In its latest Morbidity and Mortality Weekly Report, the CDC highlights several substantial changes in the nation’s rate of drug use during the past decade. In 2007, an estimated 100 persons died per day due to drug overdose-a mortality rate that has tripled since 1991. Beginning in 1999, a progressively sharp increase in drug overdose deaths began to occur, with prescription drug misuse attributing to the majority of overdose deaths. In 2008, 36,450 deaths occurred due to drug overdose, with more than half of these deaths (20,044) caused by prescription drug overdose. Of these, 14,800 deaths (73.8%) were caused by opioid pain reliever overdose. In 2009, one million emergency department visits were related to illicit use of heroin or cocaine, while 1.2 million visits were attributed to misuse of pharmaceuticals. The majority of these prescription drug overdoses were attributed to several types of opioid pain relievers, including oxycodone, methadone, and hydrocodone.

During this time frame, the rate of prescription drug misuse varied among the states as well as by gender, race/ethnicity, and age. For example, states that had lower death rates than others also had lower overdose-related deaths. The lowest overdose death rate was found in Nebraska (5.5 persons per 100,000), while the highest rate occurred in New Mexico (27.0), a fivefold difference. Between 2008 and 2009, twenty-seven states experienced overdose death rates above the national average; twenty-one of these states also had prescription drug misuse rates above the national rate, as well as rates of opioid pain reliever sales higher than the rest of the country.

Correlating to the rise in prescription drug-related deaths, the rate of drug sales and substance abuse treatment admissions had likewise increased dramatically from 1999–2008. Prescription opioid sales varied among the states, with the lowest sales rate in Illinois at 3.7 kg per 10,000 population, and the highest rate in Florida at 12.6 kg. In 2008, prescription drug sales were four times higher than they were in 1999; similarly, the rate of substance abuse treatment admissions rose six-fold during this time. According to the CDC researchers, the overall rate of prescription drug sales in 2010 (7.1 kg per 10,000) is the parallel of giving 710 mg of prescription opioids to each person in the U.S. The highest amount of prescription opioid sales noticeably occurred in the Southeast and Northwest, which also correlated with each state’s death rates and prescription drug misuse rates.

Deaths caused by opioid pain relievers occurred three times more often among non-Hispanic whites and American Indians/Alaska Natives than Hispanics and African Americans. Persons between the ages of 35 and 54 years experienced the highest opioid prescription drug-related deaths than any other age group. The CDC describes the amount of life lost due to opioid pain relievers as nearly equivalent to that lost from motor vehicle accidents. Although the rate of prescription drug misuse varied among the states and gender, age, and ethnicity groups, it had universally risen among nearly all these subcategories.

Although some persons overdosed on prescription drugs legitimately prescribed to them, the majority of overdose cases obtained diverted prescription drugs from friends, family members, or dealers. Illegal pill mills and prescription drug diversion have become two of the nation’s greatest sources of illegal sales of prescription drugs, which has gradually led to increased restrictions from state governments, including the implementation of prescription drug monitoring programs and higher penalties for physicians mishandling of prescriptions to patients. The CDC reports that 4.8% of all Americans ages 12 years and older have misused prescription drugs in the past year. The result of nonmedical use of prescription drugs has taken a substantial toll on the American population, economy and health care system-costing insurance companies as much as $72.5 billion annually in opioid prescription health-care expenses.

According to the autopsy, the drugs found in Box’s system were Oxymorphone, Morphine, Hydrocodone, Hydromorphone and Oxycodone, along with Alprazolam, his anxiety medicine. After taking all of the pills in a short amount of time, the report ruled that the cause of death was aspiration pneumonia and pulmonary edema, which in short, is depression of the central nervous system and possibly mixed drug toxicity. The report also ruled out the overdose and claimed that the prescriptions had created a toxic mix.

Box had been injured many times throughout his football career and was known to have an injured back, as well as experienced many other painful episodes. He had suffered a small fracture in his back, after lifting weights, and also a bulging disc that caused him to miss the first few games as a Sooner. In 2009, Box had surgery on his elbow and was then given a prescription for painkillers, but he did not finish them all. Although he had been hurt, Austin’s parents believed there was no record of actual painkillers prescribed by a doctor.

Gail and Craig Box, knew their son as a wonderful athlete with a very big, and generous heart. Craig’s last memory with his son was a four-day trip to see their favorite team, the St. Louis Cardinals. The day after they returned was when Austin was found dead.

Although his parents believe all of the autopsy and toxicology reports, they still have a hard time believing that that is what their son died of. Gail is also the guidance counselor at Enid High School, where Box attended. She has seen and met people who have been addicted to drugs. Although she does not believe her son was a long-term addict, she does believe he was a "silent sufferer" whom she wished she could’ve helped. She knows he wouldn’t have wanted to disappoint his parents, but Gail wishes she could’ve seen the signs in her son.

If someone you know is complaining of vague symptoms to get more medication, has a lack of interest in treatment options, mood swings, on and off anxiety or is using prescription pills for other reasons, it is time to step in and help. Look for unusual signs in your friend or family member and don’t let the effects become fatal. If you think they may be a "silent sufferer", like Austin Box, don’t let it be too late before you try to help.

This finding was part of a new study led by St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences (ICES). The study determined that most opioid-related deaths occur among patients who were treated by physicians who frequently prescribe opioids. This study suggests that doctors who prescribe opioids often may not be taking the proper care to prescribe them safely.

Dr. Irfan Dhalla, a general internist at St. Michael’s Hospital and an adjust scientist at ICES, noted that the study identified 20 percent of family doctors who are frequently prescribing opioids. These physicians wrote 55 times as many prescriptions as the 20 percent of family doctors who prescribe opioids the least.

The study, which was published in the journal Canadian Family Physician, examined prescribing rates for opioids among family physicians in Ontario. Researchers determined that doctors who were shown to frequently prescribe opioids to patients were also the most likely to write the patient’s final prescription before death.

These family practitioners are truly caught in the middle of a challenging situation. They are trying to treat a number of patients who truly suffer from chronic pain, yet the evidence supporting long-term treatment with opioids is lacking. Pharmaceutical companies have successful marketed these drugs effectively, yet their inherent danger puts the patient – and the prescribing physician – at risk.

Opiod pain medications work by binding opioid receptors in the nervous system and GI tract. Essentially they interfere with the body’s ability to read and perceive pain. Many pregnant women seek these powerful pain medications as a result of chronic illness, injury, or surgery. In the largest U.S. study conducted regarding the risk for birth defects by the Centers for Disease Control and Prevention (CDC), it was shown that women who use opiod painkillers before or during pregnancy increase their risk of delivering babies with birth defects.

The CDC study, published in the American Journal of Obstetrics and Gynecology, was based on data found in the National Birth Defects Prevention Study conducted from 1997 to 2005. Information was gathered from women across 10 different states. It is estimated that approximately 2 to 3 percent of all expectant mothers in the study were treated with prescription opiod painkillers just prior to conceiving or shortly after becoming pregnant.

The results of the analysis revealed some eye-opening information. The women in the study doubled their chances of delivering a baby with hypo-plastic left heart syndrome, a serious heart defect, as compared to women not taking these medications. The women also increased their baby’s risk of developing other heart problems, spinal problems such as spina bifida, eye disorders like glaucoma that can lead to blindness, intestinal problems such as gastroschisis, and other medical conditions, namely, hydrocephaly or "water on the brain," which has been linked to mental retardation.

While the CDC says the risk may be modest, the cost is high. Prior studies on the subject have yielded inconsistent results but have suggested increased risk in developing cleft palate and heart defects. Currently, congenital heart defects are the most prevalent and deadly type of birth defects affecting babies in the U.S. – some 40,000 are diagnosed with the disorder each year. Those who live often have to undergo many surgeries and may have to endure further treatment for related disabilities.

Researchers still have much to learn when it comes to the effects of opiods on expectant mothers and their unborn children. Women who take these sorts of painkillers should know and understand their risks so they can make better informed decisions regarding their health and the health of their babies. Doctors warn that only those medications that are deemed absolutely necessary should be ingested by those who are already pregnant or trying to conceive.

This was the focus in a recent Chron report as the U.S. consumes 70 percent of the world’s opiate production. At the same time, Americans are dying of overdoses from these drugs at a rate that is considered to be epidemic.

Just a decade ago, Congress began dramatically increasing imports into the U.S., which included opiates, which are a poppy-based pain drug related to heroin. The same federal agencies that license drug makers and oversee imports and doctors, however, have been slow to react to exponential increases in deaths as a result of prescription drug overdoses reported throughout the country.

Prominent drug addiction researcher, A. Thomas McLellan suggests that this is killing people, but there are things that can be done. A former drug czar for the Office of National Drug Policy in Washington, D.C., McLellan shared that in 2008, there were 28,000 deaths as a result of prescription drugs and one of them was his own son.

The latest reports from emergency room doctors suggest that prescription drug overdoses have doubled nationwide in the past five years. Some hard-hit metro areas have experienced even greater increases. McLellan and a group of prominent health specialists are urging the FDA to collaborate with other regulatory bodies to require specialized training on the dangers of prescription pain medications for all doctors who are licensed to prescribe them.

To date – nothing has happened.

Health officials from Ohio and Georgia are calling the latest legal drug overdose statistics evidence of a rising epidemic. Across the board, this epidemic is surging to the top of many state mortality rates. In Ohio and Georgia, prescription drug overdoses have become the leading cause of unintentional death, surpassing motor vehicle fatalities. In Ohio’s Montgomery County alone, the death toll is greater than the national average (also 2.4 times greater than the state’s average). The county also has highest rate of prescription drug overdose-related deaths in the state.

Contrary to general perceptions, the group most affected by drug overdoses is not adolescents, or socioeconomic or ethnic minorities, but middle-aged white males. Since 2006, this trend has been influenced by the accessibility of prescription medications, especially to those with reliable health care benefits. The most common type of prescription drug related to overdose deaths is opioids, which include narcotic pain relievers such as Vicodin and OxyContin, or compounds like methadone.

In Georgia, both the Chief Medical Examiner and the Georgia Bureau of Investigation have acknowledged prescription drug poisoning as the leading cause of death. In 2008, the GBI confirmed that 85 percent of the year’s overdose deaths were caused by prescription drug poisoning. The problem may be spurred by misinformation about these anxiety or pain relieving medication, such as dosage control or dependency. The misconception that medicine is “safe” belies the seriousness of these drugs’ toxicity. When adults treat prescription medications as being non-habit-forming drugs or as general remedies for common ailments, the message gets passed right along to adolescents. With prescription drug overdose deaths superseding overdose deaths caused by methamphetamine, heroin, and cocaine combined, legal drug abuse has become a serious national health problem. More than 9 million Americans are believed to be prescription drug abusers today.

The upsurge in these mortality figures may be influenced by such factors as pharmacists receiving too many prescriptions to fill at once and missing the opportunity to inform their patients of proper usage of these medications. In other cases, prescription drugs are purchased by illegal means. Some prescription drug abusers will go as far as “doctor shopping” to gain multiple prescriptions for drugs and then take the prescriptions to various pharmacies, or even stealing others’ identities to gain even more prescriptions.

As many as 34 states, with 7 more having enacted legislation, run a statewide prescription drug monitoring program (PDMP or PMP) to help keep track of how many prescriptions are filled for each individual and how many locations challenge diversion efforts among the public. The purpose of these databases is to allow doctors to instantly review their patients’ prescription drug histories before writing a prescription. PDMPs give all health professionals, law enforcement agencies, and medical profession regulatory boards immediate access to patients’ controlled-substance records to help combat the epidemic. Georgia is currently not one of the states running a mandatory PDMP; for the last two years, the program has been proposed by its state legislature, but the bill has failed to pass as of yet.

California introduced its own secure statewide PDMP database, known as the Controlled Substance Utilization Review and Evaluation System (CURES), in September 2009. CURES has become the largest and most effective Internet-based prescription monitoring database that other states have now emulated or are in the process of adopting. California doctors can discern whether their patients legitimately require pain medication or are scamming them to help feed an addiction. CURES seeks to diminish drug trafficking and abuse among prescription drug dealers and doctor shoppers, reduce legal drug overdose and injury, and decrease the number of emergency room visits and the cost to healthcare providers for prescription drug-related injuries.

Prescription drug abuse has not only become an epidemic to the American population’s health, but also its healthcare system. Prescription drug abuse and misuse is believed to cost the state and health insurers millions of dollars per year. CURES has effectively reprimanded such severe cases of doctor shopping as Frankie Greer, a California woman who gained about 8,000 oxycodone tablets, OxyContin pills, and hydrocodone tablets by visiting 183 doctors at hospital emergency rooms within a one-year period. Arrests have also been made against doctors who supply drug addicts with prescriptions, and drug seekers who have stolen doctors’ identities or their patients’ to write phony prescriptions for themselves.

Missouri, like Georgia, does not have a PDMP, and lacks not only the ability to regulate patient prescription requests but also the authority to penalize prescription drug abuse. Law enforcement has no way of reprimanding individuals who seek multiple doctors for multiple prescriptions, even if the activity is illegitimate—it remains legal. Both adults and teens are doctor shopping, and adolescents are holding what is known as “pharm parties,” where guests bring whatever pills they obtained and put them in a bowl for partygoers to reach into and wash down with alcohol. Because prescription pills are likely to be found in every medicine cabinet in the American home, the problem seems inexorable.

The Alliance of States with Prescription Monitoring Programs is a nonprofit organization that provides state and federal agencies and individuals with multiple resources for diffusing prescription drug abuse, misuse, and diversion. The Alliance continually tracks the effectiveness of these PDMPs as well as funding, legislation, organization, research, and data related to these programs. To learn more, visit the Alliance’s website at http://www.pmpalliance.org/.

In nearly every case, the teens started by popping prescription pain pills, KMBC’s Martin Augustine reported.

Brett Hayes was one of the teens who died from a heroin overdose. Brett’s father, Dorman Hayes, said that Brett was a talented wrestler, a loyal friend, and a loving son. He began abusing prescription pain pills after graduating from Blue Valley Northwest High School.

"He cared, I think, more about other people than maybe he cared about himself," mother Debbie Hayes said.

Brett’s parents said they aren’t sure how his drug habit started, but they got him into a drug rehabilitation program that temporarily cleaned him up. Then, on Nov. 6, 2008, Brett bought a $10 hit of heroin. His parents were at work and couldn’t get in touch with Brett all day.

"I felt like something was wrong," Debbie Hayes said, as it was unusual for Brett to not return their phone calls.

Later that day, Brett’s parents found his body in his room—he had been injecting heroin while sitting in a chair against his bathroom sink.

"You know, there was the syringe, the stuff," Dorman Hayes said. "He was just kind of leaned over, like he’d (gone) to sleep…We’ll never know what triggered him to do it.”

Police said that heroin was long thought to be a big city problem, but now it’s become a problem in the suburbs. Narcotics officers said many teens start turning to heroin because pills are expensive but heroin isn’t.

Brett’s parents said they hope their son’s heroin overdose can be an example to warn other families.
"There has to be something good out of Brett’s death." Debbie Hayes said. "If we can help other parents, if we can help another kid not lose his life, then that’s what we’re going to do."

Debbie Hayes said parents should ask a lot of direct questions of their children, especially if they’re good students and their grades suddenly go bad, or if their old friends aren’t around anymore. Find out what’s going on, even if it’s embarrassing.

"If you could figure out where everything went wrong, then we wouldn’t be sitting here right now. And other parents wouldn’t be in the situation that our family’s in right now," Debbie Hayes said.

Johnson County authorities are developing an education program to fight the heroin problem. Last month, they unveiled a presentation available to every police department in Johnson County.

One of the messages is for parents to lock up their prescription pills, since they are a gateway drug to heroin.