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."
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."
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