Pubdate: Mon, 05 Apr 2004
Source: Portland Press Herald (ME)
Copyright: 2004 Blethen Maine Newspapers Inc.
Author: DAVID HENCH, Portland Press Herald Writer
Note: Sidebar "Drug Facts" at end of story)


Mainers use more prescription painkillers than people in almost any other 
state, according to statistics that officials say help explain the state's 
growing problem with prescription drug abuse.

Maine ranked 7th in the nation in per capita consumption of oxycodone, the 
active ingredient in OxyContin, and was fourth in consumption of methadone, 
according to federal Drug Enforcement Administration data for 2002, the 
most recent available.

Maine's per capita consumption of fentanyl, a synthetic opiate often 
prescribed to cancer patients, was higher than every other state. Some 
other painkillers, like the active ingredient in Dilaudid, have 
less-than-average consumption here. But the DEA statistics - compiled from 
manufacturers and distributors - highlight a trend of above-average 
painkiller consumption in the state that has existed since at least 1998.

Health professionals say it's no surprise Maine has a high rate of 
painkiller use because of the state's relatively large number of elderly 
people and because traditional industries such as papermaking and fishing 
have a high risk of injury and chronic pain.

But, they acknowledge, the abundance of prescription narcotics may well 
contribute to their abuse.

"It's like with any drug of addiction, availability is a key factor in what 
people will use," said Kim Johnson, director of Maine's Office of Substance 
Abuse and Treatment.

The magnitude of prescription drug abuse is elusive, say federal 
authorities who rely on arrest data, drug seizures and treatment admissions 
to estimate the problem's severity. But the misuse of prescription drugs is 
contributing to a growing number of young people addicted to narcotics and 
ultimately has led to an increase in burglaries, robberies and thefts, 
authorities say.

Doctors, meanwhile, must balance their concern about drugs being misused 
with their duty to relieve patients' pain.

"I think physicians have felt caught in the middle, pressured from both law 
enforcement about diversion and yet on the other side, physician regulatory 
bodies about undertreatment of pain," said Dr. David Simmons, former 
president of the Maine Medical Association and a family practice doctor in 

There are legitimate reasons for Maine's high level of painkiller use.

The injuries inherent in forestry, fishing and manufacturing contribute to 
that usage, as does some Mainers' tendency to work through pain.

"A person may have to take some time out from work or change how they work, 
but it's a tough thing to do, especially when you have someone living day 
to day as far as what they get for pay," said state Rep. Anne Perry, 
D-Calais, a nurse practitioner.

Maine has the third-highest median age in the country and ranks 7th in the 
percentage of its population over 65. As people age, they are more likely 
to have chronic pain and illnesses that require pain medication.

Maine also rates better than most states in the number of doctors and 
nurses trained in alleviating pain, said Kandyce Powell, executive director 
of the Maine Hospice Council, citing a 2002 national survey of end-of-life 

The survey gave the state high marks for policies allowing physicians to 
treat pain at the end of life without "undue scrutiny," she said.

Maine was among a handful of rural states that were the first to experience 
a surge in the illicit use of OxyContin. As in those other states, the 
abuse was centered in the poorest regions in the state.

"The common denominators are poverty and low levels of expectations with 
respect to opportunity," said Simmons, an internist in Calais, where abuse 
of drugs such as OxyContin, Dilaudid and Percocet is high.

Like parts of West Virginia and Kentucky, eastern Maine witnessed what 
health professionals and law enforcement describe as an epidemic of 
OxyContin abuse.

Prescription drugs are sometimes diverted for profit. A month's supply of 
80 mg OxyContin costs $2 on Medicaid, and at $1 per milligram is worth 
almost $5,000 on the street, said Gerry Baril, supervisor for the Lewiston 
office of the Maine Drug Enforcement Agency.

That has led people to seek pain relief from multiple doctors, or use fake 
prescriptions, or sometimes rob pharmacies, he said.

The U.S. Government Accounting Office studied the rise in OxyContin abuse 
and found that Maine and other affected areas had previous problems with 
prescription drug abuse.

Some recreational drug users believe that experimenting with prescription 
medication is less dangerous.

"One of the reasons we saw a spike in use of drugs like oxycodone and 
specifically OxyContin is that there was previously a relatively large step 
between experimentation with marijuana and use of opiates," Simmons said.

The number of people admitted to substance abuse treatment programs across 
Maine for opiates besides heroin - primarily prescription painkillers - 
increased 80 percent between 2000 and 2002, from 571 to 1,030, according to 
state figures. More people are seeking treatment for addiction to 
prescription medication than to heroin.

Pharmaceutical abuse contributed to 63 percent of the accidental drug 
overdose deaths in Maine from 1997 through 2002, according to figures 
compiled by the state Medical Examiner's Office.

The Office of National Drug Control Policy said prescription drugs have 
eclipsed cocaine as the second most commonly abused drug after marijuana, 
not including alcohol.

Starting in June, an electronic database will track some prescriptions in 
Maine to make sure patients are not visiting multiple doctors for the same 
symptoms and doctors are not overprescribing pain medication.

The technique is employed by 21 other states, some with great success. 
Maine doctors also now use tamper-resistant prescription pads.

Treating pain while preventing diversion can be a challenge for doctors, 
said Simmons, who also runs a Washington County hospice. In a handful of 
cases nationally, the DEA has brought charges against doctors for 
inappropriately writing pain prescriptions, making some doctors skittish 
about prescribing large amounts of narcotics.

"It's a very tough line for many physicians to walk and they're feeling 
embattled from both sides and not feeling comfortable they can make the 
distinction between chronic pain and a patient that may be manipulating 
them for diversion," he said.

David Hench can be contacted at 791-6327 or at: SIDEBAR:


Oxycodone is a synthetic opiate twice as powerful as morphine and is the 
active ingredient in OxyContin, a popular medicine for treating chronic 
pain. The medicine can be stripped of its time-release coating to give a 
high like heroin and it is now a popular street drug blamed for an 
increasing number of people addicted to painkillers.

Methadone tends to be associated with treatment for addiction, but it is 
also an effective painkiller. Methadone drew attention in 2002 for its role 
in a number of overdose deaths in Portland and statewide.

Fentanyl is frequently provided as a patch on the skin that delivers an 
ongoing dose of the painkiller. It is a popular alternative to OxyContin 
for doctors treating pain because it is relatively difficult to divert and 

Prescription drug addiction accounted for 9 percent of new admissions for 
treatment in 2002, compared to less than 1 percent in 1995, according to 
the state Office of Substance Abuse. By comparison, heroin represented 7 
percent of new treatment admissions. Alcohol treatment was 58 percent.

An increase in statewide drug deaths from 33 in 1997 to 90 in 2001 
primarily was attributed to prescription drug abuse, according to state 

A 2002 survey of teenage drug use indicated 10.7 percent of 12th grade 
students in Maine reported having abused prescription drugs in the past month.

The Maine Drug Enforcement Agency seized 5,274 dosage units of diverted 
pharmaceuticals in 2002 and 94 diverted pharmaceutical-related arrests 
accounted for 18 percent of the agency's arrests. 
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MAP posted-by: Keith Brilhart