Source: New York Times
Date: 18 March 2004

Drug-Fighters Turn to Rising Tide
of Prescription Abuse


WASHINGTON, March 17 — After years in which marijuana, cocaine and heroin were by far the main focus of the nation's war on drugs, the Bush administration is now attacking the rising abuse of prescription drugs.

While marijuana remains the nation's most abused drug, according to government and private studies, narcotic pain relievers like OxyContin and Vicodin, along with a variety of some other prescription medications, have overtaken amphetamines to rank second.

A recent nationwide study by the University of Michigan showed that from the 2002 to 2003 school year, nonmedical use of prescription drugs among students in the 8th, 10th and 12th grades increased even as use of other illicit drugs dropped by 11 percent.

Doctors, other health care providers and law enforcement officials say prescription drug abuse produces the same problems as street drugs: addiction, crime and broken families.

And, like street drugs, it produces headlines about celebrity drug users, notably Rush Limbaugh, who admitted last year that he was addicted to painkillers. The authorities in Palm Beach County, Fla., are investigating Mr. Limbaugh and several of his doctors on suspicion of "doctor shopping," the practice of contacting a number of physicians as a way of getting more drugs than are medically necessary. That activity is a felony in Florida.

One part of the problem is that prescription drugs are advertised to millions of people every day over the Internet. Many of those drugs are from foreign sources that state and federal authorities cannot easily trace, let alone regulate. The House Government Reform Committee has scheduled a hearing for Thursday on a bill that would require such Web sites to identify their place of business, as well as affiliated doctors and pharmacists, and would ban any sales made without an in-person consultation with a doctor and a valid prescription.

Beyond Congressional interest, the White House Office of National Drug Control Policy has for the first time instructed federal agencies with antidrug programs to develop new strategies to combat prescription drugs' abuse and illegal marketing.

"We don't want to wait until we get what we had with the crack epidemic," John P. Walters, who as the office's director serves as the nation's "drug czar," said in an interview. "Hopefully we're a little bit earlier in the process."

Mr. Walters's office is largely a bully pulpit for the war on drugs, setting policy and then lobbying Congress for money that is distributed to the agencies carrying out the efforts. As a measure of the administration's concern about prescription drugs, President Bush is seeking $12.6 billion for antidrug programs next year. That would be a 4.6 percent increase, a request nine times as high as the average increase proposed for programs that do not involve defense or national security.

Much of the responsibility for the new focus on prescription drugs falls on the Food and Drug Administration and the Drug Enforcement Administration. Mr. Walters said the F.D.A. was being instructed to improve labeling of commonly abused drugs and to provide doctors more information about the medicines they prescribe. The D.E.A. has been asked to shut down online pharmacies selling drugs without prescriptions and to discourage credit card companies from facilitating sales.

Some drug experts say the effort, while impressive, comes late.

"I'm not a big subscriber to the fact that prescription drug abuse is new," said John Burke, a former Cincinnati police officer who now leads a regional antidrug task force in southern Ohio. "It's always been there. There has been some increase, but it's just getting more attention because of certain drugs, like OxyContin obviously."

Mark Kleiman, a professor of public policy at U.C.L.A., said the widespread abuse of prescription painkillers began nearly a decade ago.

"It would have been great if people looking at those numbers had started to move in the mid-1990's," Professor Kleiman said. "That's not to say it's bad to do something now. We still have a major drug problem here that hasn't been addressed in any serious way."

Since arriving on the market in 1996, OxyContin has become one of the most commonly prescribed narcotics for treating pain, notable for a time-release delivery and an active ingredient that is twice as potent as morphine. Abusers crush the tablets to gain its full impact at once through snorting or injection. The effect is a euphoria that many drug experts say is equal to that produced by heroin.

Rural areas and other regions where many are employed in physical labor have been hit especially hard by the growing popularity of OxyContin and other painkillers. Louise Howell, executive director of Kentucky River Community Care, a social services agency in the state's Appalachian region, said easy access to prescription drugs through doctor shopping and Internet sales had brought enormously painful consequences.

Citing cases in which users were supporting their habits by selling their homes and stealing from their families, she said: "It's overwhelming us. We're imploding, and it's shameful."

Sgt. Bill Purcell of the Virginia state police reports the same problems in southwest Virginia, where he supervises a regional drug task force. In the last five years, he said, there have been "dramatic increases" in illicit use of prescription drugs, a trend characterized by the theft of doctors' prescription pads, callers to pharmacies who pretend to be physicians, and nurses who call in prescriptions for themselves.

"These drugs are everywhere," Sergeant Purcell said.

Mr. Walters, the White House antidrug official, said his office intended to press more states to adopt computerized monitoring programs that help reduce doctor shopping by tracking the identities of those who write prescriptions and those who receive them; fewer than half the states now have such programs.

And Michael Horn, director of the National Drug Intelligence Center, a Justice Department agency that provides analysis for policy makers and support for drug-fighting programs, said he planned to shift more resources into generating information on prescription drug abuse.

"The increasing rates we've seen," Mr. Horn said, "are kind of scary."

But even the proposed level of federal spending may not make much difference, state and local law enforcement officers say.

"Even the D.E.A. people I talk to say they are hurting for resources," said Sergeant Purcell. "Unless we get more resources, we'll always be behind the eight ball."

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