AP: Pain Med Use in Arizona

Arizona Use of 3 Of 5 Top Painkillers Soars; Arthur H. Rotstein; Tuscon Citizen; 2007-08-20. Posted: War on Doctors/Pain Crisis blog of the Pain Relief Network; 2007-08-21. Source

See also:
Crime (not Prescriptions) Source of Abused Pain Meds
Trends Use of Opioid Analgesics: a Revisit

Disabled after 11 back surgeries for what one doctor called “a congenitally deficient spine,” Mary Lynn O’Connor has taken prescription painkillers Oxycontin or morphine for the past seven years. They’ve restored a semblance of normalcy, she says.

O’Connor, a Phoenix grandmother of four, is a prime example why use of prescription painkillers has soared in Arizona and nationwide in recent years. “It makes all the difference in the world in being able to function, in being able to do things like go to the grocery store,” she said.

Prescriptions for several of the nation’s most popular painkillers have increased dramatically across the state and country over an eight-year period, signaling greater acceptance of narcotics for pain management by doctors and patients and recognition of the need by federal authorities, experts say. Using U.S. Drug Enforcement Administration records obtained through the Freedom of Information Act, The Associated Press analyzed prescriptions for codeine, hydrocodone, meperidine, morphine and oxycodone by super-ZIP codes in each state.

Arizona’s experience from 1997 to 2005 largely mirrored or exceeded the national growth in painkiller prescriptions.

Prescriptions in Arizona increased for hydrocodone, the generic form of Vicodin or Lortab, by 187 percent; for morphine by about 377 percent — more than twice as much as nationwide — and for oxycodone, the generic version of Oxycontin or Percodan, by 640 percent.

Nationwide, their prescribed amounts increased by 199, 154 and 591 percent, respectively. The percentage changes were measured on the basis of grams distributed per 100,000 people through retail pharmacies.

Meanwhile, gram distribution of prescribed codeine decreased 25 percent nationally and 28 percent statewide. It fell 8 percent for meperidine (Demerol) in Arizona and 26 percent nationwide.

Under federal law, the Drug Enforcement Administration monitdors controlled substances from manufacture through retail distribution; the transactions are used to track the drugs’ diversion into illicit channels.

The Associated Press analyzed the data for retail sales of the five painkillers state-by-state, grouping “super” neighborhoods by using the first three numbers of each ZIP code.

The U.S. Postal Service divides Arizona into 11 such regions — for instance, 850 for metropolitan Phoenix, 865 for the far northeastern corner, encompassing Apache and Navajo counties and 859 for eastern Arizona.

Only in the 860 region, the most north-central portion of the state including Flagstaff and numerous Navajo and Hopi Indian communities, did usage increase for all five drugs examined — from a scant. 0.4 percent for meperidine to 466 percent for morsphine. The gram distribution per 100,000 population of hydrocodone, morphine and oxycodone, increased in all 11 super-ZIP codes statewide, shooting up most notably for the latter.

But even for codeine and meperidine, whose overall usage statewide dropped, there were upward spikes. Codeine rose across northern, northeastern and eastern Arizona and meperidine went up across the northern, northwestern and southwesternmost portions of the state.

Both of those drugs have fallen into disfavor with many physicians for reasons including adverse side-effects.

Dr. Stephen Borowsky, a Phoenix anesthesiologist and president of the Arizona Pain Society, said he believes the statistics in Arizona may be skewed for areas including Indian reservations (notably the 865, 860 and 859 ZIPs).

Wand said Indian Health Service authorities told him that that “they wrote prescriptions but didn’t bill” for them until around 1999, and the numbers showed a huge jump.

But why are painkillers being prescribed more?

Borowsky said the practice of pain management has mushroomed in recent years. The field has been a board-certified medical subspecialty since 1993.

Among related developments, Borowsky said, there has been “an acceptance of using opiates for noncancer patients. “First, the big issue was that it was considered inappropriate for noncancer patients years ago, because of addiction.

“Then, it was recognized that patients weren’t going to become addicted and that it was the only humane thing to do. In more recent years, it became more acceptable for noncancer patients to be treated this way,” though doctors remain ambivalent, concerned about “treating people appropriately, but … still worrying about big brother watching,” he said.

Arizona Medical Board spokesman Roger Downey reiterated that point.

There’s been concern “on one hand that we don’t get people addicted to medications, but then there’s this concern that we have to ease the pain… then there’s this concern that we don’t want to overprescribe, but we also don’t want to underprescribe,” he said.

“Don’t make the leap of saying increased narcotics use is bad,” Dr. Michael Katz, a University of Arizona College of Pharmacy clinical associate professor, cautioned.

The public is likely to view the percentage increases and conclude that “`Wow, we’ve got a huge problem,”‘ he said. “There may be some issues there, but I think some of this is because we’re doing better in treating pain.”

Lynn O’Connor, the Phoenix woman whose back issues began with ruptured discs, has undergone surgeries including laminectomies, spinal fusions and rod insertions. For more than a year she took OxyContin and for the past six years has taken morphine tablets daily to relieve her constant pain after epidural injections were no longer possible.

Outside her home, she walks with crutches or rides in an electric cart, but she sews, works crossword puzzles and can drive.

“I’m just so grateful that I can do what I can do, and function,” she said. “Would I rather be off the medication? Yes. But I would not give up my life, and I take it.”

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