Pubdate: Sun, 25 Jun 2006
Source: Telegraph (NH)
Copyright: 2006 Telegraph Publishing Company
Author: Andrew Wolfe, Telegraph Staff
Bookmark: (Heroin)
Bookmark: (Methadone)
Bookmark: (Methamphetamine)
Bookmark: (Treatment)


Drug-overdose deaths have climbed sharply in New Hampshire over the 
last 10 years, and they show no sign of slacking.

Chief Medical Examiner Dr. Thomas Andrew has compiled statistics on 
fatal drug overdoses in the state for several years, and his records 
show drug overdoses have risen steadily, from 39 in 1995 to 153 last year.

"There is a 150 to 175 percent increase in drug-related deaths over 
the past five years in New Hampshire," Andrew said.

"There was a time when we thought drug overdose deaths were going to 
exceed traffic deaths in New Hampshire, but drivers sort of sunk to 
the challenge," and motor vehicle fatalities have increased, as well, 
Andrew said. (There were 171 traffic-related deaths in the state in 2004.)

The state Department of Health and Human Services also keeps 
statistics on hospital admissions, which include treatment for 
non-fatal overdoses, but those records are less clear-cut.

Opiates remain the leading cause of fatal overdoses, and methadone 
has become the single biggest killer, topping even heroin, Andrew said.

"Methadone is driving this bus," Andrew said. "Methadone has emerged 
as public enemy number one."

Andrew said most methadone abused by addicts comes not from 
addiction-treatment clinics, but from Internet sales and pharmacies. 
Andrew called the idea that methadone clinics create a source for 
illicit distribution "an utterly disprovable myth."

"The source of methadone are the pills and tablets that are either 
being dispensed for treatment of chronic pain, or they're being 
illicitly obtained from the Internet or other means," Andrew said.

Methadone alone accounted for 23 of the 153 fatal overdoses last 
year, and it was present in the bloodstream of an additional 52 
overdose victims, Andrew's records show.

Andrew counts the total number of deaths caused by overdose, 
accidental and otherwise, but in most cases, the deceased had been 
using more than one drug, his records show.

Heroin shows as a small number in the figures because it's so rarely 
detected, Andrew said. The human body quickly converts heroin, he 
said, but heroin is believed to account for most of the unclassified 
"opiate" deaths.

Other prescription pharmaceuticals, including various opiates, 
antidepressants and other mood-altering drugs, also account for a 
large number of deaths collectively, Andrew said.

Last year, a group of law enforcement and medical professionals 
formed the Prescription Monitoring Program Ad Hoc Committee and 
drafted legislation to create a system to monitor prescription drugs 
to prevent "doctor shopping."

There is nothing to stop a person from visiting several doctors and 
getting prescriptions from each for the same condition, Andrew said. 
The bill proposed a $35 fee to be paid by doctors licensed to write 
prescriptions to fund a computer network that would allow doctors and 
pharmacies to check whether a patient already has prescriptions from 
another doctor or pharmacy, Andrew said.

Maine and Massachusetts already have such systems in place, and 
Vermont recently approved a program, Andrew said.

"Far more attention should be paid on establishing some sort of 
monitoring system," Andrew said. "It's one man's opinion, but it 
seemed to me after looking at it in detail for 2 1/2 years that a 
prescription monitoring program could make inroads into this problem."

The House at first approved the bill, then reconsidered and voted to 
send it back for further study in March, effectively killing the bill 
for now. The House Health, Human Services and Elderly Affairs 
Committee will make further recommendations sometime this fall, House 
clerk Karen Wadsworth said, but the bill would have to be 
reintroduced for any further action.

Andrew said he was surprised the bill failed to pass outright. 
Opposition focused on the perceived cost and privacy concerns, he said.

"It was deemed to be sort of the heavy hand of the state invading the 
lives of New Hampshire citizens," Andrew said, adding later, "I had 
no idea that this would fail. This seemed to me to be a no-brainer.

"Money talks, and 150 deaths apparently does not."

The proposed monitoring system wouldn't have been able to make a dent 
in Internet drug sales, Andrew said.

"At this point, there is no way to get a handle on the inflow of 
pharmaceuticals coming from the Internet," he said.

While heroin and cocaine have become chronic problems around the 
state, law-enforcement professionals lately have focused their 
attention on methamphetamine. Methamphetamine deaths have been rare 
in New Hampshire, with only one last year, but statistics from other 
states suggest police and prosecutors are right to worry, Andrew said.

"It is an exceedingly dangerous drug. . . . It's a very scary agent," 
Andrew said. "If methamphetamine manages to take hold here as it has 
in other jurisdictions, we'll have big problems."

Statistics on hospitalization for non-fatal overdoses are harder to 
come by, Andrew and other state officials said. The Department of 
Health and Human Service's Bureau of Health Statistics gathers data 
from hospitals around the state, but there is no comprehensive system 
for gathering data on treatment for drug abuse, injury surveillance 
Manager David Reichel said.

"There's a tremendous amount of interest in getting a better handle 
on drug abuse," Reichel said. "It's such an important public health 
issue, and we do have a lot of people working with drug overdoses, 
but we really do have a problem with data, how to count them."

The bureau produced a report on hospital admissions for various 
drug-related issues in 2002, breaking down the number of inpatient 
and outpatient treatments by age group and county.

That report shows there were 134 inpatient hospital admissions for 
opiate poisoning or dependence in Hillsborough County in 2002, more 
than half of them (69) involving people ages 20-39. People ages 40-59 
accounted for about 28 percent of them (38), while those ages 10-20 
accounted for about 15 percent (20) of the total.

That report serves as a snapshot of 2002, but there is no readily 
available ongoing data, Reichel said.

The state receives hospital treatment information based on billing 
and insurance codes, and because medical problems and treatment can 
be complex, the data for any one particular hospital admission isn't 
always clear-cut, Reichel said.

"It seems like every time we get a data request, we have to go back 
and start from scratch," he said. ". . . We don't have just a 
standard set of codes and decision rules for counting drug abuse and 
drug overdose. Drug overdose is just a big question mark."
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