Sales of prescription painkillers spike in Maine

PORTLAND — In 2010, Maine doctors prescribed 1,100 pounds of powerful painkillers such as Vicodin and Percocet — more than triple the amount they prescribed 10 years ago.

The greatest increase in sales was in Androscoggin and Franklin counties, according to the U.S. Drug Enforcement Administration.

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.

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 Maine Office of Substance Abuse sounded an alarm with a report on 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 addiction 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 who steals, who 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 an effort to stave off the pain.

"Painkillers cost $10 a gram on the streets," she said. "They turn to heroin because it's cheaper."

Underlying cause

According to Kivler, the reason behind the dramatic increases in prescriptions is fairly simple. He said they are largely due to a single decision by the Joint Commission on Accreditation of Healthcare Organizations, which accredits and certifies 19,000 organizations across the country.

In 2001, the Joint Commission revised its pain-management standards to require doctors to recognize the right of patients to have their pain assessed and managed.

It further requires doctors to "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 pain. Those who 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," Kivler said. "In other cultures, pain is an expectation if you have an injury. In this country, pain is something that must be treated and managed."

In Maine, he said, 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.

He said 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 over prescribing."

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 must 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 get off painkillers more easily.

"It doesn't get an opiate addict high, but it keeps them out of withdrawal," he said. "The medication is what allows them to sit in treatment."

The response must be coordinated statewide, Kivler said.

"Best practices will have to become more widespread," he said. "Let's say Mid Coast Hospital starts to tighten up. That doesn't really help, because they just go to the next place. We're talking about an 18- to 25-(year-old) demographic here. They all have iPhones. When something is working for someone, the word gets out."

Sun Journal Graphic

Area data from the U.S. Postal service. Click here to see where your town lies.

How have painkiller prescriptions grown in your town?

In Maine towns with ZIP codes beginning in "042" —  all of Androscoggin and Oxford counties — retail sales of prescription opiates have grown faster in the past decade than anywhere else in the state.

Sales of Oxycodone, a painkiller that is often prescribed under the name Vicodin, went from 11,085 grams in 2000 to more than 47,405 grams in 2010, a 77 percent increase, according to the most recent figures released by the Drug Enforcement Agency.

Hydrocodone sales, the main ingredient of Oxycontin and Percocet, increased from 4,224 grams in 2000 to 16,298 in 2010, a 74 percent increase.

Drug sales in Oxford and Androscoggin counties outnumber sales in the Greater Portland area.

For 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 sales went from about 17,200 grams in 2000 to more than 31,700 grams in 2010.

Hydrocodone increased from about 4,000 grams in 2000 to about 8,000 in 2010.

In communities with an "040" ZIP code prefix — an area that includes Brunswick, Topsham, Harpswell, Yarmouth, North Yarmouth and Freeport — the growth in sales is also higher than in the Greater Portland area.

There, hydrocodone sales spiked from nearly 8,900 grams in 2000 to more than 28,600 grams in 2010, a 69 percent increase.

Oxycodone went from about 28,400 grams to more than 102,000 grams over the same period, an increase of 72 percent.

For towns in ZIP codes beginning with "049" — which includes Farmington, Kingfield, Vassalboro, Stratton, Rangeley and Waterville — the growth in sales closely matched the state average.

Hydrocodone sales went from 5,887 grams in 2000 to 17,291 grams in 2010.

Oxycodone went from 15,256 grams in 2000 to 51,691 grams in 2010.

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. That's a 67 percent increase in sales of each drug.

While the raw number of drugs prescribed more than tripled, the statewide population increase over the past 10 years was only 4.2 percent.

— Matt Hongoltz-Hetling and Sun Journal staff

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Comments

Whitney LeBlanc's picture

Doctors perscribe

Doctors perscribe medications. Every person in this state has PLENTY of resources to find natural remedies for pain. It's called taking control of your health. News flash: A magical little pill is not going to take care of your problems. There are more negative side effects to opiates than positives. In my opinion it should be something that is ONLY administered by a doctor in the office or by a nurse in the home. I know some situations are severe and these people can barely function. In some situations it is necessary to be on something long term. Opiates are not okay for long term. That is a fact. You WILL have adverse side effects if you take it for a long period of time, no matter your previous health conditions. It is so easy to pop a pill. (that you pay $4 a month for from the super store up the road) As soon as people have them in their hands, all rules are off. They are yours! Your doctor said its okay! So it must be okay! No... Pain killers are like bandaids. They do not do ANYTHING for the specific issue, they only mask the symptoms. They actually raise pain tollerence over the long term. They make people depressed. What is the point to having someone on a monthly perscription of digestive-tract-damaging NSAIDS along with a liver destroying pain killer. It takes effort to find out what nutrients can help your specific health issues. It takes effort to make sure you are making the best food choices possible for your specific problem. It takes effort to get out there and exercise. We dont always get a lot of the nutrients that we should from the food we are eating. Any doctor should be able to reccommend natural remedies to help your specific situation. If they don't, go talk to someone else! Go to your library, read up on the internet! Your health is your wealth. Just because a doctor reccommends a certain perscription does not mean you have to agree to taking it. It makes me wonder if people are even given an option by their doctor sometimes. We all have a choice between a specific daily regimen of natural supplements, exercise routine, and specific diet - OR - the option to take a pill every 4-6 hours as needed..... the easy route isn't always the best route. I hope that these numbers decrese on the front end. I really don't like living somewhere known as the Pain Killer Capital.

John Ponte's picture

War on Drugs is out of control

Painful Problem !!
I am interested in knowing if anyone in Maine could live pain free would they .

Or is it just the people that live with no pain in there bodys think the people that do have pain in there bodys need to just suck it up and move on .

Lets face it pain and Age just about come hand and hand .

The zip code tells me where the oldes people in this state live ,more so than the meds they are taking pluse the Zip code allso shows where more peple live in the larger countys .

I would say if someone where to bean count the milk that is sold in the larger countys is as much as the pain meds that are sold in thoes countys .

The real problem is the So call Nixon War on Drugs he started forty years ago.
Over the years the war on drugs has push a real big money making botton on bought sides of this war .

The cops get paid a lot and the drug sellers make a lot of money also.

The drug dealers get caught by the cops and lose every thing they have and the cops get to used the money they strip of off the drug dealer for more drug rades.

The money that could have been put into the school systems in the state didn't go to the schools because of shot falls but the money that is put into the war on Drugs never stops flowing into the war on drugs .

Why is that ?

History has proven time an time again that any Goverment that has wage a war on it's own people ,any kind of war has never been winable with a good out come for the people or the goverment that started the war.

I would also like to know what cultures Kivier is talking about where pain is a Expectation if you have a injury .
One thing is for sure after reading what Kivier has to say . He has never broken a bone of suffer a sugery that didn't go very well .I think he is really way ont of line with his remarks .

The one remark Kivler don't tell us in the Lewiston News Paper is, Pain Meds give a person that lives there life in pain a little bit of a good quality of live of a few hours .
I am sure the people that there live a life day in and day out with out being in pain take there pain free lifes for for granted .

The War on Drugs has put a lot of citizens in jail over the drugs .
Now the War On Drugs is going after our DR.s and hospitals and most of all ,us the patients.

Just when is the War on Drugs going to end?

FRANK EARLEY's picture

Just a couple of other thoughts

After reading the comments regarding drug screening and pill counts to reduce prescription misuse, I have a couple of questions. I understand that you can get some sort of buzz or high from drugs like opiates. In fact when I received my handicapped plates, I also had to get a new drivers license two weeks after renewing my regular one. The difference? The new license has a new restriction on it "M" for medication. That's all it said, no explanation or anything. I'm just curious how many other people have this restriction, and more importantly ,what gives them the right?
I see people everyday being arrested for possession of all sorts of drugs, do they have to get that restriction? I read about people driving with cold medications or any medication and causing accidents, do they get the big "M"? I've been disabled for six years, granted I take a ton of medications, since when does being sick put you in a category that allows police or anyone else, who needs to see your drivers license to abuse your privacy? Unless I've done something to deserve it, I was under the impression that my medical information was private. Not accessible without my permission or a court order. I guess the Department of Motor Vehicles, doesn't have to follow the rules everyone else has to. Does having that restriction create more scrutiny during a traffic stop? Am I going to be required to take a blood test at the whim of any officer who looks at my silence? One other thing I no longer take opiates, but I still have the license.

FRANK EARLEY's picture

This is getting embarrassing

That line toward the end is supposed to read " any officer who looks at my license", must be the drugs.

FRANK EARLEY's picture

Watch what you say!!!

I just learned from the Medical review department of the Motor Vehicle department. that supposedly all a police officer can do if he sees an "M" on your license is ask if your taking your medications as prescribed.
If you answer yes sir , no problems. You should be sent on your way.
How ever, if you are asked about your prescriptions, and your answer is" Yes, but I sometimes use crack, it helps them last longer". A positive outcome should not be expected. That said, if you are asked if you are properly taking your prescriptions. And your answer is" You mean the ones I actually have a prescription for" Your in for a very long afternoon.
Now 99% of those questioned will answer correctly. There will always be that one percent that for what ever reason (Drugs), will screw it up. We can see these people just by tuning into any episode of COPS.
The question, I'm pursuing the answer to is this. What gives the motor vehicle department the right to collect this information, which under Federal Law they can't do a single thing with. Just remember, give the right answer. No one has to know the truth.

Jillian Campbell's picture

I think its funny that the

I think its funny that the article says "the majority of maines painkiller addicts get their drugs from a doctor, either directly or from a friend or family member. Only 5% get it from the Internet or drug dealers."
just an fyi: getting pills from a friend or family member is not the same as getting a prescription from a doctor. It is the same as getting pills from a drug dealer.
On the other hand.. don't all pills originally come from a doctor or pharmacy? Its not like people can make their own at home!

 's picture

But Who Pays for this???

The practice of requiring drug screenings would be find except the doctors offices charge the patient or the patient's insurance. These screenings cost $600.00 as quoted to me by my doctors. I do NOT take meds for pain although I live with lower back pain every day. Other meds that fall under these anti-abuse practices are meds for ADHD such as Ritalin, Concerta, Adderall, etc. These meds have a potential for addiction and/or abuse like the pain meds.

"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."

Now before people start telling me that I should just buck up and pay the bill - you should know that I work full time, (in Social Services - therefore I am NOT wealthy by any stretch), but do NOT have health insurance. Furthermore, EVEN IF I had insurance - does it not raise the cost for everyone who pays premiums to pay for these tests? OR at the very least - if the patient or insurance are going to be required to pay the bill for drug testing/screening - this should ONLY be done when there is some type of red flag raised. For example, a person is asked for a pill count and the count is off which would give cause for suspicion. Or if someone is charged with a drug charge, or if they are "doctor hopping," or "pharmacy hopping." But a random drug test, with NO reason to suspect a person is misusing should not be the responsibility of the patient. I have been told by people at Saint Mary's and DFD Russell Medical Center, "We have to do these things to cover the doctor's interests." Well I say if you are doing it to cover your butts… Then YOU Pay the bill for the testing. UNLESS I give you good reason to suspect I am abusing my medications.

Donna Diehl's picture

Drug Screenings

With all due respect to your opinion about drug screenings, let me tell you what I've experienced. I am the one in the Doctors office performing the drug screens.I can't tell you how many people come in and tell me " I take no meds", and surprisingly they test positve for drugs they shouldn't. Also, I have those that come in and tell me what prescriptions they are on and test more for what they are suppose to. There is a real problem out in the world today and as far as my Dr. He's cut out a lot of the problems by terming any patient that fails their tests. Now I'm not talking about little things to make you fail, he will give you another chance. However, you come in and test positive for cocaine, ecstasy, methadone, etc.....you are termed. These do protect the Dr's. and you as a patient. DEA is really cracking down on these Dr's. they are getting more strict and if they get rid of your Dr, then you don't have someone to prescribe your meds. Also, insurance purposes.......again from my experience, no accusations, those that complain about insurances being billed, are the ones that are failing their tests. If you have nothing to hide, then why is it such a big deal that your doctor requires this and that insurance is billed? You're not paying the bill, your insurance is. The only thing you pay is your copay, and to have insurance. Raises the rates? It's 2012, all insurance rates have increased! Also, with my company if you don't have insurance we have a financial form to fill out to see if you qualify for help with paying for the tests if not fully being covered by my company. My Dr requires you do this before you can see him. You sign a paper agreeing that your are agreeing to random drug screenings and to use only one pharmacy if you are a patient with him. If you don't like the policy, you are free to seek alternatives. Screening people is not a method of accusing them or thinking suspicious of them, it is a way to have some control in this huge problem. I think all Doctor's offices should have testers in their office as well as hospitals, and that will put a huge damper on these people abusing these drugs. I know from the publics point of view it's hard to understand why we do what we do, but I will tell you, drug screening is not a bad thing. You say, "unless I give you reason to suspect." should we expect a lawyer, a Dr, a pregnant woman to be guilty of abusing drugs? I've seen it all. I've seen pregnant women test positive for cocaine and methadone, a woman who comes in with her baby, and she tests positive for cocaine, and thc, and then drive with that baby, I've seen lawyers who test positive for other things besides their prescriptions. My point is, you never know and we didn't suspect them. Again, this is just all in my opinion based on what I do, and what I've seen.

 's picture

RE: Drug Screenings

Donna - You raise some good points, and I am not saying that there aren't people out there who abuse drugs, other than the prescriptions they are on. This is a problem for sure. But, should people be automatically put through tests (which are not medically necessary) to obtain prescriptions for medications that qualified professionals diagnosed in the first place. In my case, I have ADHD. This was diagnosed at the age of 41 years old - so this doesn’t even fall into the realm of whether someone feels that the ADHD diagnosis is given too freely. That is a debate for another day. And I am not saying that people don’t misuse their medications. What I am getting at is we, as Americans, are not allowed to act in ways that would, in any other situation constitute profiling. Police are not allowed to follow a person of African decent because of the color of their skin. Recently, a man from Turner was charged with a crime because he made an assumption about another man who was at the Auburn Lake Pull off. He followed the man out of the place and rammed his vehicle two times because he thought the man was gay. Citizens are not allowed to act in ways that are discriminatory toward others because of what we FEAR they may be or may be doing. Doctors should be no different. I DO understand the problem that people use and/or abuse drugs - I am not debating that. But we can't punish people financially because they have been diagnosed with some disorder (psychologically or otherwise) by a professional and then because they follow the doctors advice and take a prescribed medication, treat them as if they are criminals. IF they have prior convictions for drug use/abuse, or have been found to somehow be cheating the system, i.e., seeking the prescription from other doctors at the same time or pharmacy hopping - that is different. The Judicial system in this country is set up so that a person has to prove that you are guilty for a reason. And this is the ONLY situation that I am aware of where you are forced to prove your innocence without being formally charged with a crime, and at your own expense.

To speak to your assertion that those who complain about billing insurance (and I DO realize that you were not making accusations toward me) - there may be truth to that, but at the same time it still comes down to whether or not it is right to do this. Too many people have the attitude of "oh it does not matter - I have insurance to pay for that, whether it be a medical test, or a drug, or prolonged treatment. Insurance is there to be used - for sure. That is what people pay their premiums for, but as in any business - they have a bottom line to be mindful of as well.

When it comes to those who do not have insurance as you say, most doctors offices have forms to fill out for a sliding fee scale. These do not account for people who work full time and make enough money to put them over the federal guidelines for poverty. And, even if someone makes enough money where they do not qualify for the sliding fee scale, is it right to cause them to have to pay $600.00 for a test that is NOT medically necessary? The doctors office does not take into account how much a persons rent or mortgage is, or if they have a car payment, or what their heating oil bill is each year. Many people make enough money to pay for their bills, but don’t have disposable income.

Drug abuse has been a huge problem for a very long time. If people are caught abusing drugs they should be held accountable and punished. But, that is the job of law enforcement, DEA and the Judicial System - not the job of doctors to root out the drug abusers. If you answer a knock at your door and it is the local police officer wanting to ask you if you have seen your neighbor in the past few days - does he have the right to search your home if he feels your pupils are dilated too much, and therefore thinks you may be smoking Crack, or snorting Cocaine? No, of course he doesn’t. IF he sees a crack pipe sitting on the coffee table as he looks around you into your home, then he has probable cause, but looking at you does not give him the right to enter your home and search. Likewise if he looks in and sees a prescription bottle on your coffee table, he does not have the right to enter your home because you are on a prescription drug. If you are driving and get pulled over and an officer suspects you of driving under the influence, he can put your through field sobriety tests and perhaps a breathalyzer, but he cannot demand that you undergo a drug screening test AND force you to pay for it. So how is it that our doctors with whom we trust with our health care suddenly have more authority than the Police who are paid by our tax dollars to protect us from crime?

I appreciate your thoughtful reply to my comment here and can sympathize with what you are saying. It is a tough problem to solve. I don't pretend to know the answers - but I know when things are wrong - and I can even get past the privacy issues, as you said if you have nothing to hide… But, I cannot get past the piece where I am expected to foot the bill (for those who are uninsured) for the drug tests. I know the argument is that you don’t HAVE to pay the bill, you can choose to not get the prescription - but that is not fair treatment either.

Donna Diehl's picture

Drug Screenings

Scott you are a very intelligent man, and I appreciate the feedback as well as your knowledge and respect. I will say this as far as the Doctors testing. You don't have to go to them, you can always go to another Dr. who doesn't do these. As far as my financial papers that I make my patients fill out, it does ask for income, rent, utilities, and how many kids, and how much you pay for taxes. The only time I've seen someone turned down is obviously if you're making $3,000 a month and have no bills. That was the first time I saw someone denied for help, other than that, they've been granted the help. I don't have any answers as to how to fix the problem either, and nor does the Govt. I think it's going to take everyone on board to realize there's a problem first. Also, before doing this I was a Pharmacy Tech and I can't tell you how many times I saw elderly having to decide between medicine and other bills, and it would furiate me!!!!!Then I would see Maine Care patients come through dressed to the hill, all made up, nice nails, hair, clothes, brand new cars and charge their damn prescriptions, then to turn around and sell them, Or some of them anyhow!!!!!Just totally furiates me! Doing that, and now this, has been a real eye opener to the problems with prescriptions out there.

FRANK EARLEY's picture

Very unfair article

I call this article unfair because in my opinion its totally one sided. Its the type of rhetoric that ties the hands of legitimate health care providers from doing their job, with out feeling like their under a microscope.
I don't know how long you need to take opiates to become addicted, but I do know that if you need to take it you don't get all the jolly's that seem to be all the rage.
I have been diagnosed by several Neurologist and numerous other doctors both in Maine and Boston of a condition that is the cause for my chronic pain. It's in both my feet and its at times almost unbearable. It makes no difference if I'm walking, sitting, or lying down. The pain is still there.
I work closely with my doctor, to try and get as much relief as I can. the best I've been able to accomplish is four hours at a time. Three times a day. I took Hydrocodine and Oxycontin at varying dosages for three an a half years three times a day. I had to switch off of opiates for other than addictive reasons. I went from opiates one day to another class of medication in just one day. No withdrawal and the new medication wouldn't have helped withdrawal if I did experience it.
What bothers me with the article and the way its written Is that it "Demonizes anyone who needs pain medication" All the article reflects is the harm, the crime, and those terrible doctors who are aiding the druggies. According to this article that's what I am, a druggie. I don't remember one mention of people with serious illnesses that require life long pain relief.
If your going to write a story, research all the facts, not just the ones that glamorize addiction. That sell news papers. Either explore both sides or don't write anything. You would think as a reporter you would realize there are always two sides to every story.
Just my humble opinion....

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