PORTLAND — In 2010, Maine doctors prescribed 1,100 pounds of powerful painkillers like Vicodin and Percocet to their patients – more than triple the amount they prescribed just 10 years ago.
Carolyn Wallace, a Portland-based drug and alcohol counselor, said that fully half of the people she treats for addiction are hooked on painkillers.
The source of the drug is no secret.
“Almost to a client, they start out with a prescription,” she said.
Tom Kivler, director of the Division of Behavioral Health at Brunswick’s Mid Coast Hospital, said that the majority of Maine’s painkiller addicts get their drugs from a doctor, either directly, or through a friend or family member.
“Only 5 percent get it from the Internet or a drug dealer,” he said.
For local communities along Maine’s coast, prescriptions for oxycodone and hydrocodone have skyrocketed.
In 2010, so many painkillers were prescribed that they could have supplied every man, woman, and child in Maine with 78 five-milligram doses, according to U.S. Drug Enforcement Agency statistics.
The costs of painkiller addiction are borne by everyone.
In March, the state Office of Substance Abuse sounded an alarm with a report on substance abuse trends that identified prescription drugs as “a serious health concern.”
“Prescription drug misuse continues to have a large impact on treatment and hospitalizations in Maine,” the report said.
Kivler said staff at Mid Coast Hospital’s Addiction Resource Center saw a trend in 2005.
“We were noticing that a third of our patients were showing up for opiate addiction,” he said, “and we had a hard time keeping them in treatment because the withdrawal symptoms are so severe.”
Wallace said that the costs of addictions go beyond the use of hospital resources.
“People who are addicted will do anything to get the drug,” she said. “They’ll go to any means to get it. Almost anybody that steals, that breaks into your home to take things to sell, that’s why.”
Wallace said that rather than face severe withdrawal symptoms, people will turn to other illicit drugs in a desperate effort to stave off the pain.
“Painkillers cost $10 a gram on the streets,” she said. “They turn to heroin because it’s cheaper.”
According to Kivler, the reason behind the dramatic increases in prescriptions is fairly simple.
He says that they are largely due to a single decision by the Joint Commission, which accredits and certifies 19,000 health-care organizations across the country.
In 2001, the Joint Commission revised its pain management standards to require that doctors recognize the right of patients to have their pain assessed and managed.
It further requires that doctors “screen patients for pain during their initial assessment.”
“Pain really became somewhat of a vital sign that physicians were asked to pay attention to,” Kivler said.
Because of this, it is now standard practice for doctors to ask all patients whether they are experiencing any pain. Those that answer yes begin a conversation about painkillers.
“There were pharmaceutical companies that were involved in lobbying that through,” Kivler said.
The nature of the doctor-patient relationship has been changed on a fundamental level, he said, accelerating an American trend toward excessive treatment.
“There are cultural issues at play here. In other cultures, pain is an expectation if you have an injury,” Kivler said. “In this country, pain is something that must be treated and managed.”
In Maine, he said, the prescriptions happen on a grand scale, largely because many local workers are in jobs that expose them to aches, pains, and injuries.
“We have a lot of industries like fishing and logging and farmers, where people have a lot of legitimate pain,” Kivler said.
Kivler said that doctors are only part of the solution.
“Doctors are in a really hard position,” he said. “They can either not prescribe and they have a patient who is really unhappy and might register a complaint, or they can be accused of overprescribing.”
But he said the situation is likely to improve.
“I predict it to be getting better in the next 10 years. I really do,” he said. “This is an issue that we’re starting to grapple with.”
He expects the solutions to come piecemeal, as doctors, legislators, pharmacists, and law enforcement officials respond to the new reality of painkiller prescriptions.
Hospitals need to do a better job of tracking and holding staff accountable for painkiller inventories, Kivler said. One positive change is the use of automated dispensers that dole out drugs to hospital staff like high-security vending machines.
“When you have a lot of painkillers sitting around in medicine cabinets for over a year, and it looks like no one might miss them, that’s a problem,” he said.
The state also now provides a prescription monitoring database, which allows doctors to see whether their patients are getting drugs from other practitioners.
“We find that there are people out there who have scrips from multiple doctors,” Kivler said. “It’s not that hard to do.”
Patients also have to be kept more accountable for the pills that are put into their hands, he said. This is accomplished by administering drug screenings, and requiring patients to bring in their pill bottles halfway through the treatment period, to demonstrate that they have been taking the correct amounts.
Kivler also said that the state must be more proactive in promoting the use of suboxone, a drug that can help people to get off of painkillers more easily.
“It doesn’t get an opiate addict high, but it keeps them out of withdrawal. The medication is what allows them to sit in treatment,” he said.
At the end of the day, Kivler said, the response has to be coordinated statewide.
“Best practices will have to become more widespread. Let’s say Mid Coast Hospital starts … to tighten up,” he said. “That doesn’t really help, because they just go to the next place. We’re talking about an 18-to-25 demographic here. They all have iPhones. When something is working for someone, the word gets out.”
For Maine communities with Zip Codes beginning in “041” – a stretch that includes Portland, South Portland, Cape Elizabeth, Falmouth and Cumberland – sales of the drugs have essentially doubled over the past 10 years.
Oxycodone, a painkiller that is often prescribed under the name Vicodin, went from about 17,200 grams in 2000 to more than 31,700 grams in 2010, according to the most recent figures released by the Drug Enforcement Agency.
Hydrocodone, the main ingredient of Oxycontin and Percocet, increased from about 4,000 grams in 2000 to about 8,000 in 2010.
In communities with a “040” Zip Code prefix – an area that includes much more real estate and the communities of Brunswick, Topsham, Harpswell, Yarmouth, North Yarmouth and Freeport, the trend is much more startling.
There, hydrocodone sales spiked from nearly 8,900 grams in 2000 to more than 28,600 grams in 2010.
Oxycodone went from about 28,400 grams to more than 102,000 grams over the same period.
Statewide, hydrocodone prescriptions went from about 42,000 grams in 2000 to 126,000 grams in 2010; statewide oxycodone prescriptions went from 127,800 grams to 383,000 over the same period.
While the raw number of drugs prescribed more than tripled in greater Portland, the statewide population increase over the 10 years was only 4.2 percent.
— Matt Hongoltz-Hetling
This Friday and Saturday, various communities are hosting drug take-back programs, and residents are encouraged to bring in their medications, in original packaging if possible. Pet medications are also accepted.
In Portland, on Friday, April 27, and Saturday, April 28, from 10 a.m.-2 p.m., drugs are accepted at Maine Medical Center; Rite Aid Pharmacy, 290 Congress St., or University of New England, 716 Stevens Ave.
Residents of Falmouth, Freeport, Cape Elizabeth, Brunswick, Yarmouth and Cumberland can take their drugs to their local police departments on Saturday, April 28th from 10 a.m.-2 p.m. In Harpswell, a collection site will be active at Town Hall, 263 Mountain Road, on Saturday from 10 a.m.-2 p.m.