interviews on the prescription epidemic.

Byline: 
Carol Smith's picture

The Devil in the Medicine Cabinet

Rosemary Orr with her son, Robin, at his high school graduation in June, 2000.
Photo courtesy of the Rice family.

Dr. Rosemary Orr didn’t see it coming that day. It was the morning after Mother’s Day. She needed a ride to work, so her 24-year-old son Robin drove her. She was in a hurry to get to Children’s Hospital and Medical Center in Seattle, where she is a pediatric anesthesiologist. Otherwise, she says, she would have spent more time talking with him.

She’d been worried about his sleeping habits, his weight loss lately. She knew her smart, handsome son had struggled with addiction to OxyContin in the past. But he’d kicked it. He’d assured her of that. He’d looked her in the eye and said, ‘You don’t have to worry about me, Mom.”

No parent wants to believe her child is using. Not even one who is a doctor.

“I was stupid and desperate enough to believe that explanation,” Orr says now, five years later, over coffee a few miles from her work, where she takes care of the pain of others. Her own pain, she takes with her.

When she got home from work that day, Robin’s phone was ringing, but he wasn’t answering in his room downstairs. She knocked. And knocked again. She went around her house and peered in through his bedroom window.

Byline: 
Carol Smith's picture

New Prescription Drug Law Holds Promise, but Concerns Linger

In Spokane, Dr. Darin Nevin (left) and Lee Taylor want to expand data sharing to emergency rooms across the state.
Credit: Dan Pelle/The Spokesman-Review

Washington State has made an aggressive attempt to crack down on the prescription drug epidemic by passing strict new rules governing pain management. But even those may not be enough to stanch the flood of deaths from prescription opiates in this state.

The passage of a new law, regarded as one of the toughest in the nation, makes Washington the first state to require dosing limits for doctors and others who prescribe these medicines. The law, RCW 2876, went into effect January 2, but those who have watched the epidemic spiral out of control still see significant challenges ahead.

Among the first is the dearth of pain specialists in the state. Under the new law, doctors and other prescribers with patients who need more than 120 mg a day must seek a second opinion from a pain specialist. But there are few of those professionals to go around.

Medicaid is already struggling to comply with the new law. Despite having thousands of patients currently over the threshold limit, the agency can only get one or two evaluated by a pain specialist a month, said Dr. Jeff Thompson, medical director of the state’s Medicaid program.

“Access is an issue,” said Dr. Gary Franklin, medical director of the state’s Department of Labor & Industries, adding that telemedicine consultation programs and other efforts to increase capacity are helping, but still don’t fill the need.  

The new law makes Dr. Merle Janes of Valley Rehab & Emergency in Spokane angry. He said legitimate pain patients and doctors who prescribe for them are paying the price for the policy changes designed to nab addicts. People in real pain can’t get adequate relief, he says.

“It’s been a disaster for all these people,” Janes said.

Dr. David Tauben, a clinical associate professor and director of medical education in pain management at the University of Washington, agreed that not enough doctors are treating pain well.

“But this problem was happening well before the new law,” Tauben said. He’s optimistic that the new law will actually encourage more doctors to take on pain patients because they will have guidelines to follow to help keep them from running afoul of disciplinary agencies. The guidelines should remove ambiguity and help doctors communicate better with patients about the goals and limitations of pain treatment, he said.

Byline: 

Drug Companies Fight Take-Back Program for Unused Medicine

Meanwhile, environmental authorities say prescription drugs are turning up in waterways and even drinking water – and it’s happening often enough that the old medications now are considered hazardous waste.

“People don’t have a safe way to dispose of these medicines,” said Margaret Shield, policy liaison for the Local Hazardous Waste Management Program in King County, a consortium of local governments. “Often people don’t think of medicines as being potentially hazardous, but they are in the wrong hands and they need to be properly disposed of just like other household hazardous waste.”

Yet efforts in Olympia to pass a law to force drug companies to pay for a statewide system for properly disposing of old medicines have foundered for five years running now in the face of opposition by the pharmaceutical industry. If the legislation passes, Washington would become the first state to require the industry to fund a drug take-back program.

About one-third of all medicines sold annually in Washington – 33 million containers of pills – go unused, say proponents of stricter regulation. Some get flushed down the toilet, but many more sit unused in medicine cabinets. This stock of drugs is a contributing factor in Washington’s epidemic of prescription drug abuse.

“More people are dying from prescription drugs than out there on the highways,” said Patric L. Slack,commander of the Snohomish Regional Drug Task Force.

Interview: Rayne Pearson

Rayne Pearson, Attorney. Credit: Ethan Morris/KCTS.

Prescription drug overdoses kill two people a day in Washington state. But the damage caused by addiction to painkillers is even more widespread. As part of its collaboration with InvestigateWest, KCTS invited recovering addicts and their families to share their stories. Here Ethan Morris, executive producer for public affairs at KCTS interviews Rayne Pearson, a practicing attorney in Seattle.

Ethan Morris: Let’s start by telling me your name and why you’re here.

Rayne Pearson: My name is Rayne and I am a recovering addict.

EM: What are you recovering from?

RP: I’m in recovery from prescription drugs mostly. Opiates and benzodiazepines.

EM: Can you tell me how you came to start using drugs?

RP:  I started using drugs when I was very young, about 14 or 15. And I think, like a lot of addicts, I started with alcohol and pot and I was definitely addicted from the very first time I ever used drugs. I used drugs on a daily basis, probably from the time I was 17 until the time I got clean when I was 32. The disease is progressive, so my using intensified. I started using harder and harder drugs, and I think it was probably in my mid 20’s when I had my first prescription for Xanax, which is a benzodiazepine. I started abusing it right away.

Byline: 

How Addiction Nearly Killed Justine

Editor's note: Stephanie Schendel, a journalism student at Washington State University, interned at InvestigateWest during the summer of 2011. Here she shares a compelling first-person account of how the prescription drug epidemic affected her own life and that of her roommate, Justine, who agreed to be interviewed for this story. It’s a personal tale, but also one that is playing out on campuses around the state and country as colleges grapple with the ready availability of alcohol and prescription drugs, and the students who get hooked on them.

First impressions

When I first met Justine, she was chugging from a bottle of vodka.  I was 18 years old and at my first frat party.  I barely knew anyone, and the fraternity’s basement smelled like old beer and cheap deodorant.  The smell, blaring music, and the amount of people and alcohol overwhelmed me, but not Justine. Outgoing and friendly, Justine seemingly already knew everyone there, even though it was her first week of college.

The first thing Justine told me that night was that she’d already downed 18 beers  in order to “medicate” for the tattoo she had gotten earlier that day.  I was alarmed and impressed.  She showed it to me, the irritated skin still red and puffy.  It was three words written in Hungarian. She said they meant “strength, loyalty and compassion.”

She didn’t remember meeting me that night.  Or even the second or third night we met, but I remembered her: She was girl who had an insane tolerance for alcohol and could out-drink a fraternity any day of the week.

By then, she was already deep into her addictions.  Years later, she told me her substance abuse had started in middle school with pot and alcohol.  By the time she was thirteen she was stealing pills from her grandmother’s medicine cabinet.

Byline: 

Where There's Smoke, There's Sickness: Wood Smoke now a major Northwest air polluter

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The warning label on the wrapping of neatly split firewood is one we're more accustomed to seeing on cigarettes or heavy-duty chemicals: “known… to cause cancer, birth defects or reproductive harm.”

But in fact, heart attacks, strokes, high blood pressure, asthma attacks and premature death – in addition to cancer – all are linked to wood smoke pollution. It’s a finding that poses a vexing dilemma for poor and rural communities around the Northwest where wood is a cheap or even free source of heat.

And in Tacoma, where the air is so dirty it violates the Clean Air Act, authorities are gearing up for what promises to be an arduous and expensive campaign over the better part of a decade to clean up wood smoke pollution. It’s an effort that already has some residents chafing at government interference, and one that will set the stage for how other Northwest communities are treated when they bump up against tightened federal pollution standards.

In Tacoma and many towns across the Northwest, wood smoke is a prime culprit in driving spikes of sooty, toxic air pollution that leave some residents – particularly asthmatics, kids and the elderly – gasping for breath.  It’s especially bad during sunny, cold stretches like those we’ve seen in recent weeks, because atmospheric conditions trap the pollution close to the ground.

Seattle glass recycler Saint-Gobain leads list of NW companies fined for violating Clean Air Act

In partnership with:
Coverage by iWatch News
Coverage by NPR
Coverage by Northwest News Network
Coverage by EarthFix

Robert McClure and Lisa Stiffler

InvestigateWest

Saint-Gobain Containers bills itself as a “world leader” in protecting the environment.  Its hulking south Seattle plant recycles used glass into new bottles – part of a noble effort to conserve resources, the company says.

“We are committed to a sustainable future for not only our business – but the planet,” the company says.

And yet Saint-Gobain’s Duwamish-area plant, operating under its Verallia label, has racked up more than $962,000 in fines for violating the Clean Air Act in the last five years, making the Paris-based company the most-fined toxic air pollution emitter in the Northwest, government records show.

Saint-Gobain’s plant on Highway 99 just north of the First Avenue Bridge is only one of dozens of facilities around the Northwest, and particularly concentrated in the Puget Sound region, where regulators have struggled for years to rein in pollution – often exceeding time frames that regulators themselves set as deadlines.