‘Prescription for Abuse’ Honored at Best of the West

Last February, Carol Smith’s report, “The Prescription Epidemic” revealed how aggressive marketing and sales of pharmaceuticals drove a culture of overprescription in Washington and created the spectacular run-up in the number of deaths from prescription overdoses.

Today that story—and the documentary of the same name that we co-produced with KCTS—was recognized by Best of the West, a journalism contest for news outlets from Alaska to Texas. Here’s what the judge had to say:

InvestigateWest’s Carol Smith and Stephanie Schendel and KCTS’ Ethan Morris take second for their collaboration in print and video of the prescription-drug epidemic in Washington. The investigation comes after the state’s enactment of a law that limits the doses doctors and others prescribers can give out. It is considered one of the strongest prescription drug laws in the United States.

“InvestigateWest’s report on the prescription drug epidemic in Washington tackles a controversial topic – the unintended consequences of making pain medication available to those in need. Carol Smith and her colleagues revealed not just the personal cost of overdoses but also the hidden influence of drug companies on the guidelines for the use of painkillers. The research, the writing and the multimedia presentation offer readers creative, compelling and unforgettable work,” the judge wrote.

Congratulations also to the staff of The Oregonian, who won top honors in the category for their reporting on the Oregon Public Employees Retirement System.

Interview: Dr. Michael Copass

Dr. Michael Copass, medical director of Medic One
(InvestigateWest/Medic One Foundation)

Dr. Michael Copass, whose famously crusty persona and exacting standards in the emergency room inspired equal parts dread and admiration among generations of medical students, residents, nurses and paramedics-in-training, sat down with InvestigateWest’s Carol Smith to talk about Medic One – the emergency response system he helped pioneer, and how it is responding to the epidemic of overdose deaths in King County.  Over the nearly four decades he was director of Emergency Services for Harborview Medical Center, the region’s Level 1 trauma service, Copass acquired a legendary status for his fierce devotion to patients and his high bar for those under his command. Paul Ramsey, dean of the University of Washington School of Medicine, once referred to him as a “cross between General Patton and Albert Schweitzer.” The Medic One model of emergency response, which began in the late 1960s, is now emulated around the world. Copass, who retired from Harborview in 2008, remains medical director of Medic One.

Smith: I think the lay public confuses Medic One vehicles with ambulances, and we use the terms interchangeably. What kind of equipment is different on a Medic One versus a private ambulance?

Copass: Private ambulances carry comfort equipment – oxygen, suction gear. A Medic One unit basically is an under-stocked ER. (It has) two defibrillators — one on active duty, one on reserve.  It has individuals trained at the 2,800-hour level of education versus individuals who are trained at 120 hours.

Legislature seeks Rx to discourage pharmacy robberies

Bill McNary smooths his white coat and steps out from behind the high counter where he presides over medications dispensed at the Maple Leaf Pharmacy in a quiet residential neighborhood of north Seattle. He scans the few customers who are browsing the aisles full of Ace bandages, aspirin and assorted other sundries for life’s aches and pains.

These days, even the most benign-looking customer could be a deadly threat. Worried about the kinds of robberies McNary, co-workers, and customers have experienced, pharmacists across Washington are seeking changes in state law.

In December, 2009, a young man who McNary said looked “normal enough” strolled into the pharmacy, glanced around, bought a Chapstick, which gave him a view over the counter, and left. When he came back a few hours later, the store was packed with customers waiting for flu shots. He was waving a gun.

The man, Jacob Shook, burst behind the counter and overpowered one pharmacy technician, knocking her to ground.

Technician Geraldine Crews whipped around, phone in hand, as her co-worker flew to the floor. She saw the glint of a gun barrel and hit the ground herself.

“He jerked me up, and slapped me with the gun,” she said. “He got angry. He said, ‘Do you know what Oxy is?’ ” She knew that OxyContin, a powerful pain pill that acts like heroin, sells for upwards of $80 a pill on the street. She also knew that people addicted to it can be desperate.

“Here – take it all and go,” she remembers telling him. She was terrified that if she didn’t, he’d turn the gun on customers.

“This place was full of people — there was a five- or six-year-old little boy with his parents here,” she said. “I’m sure it gave that little boy nightmares.”

Interview: Rose Dennis

Rose Dennis, Board of Directors, SAMA. Credit: Ethan Morris/KCTS. Prescription drug overdoses kill two people a day in Washington state. But the damage caused by addiction to painkillers is even more widespread. As part of its collaboration with InvestigateWest, KCTS invited recovering addicts and their families to share their stories.

Interview: Maria Downing

Maria Downing, SAMA Family Action Council. Credit: Ethan Morris/KCTS.

Prescription drug overdoses kill two people a day in Washington state. But the damage caused by addiction to painkillers is even more widespread. As part of its collaboration with InvestigateWest, KCTS invited recovering addicts and their families to share their stories. Here Ethan Morris, executive producer for public affairs at KCTS, interviews Maria Downing. Downing is on the Family Action Council for SAMA, the Science and Management of Addictions, an organization that works to educate families and youth about addiction. Her grown son died of his addiction.

Ethan Morris: If you could start, tell me your name and tell me about your son?

Maria Downing: I’m Maria Downing. My son is Greg Downing, born in 1967. We didn’t know until later on that he’d actually been introduced to marijuana at 11 years of age. There was a van a couple of blocks away from the elementary school he attended, offering it to the kids. Just offering it. By 14, he was definitely drug addicted, substance addicted.

It was a struggle for everyone, including himself. I think that his perception was that he had control of it, that he could walk away from it whenever he could. I think that still was in his head somewhere, although less so by the time he passed at 41 and a half.

School became very difficult. He was a challenged student. Very, very smart. Great memory for numbers. Incredible memory. He was a poet and a writer in school, a super athlete, the best in the state really when he went up to Fort Casey for the summer school soccer programs. Also an outstanding catcher. Loved basketball, all the sports.

The Devil in the Medicine Cabinet

Rosemary Orr with her son, Robin, at his high school graduation in June, 2000.
Photo courtesy of the Rice family.

Dr. Rosemary Orr didn’t see it coming that day. It was the morning after Mother’s Day. She needed a ride to work, so her 24-year-old son Robin drove her. She was in a hurry to get to Children’s Hospital and Medical Center in Seattle, where she is a pediatric anesthesiologist. Otherwise, she says, she would have spent more time talking with him.

She’d been worried about his sleeping habits, his weight loss lately. She knew her smart, handsome son had struggled with addiction to OxyContin in the past. But he’d kicked it. He’d assured her of that. He’d looked her in the eye and said, ‘You don’t have to worry about me, Mom.”

No parent wants to believe her child is using. Not even one who is a doctor.

“I was stupid and desperate enough to believe that explanation,” Orr says now, five years later, over coffee a few miles from her work, where she takes care of the pain of others. Her own pain, she takes with her.

When she got home from work that day, Robin’s phone was ringing, but he wasn’t answering in his room downstairs. She knocked. And knocked again. She went around her house and peered in through his bedroom window.

In Spokane, Dr. Darin Nevin (left) and Lee Taylor want to expand data sharing to emergency rooms across the state.

New Prescription Drug Law Holds Promise, but Concerns Linger

In Spokane, Dr. Darin Nevin (left) and Lee Taylor want to expand data sharing to emergency rooms across the state.
Credit: Dan Pelle/The Spokesman-Review

Washington State has made an aggressive attempt to crack down on the prescription drug epidemic by passing strict new rules governing pain management. But even those may not be enough to stanch the flood of deaths from prescription opiates in this state.

The passage of a new law, regarded as one of the toughest in the nation, makes Washington the first state to require dosing limits for doctors and others who prescribe these medicines. The law, RCW 2876, went into effect January 2, but those who have watched the epidemic spiral out of control still see significant challenges ahead.

Among the first is the dearth of pain specialists in the state. Under the new law, doctors and other prescribers with patients who need more than 120 mg a day must seek a second opinion from a pain specialist. But there are few of those professionals to go around.

Medicaid is already struggling to comply with the new law. Despite having thousands of patients currently over the threshold limit, the agency can only get one or two evaluated by a pain specialist a month, said Dr. Jeff Thompson, medical director of the state’s Medicaid program.

“Access is an issue,” said Dr. Gary Franklin, medical director of the state’s Department of Labor & Industries, adding that telemedicine consultation programs and other efforts to increase capacity are helping, but still don’t fill the need.  

The new law makes Dr. Merle Janes of Valley Rehab & Emergency in Spokane angry. He said legitimate pain patients and doctors who prescribe for them are paying the price for the policy changes designed to nab addicts. People in real pain can’t get adequate relief, he says.

“It’s been a disaster for all these people,” Janes said.

Dr. David Tauben, a clinical associate professor and director of medical education in pain management at the University of Washington, agreed that not enough doctors are treating pain well.

“But this problem was happening well before the new law,” Tauben said. He’s optimistic that the new law will actually encourage more doctors to take on pain patients because they will have guidelines to follow to help keep them from running afoul of disciplinary agencies. The guidelines should remove ambiguity and help doctors communicate better with patients about the goals and limitations of pain treatment, he said.

Drug Companies Fight Take-Back Program for Unused Medicine

Meanwhile, environmental authorities say prescription drugs are turning up in waterways and even drinking water – and it’s happening often enough that the old medications now are considered hazardous waste.

“People don’t have a safe way to dispose of these medicines,” said Margaret Shield, policy liaison for the Local Hazardous Waste Management Program in King County, a consortium of local governments. “Often people don’t think of medicines as being potentially hazardous, but they are in the wrong hands and they need to be properly disposed of just like other household hazardous waste.”

Yet efforts in Olympia to pass a law to force drug companies to pay for a statewide system for properly disposing of old medicines have foundered for five years running now in the face of opposition by the pharmaceutical industry. If the legislation passes, Washington would become the first state to require the industry to fund a drug take-back program.

About one-third of all medicines sold annually in Washington – 33 million containers of pills – go unused, say proponents of stricter regulation. Some get flushed down the toilet, but many more sit unused in medicine cabinets. This stock of drugs is a contributing factor in Washington’s epidemic of prescription drug abuse.

“More people are dying from prescription drugs than out there on the highways,” said Patric L. Slack,commander of the Snohomish Regional Drug Task Force.

Interview: Rayne Pearson

Rayne Pearson, Attorney. Credit: Ethan Morris/KCTS.

Prescription drug overdoses kill two people a day in Washington state. But the damage caused by addiction to painkillers is even more widespread. As part of its collaboration with InvestigateWest, KCTS invited recovering addicts and their families to share their stories. Here Ethan Morris, executive producer for public affairs at KCTS interviews Rayne Pearson, a practicing attorney in Seattle.

Ethan Morris: Let’s start by telling me your name and why you’re here.

Rayne Pearson: My name is Rayne and I am a recovering addict.

EM: What are you recovering from?

RP: I’m in recovery from prescription drugs mostly. Opiates and benzodiazepines.

EM: Can you tell me how you came to start using drugs?

RP:  I started using drugs when I was very young, about 14 or 15. And I think, like a lot of addicts, I started with alcohol and pot and I was definitely addicted from the very first time I ever used drugs. I used drugs on a daily basis, probably from the time I was 17 until the time I got clean when I was 32. The disease is progressive, so my using intensified. I started using harder and harder drugs, and I think it was probably in my mid 20’s when I had my first prescription for Xanax, which is a benzodiazepine. I started abusing it right away.

How Addiction Nearly Killed Justine

Editor’s note: Stephanie Schendel, a journalism student at Washington State University, interned at InvestigateWest during the summer of 2011. Here she shares a compelling first-person account of how the prescription drug epidemic affected her own life and that of her roommate, Justine, who agreed to be interviewed for this story. It’s a personal tale, but also one that is playing out on campuses around the state and country as colleges grapple with the ready availability of alcohol and prescription drugs, and the students who get hooked on them.

First impressions

When I first met Justine, she was chugging from a bottle of vodka.  I was 18 years old and at my first frat party.  I barely knew anyone, and the fraternity’s basement smelled like old beer and cheap deodorant.  The smell, blaring music, and the amount of people and alcohol overwhelmed me, but not Justine. Outgoing and friendly, Justine seemingly already knew everyone there, even though it was her first week of college.

The first thing Justine told me that night was that she’d already downed 18 beers  in order to “medicate” for the tattoo she had gotten earlier that day.  I was alarmed and impressed.  She showed it to me, the irritated skin still red and puffy.  It was three words written in Hungarian. She said they meant “strength, loyalty and compassion.”

She didn’t remember meeting me that night.  Or even the second or third night we met, but I remembered her: She was girl who had an insane tolerance for alcohol and could out-drink a fraternity any day of the week.

By then, she was already deep into her addictions.  Years later, she told me her substance abuse had started in middle school with pot and alcohol.  By the time she was thirteen she was stealing pills from her grandmother’s medicine cabinet.