Investigation delves into Wash.’s prescription drug problem
Filed under: Aging, Children, Europe, Government, Health care reform, Health data, Health policy, Hot Health Headline, Pharmaceuticals, Public health, Public records
Everything time we think prescription drug abuse stories have peaked, something comes along to push the story further. This time, InvestigateWest’s Carol Smith sets herself apart by starting from square one and clearly explaining the origins and dimensions of Washington’s particularly nasty drug issues, tracing back each facet of the problem to its source and spotlighting what makes the Evergreen State unique.
Washington has been one of the hardest hit states in the country, in part because of aggressive prescribing practices. That, coupled with lack of oversight of doctors who over-prescribe, has led to the spectacular run-up in the number of deaths from prescription overdoses.
The backdrop for her work is an epidemic that shows no signs of abating, despite a recently implemented state law Smith calls “a bold attempt to reduce overdose deaths by launching the first-ever dosing limits for doctors and others who prescribe these medicines.”
Prescription drug abuse is at epidemic levels throughout the state, and elsewhere in the country, despite lawmakers’ attempts to get a grip on it. Washington now has one of the highest death rates in the nation. Deaths from prescription drug overdoses in this state have skyrocketed nearly twenty-fold since the mid-1990s, and now outstrip those from traffic accidents.
Why caused it to leap so quickly? Smith tracks down several key tipping points. “There’s plenty of blame to go around for what caused the epidemic,” she writes. “Aggressive marketing of opiates by drug companies, nonexistent tracking of overprescribing, lack of insurance coverage for alternative treatments for pain, and demand by patients for quick fixes, to name a few.”
She drills down into many of those causes, with my personal favorites being two key origin stories:
- How marketing by OxyContin maker Purdue Pharma led to relaxed guidelines for chronic pain treatment and a “1999 law specified ‘No disciplinary action will be taken against a practitioner based solely on the quantity and/or frequency of opiates prescribed,’” both of which helped cause a jump in prescriptions.
- How “the rise in the death rates of Medicaid patients tracks along with the state’s cost-saving decision to move many of its poorest residents to the cheapest, most potent pain reliever available: Methadone.”
See the upper right-hand sidebar for more stories from the six-month investigation.
Web outlet pumps out dozens of stories on prescription drug abuse
Filed under: Health journalism, Health policy, Hot Health Headline, Pharmaceuticals, Public health
In partnership with USC’s Annenberg School for Communication & Journalism and a number of other organizations, Santa Barbara online news outfit Noozhawk (about), put together “Prescription for Abuse,” an exploration of the misuse and abuse of prescription drugs in the Santa Barbara area.
In the extensive, online-only series, the reporters take a look at the problem and its underlying causes, then go a step further by exploring possible solutions as well.
In a uniquely meta twist, the series even looks at how journalism such is advancing public health goals and explains how the project came together. The series features at least 36 individual articles, by my count, and every health journalist who takes the time to browse the full catalog will come across at least a few easily localizable ideas, but in this space I’ll just highlight those stories that deal directly with the series itself:
- USC, California Endowment Unite to Support Health Journalism at the Source
- Bill Macfadyen: Prescription for Abuse Project Is a Series of Opportunities
- Santa Barbara Teen News Network Adds Another Dimension to Prescription Drug Abuse Series
- Annenberg Fellowships Take a Diverse Approach to Community Health Journalism
- Bill Macfadyen: Noozhawk Earns a USC Annenberg Health Journalism Fellowship
- Noozhawk Journalists Recount Lessons Learned from Prescription Drug Abuse Series
Thieves target pharma cargo, cause shortages
Reporting for WBBH-Fort Myers, Fla., Andy Pierotti reports that highly specialized thieves have made an art form of snatching shipping containers in the state, slipping in like ninjas and getting away with the massive haul in fewer than 90 seconds. They’ll take anything they can get, Pierotti writes, but the big prize is a shipment full of pharmaceuticals.
An intercepted shipment, especially one loaded with rare drugs with tight supply chains, can cause nationwide shortages and price hikes, experts say. And, no matter how esoteric the product, the criminals seem to be able to find buyers.
An NBC2 investigation discovered over the last four years in Florida, thieves stole at least 24 cargo containers full of pharmaceuticals. From dialysis products to eye medicine, they were valued at $5.6 million.
Erik Hoffer, an expert in pharmaceutical cargo crime, says the evidence disappears fast.
“Those pills can be blended into real and fake, there’s no way to trace it anymore and you’ve eaten the evidence,” said Hoffer.
Local hospital administrators say they can feel the pinch when a shipment goes missing, and that the problem has worsened in recent years. There are possible solutions, but their implementation would likely spell more price increases.
Possible remedies to the problem include putting tracking devices on individual pill bottles or cartons, and a consumer interactive tool on the pill box that allows them find out [if] it was reported stolen.
The problem is, that’s expensive and the cost would likely be passed down on the customer.
The stolen drugs pose a health risk, as well. One expert says the stolen drugs can be blended with other drugs and resold, with consumers none the wiser.
Series, inquest illuminate Canada’s pill problem
Filed under: Hot Health Headline, Pharmaceuticals
Writing for the reader-funded site rabble.ca with the help of a Canadian Institutes for Health journalism award, Ann Silversides is devoting a four-part series to Canada’s prescription drug problem, declaring the country to be a “world leader in prescription drug abuse.” Canada’s pill problem hasn’t hit the headlines with the vehemence it has in the states, but Silversides says evidence points to Canadian drug abuse that’s every bit as damaging as what’s happening south of their border.
Photo by jypsygen via Flickr.In the U.S., prescription opioids have been the leading cause of unintentional overdose deaths — far surpassing cocaine and heroin — since about 2001. The same is true in Canada, if the statistics from Ontario hold true for the rest of the country. (There is a striking lack of research in the area of prescription drug misuse in Canada, especially about the progression from use to abuse of these drugs.)
Yet in 2008, Canada had the highest rate per capita consumption of oxycodone in the world, surpassing even the United States, according figures from the International Narcotics Control Board.
The second installment in the series zeroes in on a specific Ontario inquest into two opiate overdose deaths, one which promises to shine a bright light on the nation’s broader struggle with the prescription drug abuse epidemic. Other articles in the series:
- Prescription opiate abuse now a public health crisis in Ontario
- Fractured health-care system sets scene for drug deaths
Fla. juvenile justice system relies on heavy antipsychotic use
Filed under: Children, Conflicts of interest, Health journalism, Hot Health Headline
In looking into the state Department of Juvenile Justice’s use of powerful prescription antipsychotics, The Palm Beach Post’s Michael LaForgia “analyzed department drug purchasing information and state Medicaid billing data and reviewed thousands of pages of DJJ inspection reports, drug company disclosure records and court documents.” It shows, as he surfaces with some powerful numbers and equally alarming anecdotes (Part 1, Part 2, Infographic).
…in state-run jails and residential programs, antipsychotics were among the top drugs bought for kids - and they routinely were doled out for reasons that never were approved by federal regulators, a Palm Beach Post investigation has found.
A key concern is that the prescriptions may be driven by their improper use as chemical restraints, or by the hefty speaker (and related) fees being paid from pharmaceutical companies to the most prolific prescription writers. Unfortunately, specifics are hard to come by as most homes are run by private contractors and the state doesn’t have the resources for close monitoring. For this story, the reporters were only able to obtain two years worth of data for 25 jails and three programs – a fraction of the statewide total. Those data still paint what LaForgia calls a “startling story.”
A look at the sheer numbers of drugs purchased … suggests a startling story is unfolding in state homes for wayward kids.
In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081 tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails and homes for children.
That’s enough to hand out 446 pills a day, seven days a week, for two years in a row, to kids in jails and programs that can hold no more than 2,300 boys and girls on a given day.
Veteran journalists speak from front lines of prescription drug epidemic
Filed under: Health journalism, Hot Health Headline, Member news, Pharmaceuticals, Public health
In a subject area increasingly defined by its steady drumbeat of alarming numbers and increasingly dire statistics, the opening to a recent episode of WBUR’s On Point with Tom Ashbrook still manages to make even the most jaded readers sit up and take notice.
Prescription drug abuse is sky-rocketing in the United States as accidental overdose deaths now exceed crack deaths in the 1980s. Overdose from prescription painkillers like Oxycontin and Xanax is now the leading cause of accidental death in 17 states.
The show touches upon every point of the prescription drug epidemic, from the pill mills of Florida to the devastated counties of rural Appalachia, where entire generations have been lost. The show is driven by the expertise of guests like Louisville Courier Journal reporter Laura Ungar and The Charleston Gazette’s Alison Knezevich, both of whom will be speaking at the June 3 lunch session of AHCJ’s upcoming Rural Health Journalism Workshop in St. Louis. The thoughts of these veteran journalists are also supplemented by a unique interactive element, thanks to On Point’s national reach and call-in format. One example:
On Point caller Michelle in Carter County, Ky., grew up with her mother addicted to prescription medications.
“We would wake up in middle night and have to put her to bed because she was like a zombie,” Michelle said. “It was like no one was there.” Michelle is now going to school to be a drug abuse therapist.
A summary of the show is available online, as is an MP3 of the entire broadcast.
DEA disciplines Fla. physicians; state allows them to continue practicing
Filed under: Health data, Pharmaceuticals, Public records
Writing for Health News Florida, Brittany Davis shows the importance of following up on a disciplined caregivers story. In February, the DEA released the names of 32 Florida doctors whose prescriptions, they say, were fueling the state’s notorious pill mills. The DEA suspended the narcotics licenses of those doctors at the time.
In her follow-up, Davis finds that at least four of the physicians are still practicing, five have been arrested, at least 12 have shuttered or moved their practices, and a full two dozen still have clear Florida medical licenses despite the federal action. The disconnect between state and federal agencies, she found, may come down to simple communication problems.
[DEA spokesman David Melenkevitz] said the DEA focuses on enforcement, not outreach, and may not necessarily pass on its findings to the [state Department of Health].
“We’re a federal agency and they’re a state agency,” he said. “We work together but operate separately.”
Pat Castillo, of the United Way Broward County Commission on Drug Abuse, said she is “concerned about the disconnect” between the DEA and the DOH.
She’d like to find a way to fill in the gap and help patients get the most updated information on whether their doctors have been in trouble, she said.
“If their DEA licenses are taken away, certainly that’s a red flag,” Castillo said. “Having that kind of information is critical.”
A spokesperson for the state’s Department of Health said that the agency may not “know about the DEA suspensions, or the agency may be conducting its own investigation.”
Reporter examines W.Va.’s drug epidemic
Filed under: Hot Health Headline, Pharmaceuticals, Public health
The Charleston (W.Va.) Gazette’s Alison Knezevich has geared an in-depth series around the fact that West Virginia has the highest rate of drug deaths in the nation. The overwhelming majority of those drug deaths involved prescription drugs.
In subsequent stories, Knezevich shifted her focus from the abusers to the medical community, beginning with those gatekeepers whose prescription pads are constant reminders that “nearly two-thirds of West Virginians who misuse pain relievers get them from friends or relatives for free.”
The tightrope walk between managing real pain and supplying addicts is such an exhausting one that some doctors fear employment in rural West Virginia clinics. It’s a dilemma faced even by those physicians who specialize in rehab, thanks to a newly popular brand-name drug for recovering addicts.
Florida addicts priced out of private rehab
In the St. Petersburg Times, reporter Leonora LaPeter Anton attempts to reconcile a local paradox: The state has suffered from epidemic of prescription drug abuse, yet Florida’s numerous private drug rehab centers remain empty. Why aren’t supply and demand coming together? The short answer, she found, is price.
… few who succumb to prescription drugs get the treatment they need. A national drug study estimated that just 10 percent of those who need treatment ever get it.
The problem is cost. Those with insurance quickly exhaust meager benefits and most don’t have $5,000 to $20,000 a month for round-the-clock rehab.
And the long answer? It comes back to insurance, then takes a sharp turn toward federal legislation. Insurers are reluctant to cover even 30-day treatment stays these days, Anton writes. “The typical plan at Blue Cross and Blue Shield of Florida, for example, offered $2,500 a year in substance abuse benefits. Anything over that was not covered.”
It’s a gap that the newly implemented Mental Health Parity and Addiction Treatment Act was designed to overcome. The new laws require that issues like substance abuse be covered at the same level that classic “medical” problems are.
Still, the new regulations apply only to companies with 51 or more employees. Though the law will likely improve care and make it more affordable, it won’t change the way insurers decide what is medically necessary. So with the push away from inpatient treatment, many addicts will try outpatient programs, which cost less, experts say.
Perhaps that is why 120 outpatient programs opened across Florida in the past two years. Florida licensed almost 400 new substance abuse treatment programs across the state, including 62 in the Tampa Bay area. Many focus on intervention, detox and the use of weaning medications such as Suboxone and methadone.
Florida pill mills spread, resist prosecution
Filed under: Health policy, Hot Health Headline, Pharmaceuticals, Public health
With South Florida beginning to crack down, the pain pill mills that fuel the Appalachian drug trade are moving northward. Kate Howard and Paul Pinkham of the Florida Times-Union report that the trade, which has ravaged Appalachia for a decade and exploded in recent years, has hit Jacksonville with a vengeance. There are more than 50 pain clinics in the area, and they even tell stories of 20-something clinic owners and physicians driving sports cars and intimidating each other in competition for the lucrative out-of-state trade. Florida’s first statewide steps to combat the trade haven’t yet taken hold, the duo writes.
After years of trying, Florida became the 39th state to pass a prescription monitoring bill last year, but it wasn’t funded. Amid lingering questions about its potential effectiveness, the database was slated to launch in December with $500,000 raised through grants and private funding, but is now on hold because of a bid dispute.
Even if Florida does succeed in stopping the pill mills, there are fears that tough legislation will just push the problem into neighboring (and less regulated) Georgia.
Why is it so hard to crack down on pill mills?
Across the state, Letitia Stein and Susan Taylor Martin of the St. Petersburg Times explore what makes it so impossible to shut down the handful of rogue doctors who can each put thousands of pills a day into the hands of abusers. In some ways, it’s similar to other disciplined doctors stories we’ve been seeing lately, as it carefully details the administrative wasteland that stands between local doctors and actual punishment for their actions. Cases languish for an average of 18 months, there is not always consistent communication between enforcement agencies, and disciplinary board members say they don’t have the legal power to search for problem doctors.
“The biggest problem is. we can’t discipline anybody unless a complaint is filed,” said Rosenberg, a West Palm Beach dermatologist on the Board of Medicine. “And drug addicts aren’t about to complain about their drug dealer.”
Stein and Martin looked at about 200 Florida doctors who had been disciplined or investigated for inappropriately prescribing pain pills in the past five years, and found that more than a quarter still have active licenses. Most of them are experienced doctors with specialty certifications, and some practice despite being convicted of crimes or linked to fatal overdoses.
And Florida’s new legislative crackdown on pill mills? The reporters say it specifically targets pain clinics, yet rogue physicians often operate out of other settings.
-
Join us in Atlanta
for Health Journalism 2012
Fellowship applications
due Feb. 27
New at HealthJournalism.org
- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
- AHCJ asks Supreme Court to permit broadcast of arguments in health reform case
- Tips for print, online journalists to embrace broadcast opportunities
- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
