It happened the other week.
When rescue personnel arrived at the scene, a group of young people was in distress. Their friend was unconscious. They suspected he had had an overdose. They had tried to revive him to no avail.
EMTs went to work instantly. There was no pulse. The man was in cardiac arrest but they were able to get his heart beating again. They rushed him to Kent Hospital where a crew was waiting. He would live but, because of the lack of flow of blood, doctors fear he would be brain dead for the rest of his life.
What happened? Why is at least two of Kent’s 15-bed intensive care unit mostly occupied with people under 30 who have overdosed on drugs? And what sort of drugs, and how are they obtained?
“The biggest drug is alcohol,” says Dr. Michael Dacey, Kent’s senior vice president and chief medical officer. That’s part of the issue. More and more frequently, it’s a combination of alcohol and prescription drugs, such as OxyContin and Xanax, that can be a lethal cocktail. These drugs, classified as opiates benzodiazepines respectively, are often prescribed to fight pain and mood disorders.
Dr. Michael Fine, director of the state Department of Health, said the injury caused by the improper use of prescription drugs is more common than injury caused by automobile accidents.
“It is the most common cause of premature death,” for adults between the ages of 18 and 50, he said.
Fine said that prescription drug monitoring is a major focus of the department and a program modeled in part on what is being done in Connecticut will be launched later this year. The program will involve improved methods of policing the prescription of drugs; through electronic prescriptions; promotion of means other than drugs for pain management; clear guidelines on the prescription of drugs; recommendations for reduced prescriptions; and checks on people using prescription drugs.
He cites no one drug as being the killer and added, “The real danger is when you use multiple drugs.”
There’s more at play than the misuse of drugs by those with prescriptions. In the last six months, Dacey has seen an increase in cardiac arrests caused by heroin.
“There are many more out of hospital cardiac arrests,” he said. Further, he believes it can be linked to higher potency heroin in the market.
Yet, he says, “The drug of choice is OxyContin (oxycodone). The drug comes in time-released caplets that are crushed into a powder to be snorted to introduce it quickly into the blood. The drug is synthetic opiate that works by changing the way the brain and nervous system respond to pain. But it also induces euphoria in doses larger than needed to manage pain.
“It’s a big rush and it can stop your breathing,” he said.
According to online information on OxyContin, “Do not drink alcohol while you are taking Oxycontin. Dangerous side effects or death can occur when alcohol is combined with a narcotic pain medicine.”
A prescription drug monitoring study being performed by RARx [rapid assessment and response] at Rhode Island Hospital finds the Warwick area has the highest rate of fatalities resulting from opiates in the state. Dr. Traci Green, Assistant Professor of Medicine and Community Health at Brown University, said the study has reviewed all the deaths in the state involving the Medical Examiner, is focusing on accidental and undetermined deaths.
“Warwick had the highest rate of drug involved deaths [per 1,000 population],” in 2009, she said, when there were 14 death overdoses. The study, funded by the Centers for Disease Control and Prevention, reveals that the use of drugs and the way they are prescribed can often be complex. Looking at patient profiles, Green said, researchers find that patients are frequently being treated by multiple physicians for different conditions. She said, for example, a diabetic patient might be on a series of medications for that condition in addition to drugs for depression and other issues.
Obtaining the drugs, especially painkillers, she concludes, is too easy but asks rhetorically, “Why in Warwick and in certain populations?”
She said the study has found more Schedule 2 and Schedule 3 medications called “abusable medications” are dispensed in Warwick than any other Rhode Island community.
“This has led us to the understanding that there is over prescribing and over dispensing,” she said.
What’s happening is not foreign to David Lauterbach, president of the Kent Center that deals with mental disabilities and illness.
“We’re seeing accidental overdoses, the loss of clients,” he said in a recent interview. “It’s a combination of substances, opiates and alcohol that kills you.”
Some cases that end at Kent Hospital and funeral homes are situations where people are deliberating seeking a high and went too far. They gained access to drugs, perhaps through friends or family members who has a prescription and deliberately mixed them with drugs or alcohol. In other situations, people with prescriptions aren’t taking the proper dose or are mixing them with alcohol.
“The state is really struggling with the management of pain,” said Lauterbach. He notes that advertising has conditioned people to think they’ll be better by popping a pill. He says they turn to their physicians because they feel achy, can’t sleep at night or are depressed.
Lauterbach sees it at the Kent Center that provides services for about 1,500. Each patient goes through a screening and assessment. The staff works up a program that is a combination of psychotherapy and medication.
“Some people just tell us to give them the meds,” said Lauterbach. And he asks, “How do you manage pain without covering up another problem that we should be dealing with?”
Detective Captain Robert Nelson of Warwick Police said the number of deaths by overdoses is a concern. Police get involved in “sudden death” cases outside of hospitals and therefore don’t have a complete picture of the number of deaths. Nonetheless, Nelson said the market for prescription drugs is large and difficult to intercept because the drugs are obtained legally and then given away or filched by friends and family.
Nelson said, “The 20 to 25 year old crowd do a lot of pills.”
He described the tendency of many people to not use the full prescription, either believing they can do without it or saving it thinking they’ll need it later.
“Parents and grandparents hoard pills and their children and grandchildren steal a few,” he said. He said Xanax is one of the most commonly found prescription drugs.
“Most housewives have it,” he said.
Xanax, which belongs to a group of drugs called benzodiazepines, is used to treat anxiety, panic disorders and anxiety caused by depression. It can become habit forming. It should not be used in combination with alcohol.
Also a benzodiazepine, Valium is another drug frequently prescribed to treat anxiety. Both Xanax and Valium are common and, although “controlled,” easily obtained.
“The only way to get to a dealer is to get someone to give up on their friends,” Nelson said.
Generally, Nelson said, the department is seeing “a lot more” overdoses. He also said there is an increase in suicides although, it can be difficult to distinguish between an “accidental” overdose and a suicide.
“Take back” campaigns, such as that held last year, where residents can drop off outdated prescription have proven successful in Warwick. Mayor Scott Avedisian would like to see more of them and has talked to Green about the possibility of drop boxes.
“If you install a trash can, hopefully people will use it,” said Green. She suggests the Warwick Police station is well located for an around the clock drive through a drop box open at all times.
There’s more to addressing than greater controls, education and means of preventing the drugs from falling into the hands of people who may want to experiment with them.
Green sees a need for a change in attitudes as well as establishing programs to help those who have an addiction.
“The medical profession doesn’t really embrace addiction very well,” she said.
As for treatment, she said Warwick lacks programs for methadone and suboxone, which are used to treat addiction. She also mentioned what is being termed the “Good Samaritan bill” that is seen as lessening the anxiety of calling 911 in cases of overdoses for fear that the police will become involved.
Green said the two-year study, which started in June, is being conducted in Rhode Island and Connecticut. The research team selected Warwick for the primary subject of the study based on preliminary findings that fatalities from over doses is higher here than elsewhere.