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Abuse of prescribed medicines about to eclipse that of illicit drugs

Pittsburgh Post-Gazette, March 01, 2007

After treating more than 2,000 people for OxyContin addiction since 2000, Dr. Neil A. Capretto, Gateway Rehabilitation Center's medical director, wasn't surprised by the findings of the United Nations-affiliated International Narcotics Control Board that abuse of prescription drugs is about to exceed the use of illicit narcotics worldwide.

"There's just been a growing, nonmedical, addictive use of prescription drugs," he said, particularly opioid drugs like OxyContin, codeine, morphine, Percocet, Vicodin and Dilaudid. Opioids possess some properties characteristic of opiate narcotics like heroin and morphine but are not derived from the opium poppy.

"The good news is we're treating pain better than we did 10 years ago," Dr. Capretto said. "The bad news is there are more people abusing and misusing [prescription drugs]. Unfortunately, from our end, I'm really afraid it's going to get worse before it gets better."

In a report yesterday, the International Narcotics Control Board said abuse of prescription drugs is about to exceed the use of illicit street narcotics worldwide. The shift has spawned a lethal new trade in counterfeit painkillers, sedatives and other medicines potent enough to kill.

Prescription drug abuse already has outstripped traditional illegal drugs like heroin, cocaine and Ecstasy in parts of Europe, Africa and South Asia, the board said in its annual report for 2006.

In the United States alone, abuse of painkillers, stimulants, tranquilizers and other prescription medications has gone beyond "practically all illicit drugs with the exception of cannabis," with users increasingly turning to them first, said the group, based in Vienna, Austria.

Unregulated markets in many countries make it easy for traffickers to peddle a wide variety of counterfeit drugs using courier services, the mail and the Internet.

"Gains over the past years in international drug control may be seriously undermined by this ominous development if it remains unchecked," Narcotics Control Board President Philip O. Emafo said.

The problem is compounded in Western Pennsylvania, Dr. Capretto said, because it is "one of the OxyContin epicenters of the world." The powerful drug is prescribed here more than in other areas because of the region's large elderly population and large number of former industrial workers who suffered work-related injuries.

Since 2000, Gateway has experienced a 600 percent increase in admissions for addictions to opioids, both prescription pills and heroin, he said.

The prescription and heroin addictions are often linked, Dr. Capretto noted, because abuse of OxyContin has led many addicts to heroin for economic reasons. While an 80-milligram OxyContin pill can sell for up to $80 on the street, a stamp bag of heroin has dropped to $10, even as purity levels have reached 90 percent.

"Someone spending hundreds of dollars a day on OxyContin can buy heroin for one-third, one-fourth that amount now," he said. "You have suburban kids who never thought they'd stick a needle in their arm shooting up.

Richard Goldberg, Allegheny County deputy district attorney in charge of the narcotics unit, agreed that OxyContin users are turning to heroin because dealers of both drugs are reacting to market forces of "supply and demand" in a price war.

Dr. Capretto said he's treated OxyContin abusers who enlisted others to stand outside of doctors' offices to buy partial prescriptions from elderly patients.

"They'd buy half a prescription for $200 and sell it for 10 times that much," he said.

He said he knows of high school students from an upper-middle-class school district who broke into a fellow student's home to steal his father's OxyContin, prescribed for a car accident; of addicts who go to real estate open houses to go through medicine cabinets; and addicts who go from doctor to doctor with fake medical records, knowing just how to act and just what to say.

Mr. Goldberg said prosecutions in Allegheny County involving prescription drugs peaked about two years ago when they made up about 30 percent of nearly 6,000 drug cases. Now, that number has dropped back to the 20 percent range where it was previously, he said.

After an upswing involving OxyContin prosecutions several years ago, the pendulum has swung back to Vicodin, he said.

"Vicodin has been there and will always be there. It's one drug doctors are more comfortable in prescribing," he said.

The number of Americans abusing prescription drugs went from 7.8 million in 1992 to 15.1 million in 2003, nearly doubling, the Narcotics Control Board said. Among their prescription drugs of choice: the painkillers oxycodone, sold under the trade name OxyContin, and hydrocodone, sold as Vicodin and used by 7.4 percent of college students in 2005.

Although the number of U.S. high school and college students abusing illicit drugs declined in 2006 for a fourth consecutive year, "the high and increasing level of abuse of prescription drugs by both adolescents and adults is a serious cause for concern," it said.

Counterfeiters are exploiting intense demand for prescription drugs that can give a "high" comparable to cocaine, heroin or methamphetamine, the watchdog group said.

It singled out Scandinavia, where demand for flunitrazepam -- a sedative sold as Rohypnol and widely known as a "date rape drug" -- increasingly is being met by unauthorized production, and North America, where widespread abuse of prescription drugs, including the narcotic fentanyl -- 80 times as potent as heroin -- has been blamed for a spike in deaths.

"The very high potency of some of the synthetic narcotic drugs available as prescription drugs presents, in fact, a higher overdose risk than the abuse of illicit drugs," Dr. Emafo said.