Pubdate: Sat, 27 Feb 2016
Source: Sacramento Bee (CA)
Copyright: 2016 The Sacramento Bee
Author: Dan Morain


Heroin, Prescription Opioid Deaths Continue to Rise, Despite Controls

Gary Mendell Created Nonprofit Called Shatterproof to Save Other 
Parents' Children

California Medical Association Lobbies Against Legislation Intended 
to Fight Opioid Epidemic

Like the pragmatic businessman he is, Gary Mendell came to town armed 
with facts to make his case, although a few years ago, he never could 
have imagined discussing the topic at hand, drug addiction.

Prescription opioid sales increased almost fourfold between 1999 and 
2010; overdose deaths rose fivefold. There are 25 million addicts; 15 
people die every hour of every day of addiction. And so on.

Mendell was chief executive officer of a high-end hotel chain based 
in Connecticut where he lives. And then his son, Brian, became an 
addict. He was 25, living in a halfway house in Los Angeles and 
hoping to become a drug counselor when, as Gary pieced it together, 
depression struck, and his son committed suicide. That was in October 2011.

"What really took his life was shame, the stigma of it all, feeling 
like an outcast," Mendell said.

Over a beer he didn't finish at the downtown Hyatt bar and later by 
phone, the father recounted the devastation, how he was unable to get 
out of bed or leave his home or make it to work.

As the pall lifted, he steeped himself in addiction research and used 
his business acumen and much of his wealth, $4.1 million so far 
toward a $5 million commitment, to create a research and advocacy 
organization, Shatterproof. It's dedicated to ending prescription and 
illicit drug addiction and combating the stigma associated with it. 
He works there full time, for no pay.

The other day, Mendell awoke unable to see out of his right eye. At 
the hospital, he was diagnosed as having suffered a stroke. He was 
treated with kindness and respect throughout the ordeal. How 
different it was for his son.

"Frankly, I can't think about it without crying," Mendell said. "He 
had a brain disorder. Instead of being treated like a patient, he was 
treated like an outcast."

You can't avoid evidence of addiction these days. It's on television 
and on the streets. I crossed the railroad tracks walking toward 
Peet's Coffee on 19th Street and saw three used syringes.

On the campaign trail, presidential candidates from both parties turn 
somber and discuss prescription drug and heroin addiction. President 
Barack Obama requested $1.1 billion more from Congress to combat 
addiction earlier this month. Last week, representatives of the 
National Governors Association met with Obama to discuss strategy.

In Sacramento County, where overdose deaths hit 111 in 2013 after 
falling to 64 the year before, local officials will gather this week 
to focus their efforts.

Nationally, 18,893 people died of prescription opioid overdoses in 
2014, up from 4,030 in 1999. An additional 10,574 died from heroin 
overdoses in 2014, up from 1,960 in 1999, the Centers for Disease 
Control and Prevention reports.

Brian is not one of those statistics, though Mendell has no doubt 
that addiction to prescription painkillers and heroin led Brian to 
the end of his rope in 2011.

Once, doctors were too hesitant to prescribe opioids for serious 
pain. That began changing in the 1990s. In 1995, the U.S. Food and 
Drug Administration approved Purdue Pharmaceuticals' slow release 
form of opioid, OxyContin.

In 1999, well-intentioned California legislators sought to ensure 
that patients in terrible pain would have access to medication, so 
they wouldn't beg for death.

A Senate analysis of the most far-reaching bill, AB 791, said it was 
intended to "change the medical community's approach toward pain 
management and end-of-life care." Medical students would be schooled 
on pain and doctors would receive training. Pain management would 
become "a part of the standard practice of medicine."

The powerful California Medical Association supported the bill, as 
did hospice care providers. The Legislature approved it without a 
single dissenting vote. Several states followed California's lead. 
Health care providers now ask patients to rate pain on a scale of one 
to 10; pain is a vital sign, like blood pressure.

"Everybody thought it was a great idea," said the bill's lead author, 
then Assemblywoman Helen Thomson, a Democrat from Davis. And it is, 
except that too many practitioners handed out too many painkillers 
for too many ailments, not fully understanding that they are 
addictive, like their illicit twin, heroin.

We spend tens of billions of dollars on prescription painkillers, and 
Mendell travels the country, lobbying for ways to reduce drug abuse.

In California, his focus is on a bill by Sen. Ricardo Lara, a Los 
Angeles-area Democrat, that would require doctors to check a state 
database, known as the Controlled Substance Utilization Review and 
Evaluation System, before writing prescriptions for opioids. Among 
its purposes, the system is supposed to stop patients from going to 
different doctors to feed their addictions.

Mendell offers facts: In the year after New York adopted a similar 
drug monitoring program, opioid prescriptions fell by more than 9 
percent, and instances of doctor shopping fell by 74.8 percent.

"It is just simple math," Mendell said.

But nothing is simple in the Capitol. The California Chamber of 
Commerce, insurance companies, police groups, consumer advocates, 
plaintiffs' lawyers and unions support Lara's SB 482. But because of 
opposition by the California Medical Association, the bill has stalled.

"At its most basic, it legislates the practice of medicine, which CMA 
opposes," the doctors' opposition letter says.

Doctors know best, evidently.

Most are responsible. Last year, doctors, pharmacists and law 
enforcement tapped into the database to check on 6.1 million patient 
records, up from 3.5 million the year before.

Yet clearly, some doctors aren't paying attention, or are 
over-prescribing to make a quick buck. And so Mendell travels the 
country, offering his facts, hoping to save the next father's son.
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MAP posted-by: Jay Bergstrom