BAD SCRIPTS, Part 2: Special Report, the cost of prescription drug abuse

Jennifer Dodd never figured she’d wind up where she did. Not in a million years.

She was a caring and committed healthcare professional, not a thief. Not a criminal.

But there she was all the same, turning herself into the authorities, washing her nursing career down the drain, after she was caught stealing drugs from the hospital where she worked.

It all happened so fast. A year after she was diagnosed for rheumatoid arthritis, the pain increased and she needed more and more pain-killing medication to make it through the day. It was hard to get more. The drugs were expensive and it was so tempting. The hospital kept that stuff she needed in easy reach. So she started sneaking pills from the distribution bin on the wing’s floor as supplement her own Percocet prescription.

“I just felt that I needed more and more of it to get that…it just kept me going,” Dodd said. “It was just a euphoric feeling.”

The euphoria was short lived. The scheme did work for awhile, but then someone noticed. An investigation followed. She  was confronted by her superiors, drug tested, fired. An eight-year career over, a life in turmoil.

It’s hardly the first time its’ happened and the Florence nurse is just one of many. Some 266 nurses have been arrested in South Carolina during the past four years on charges of drug diversion (and other charges) related to the disapperance of millions of dollars worth of prescription drugs.

Prescription painkiller abuse has always been a problem, but it’s only recently that it has become an epidemic, claiming, accordingly to national statistics, 14,800 lives in 2008 through overdoses. That’s a 300 percent increase since 1999.

Drugs that are prescribed to treat acute and chronic pain are being abused by many with a false sense of security. For many, the powerful narcotic they began using therapuetically after an injury or surgery, or which they may have taken recreationally, really wasn’t safe even though it was legal. Like their illegal counterparts, prescription drugs, taken without supervision, are highly addictive and can lead to a vicious cycle of abuse.

According to the Centers for Disease Control and Prevention (CDC) from 1999-2008 overdose deaths have increased by 285 percent in the state of South Carolina. This number includes all illicit, prescription and over-the-counter drugs. CDC spokesperson Courtney Lenard said it’s difficult to pinpoint just prescription painkillers as a culprit.

“We typically shy away from giving state specific data on opioid pain reliever deaths because of state differences in medical examiner documentation,” Lenard said.

Second only to crack

The problems the drugs cause for users – ruined lives, ruined relationships, even death – are mirrored in local, state and national law enforcement organizations. Besieged by crime in particular, and especially by crimes related to drugs, prescription drugs represent just one more growing issue that must be addressed.

 “It’s becoming a bigger problem and the reason I say that is because people are not afraid of taking these drugs or the consequences,” said Lieutenant John Calhoun of the Florence City Police Department  “And they get in this mindset that nothing bad is going to happen (because the drugs are prescription drugs). You’re much more likely to take that pill than go out and buy crack.”

The mindset that prescription drugs are safer, combined with the ease of transportation, the difficulty of enforcement, and the acceptance and prevalence of prescription drugs, makes it the second biggest drug problem in Florence behind crack.

“It’s a much bigger problem than people realize and it’s a problem that can be easily hidden,” Calhoun said.

And it’s a problem, Calhoun said, that knows no socioeconomic boundaries.

Prescription drugs with alluring affects are everywhere. Most any medicine cabinet will contain a few leftover doses of prescription painkillers like Vicodin or Percocet from past ailments, medical operations or a pain management regime for a serious disease such as cancer. In many households, a stronger prescription for narcotics such as fentanyl or Oxycontin may be lying around. That’s the easiest way that people, especially younger adults, gain exposure to the drugs that can be crushed or snorted, even dissolved and injected.

Without proper attention to the security of medications parents can end up being unintentional drug suppliers to their children.

Once a painkiller addiction picks up, however, stealing from the medicine cabinet or from family members doesn’t provide the quantity needed to satisfy an addict’s need, especially to stave off withdrawal symptoms. So the addicted, and those looking to service these same addicts, look elsewhere. And that produces a mini-crime wave.

From January 6, 2008 to January 9, 2012 for example,  the Florence County Sheriff’s Office made 275 arrests on prescription drug possession, fraud and forgery charges. As noted, there were other arrests where medical employees stole drugs from an employer cache.

And some of the crimes extend beyond the obvious forging of signatures or direct stealing of the drugs.

Holly Morrison, a counselor and therapist at Circle Park Behavioral Health Services in Florence, has heard plenty from clients about just how far they will go to get those drugs.

“I’ve had people pop a shoulder out of joint (in order to get another pain med prescription,” she said. “To go to the emergency room, they will break teeth, lie about pain all together, they will prostitute themselves and their children. They will lie and steal and cheat … not (them, really) but the addiction.”

Doc shopping, pill popping

Unfortunately for law enforcement, there are a variety of ways for pills are diverted from their legal, medical use to the streets and black market for abuse.

One of the most common ways is through “doctor shopping.”

Doctor shopping refers to a patient who visits multiple medical professionals, such at doctor’s offices, emergency rooms and/or urgent care centers, for treatment of the same injury/condition. They receive multiple prescriptions for real or feigned, pain-related conditions. Afterwards, they visit several pharmacies to collect the drugs for themselves and/or sale.

While not every patient with multiple doctors and multiple prescriptions is a drug abuser, suspicious activity can alert pharmacies and law enforcement officials to the person’s activity through the South Carolina Reporting & Identification Prescription Tracking System (SCRIPTS) which is a Prescription Drug Monitoring Program (PDMP) similar to those in place in 35 other states.

The service has been online since February 2008. It tracks dispensation of controlled substances schedules II, III and IV — drugs such as Oxycontin, Percocet, Xanax, etc. It’s based on the reporting of pharmacies. Systems such as SCRIPTS is one way Gil Kerlikowske, director of the Office of National Drug Control Policy, plans to reach the goal of lowering prescription drug abuse deaths by 15 percent by 2015.

“We need to make sure that we are doing everything to improve these PDMPs,” Kerlikowske said in a CDC conference call in November. “That will reduce the doctor shopping.”

One major loophole in the Prescription Drug Monitoring Act, is that dispensers are only required to report to the online database monthly what drugs they dispense. Plenty can happen inbetween the time one report is followed by another. And, of course, someone has to be monitoring the databases, and resources have to be available for enforcement.

According to SC Department of Health and Environmental Control (DHEC), the agency that controls SCRIPTS, more pharmacies are reporting on a weekly basis.

“It enables any kind of inconsistencies or red flags in the service to be identified and stop the diversion of prescription drugs,” Adam Myrick, public information officer for DHEC’s Bureau of Drug Control. “It’s something that has been helpful.”

Since 2008 the S.C. Bureau of Drug Control has arrested 2,286 people such as doctors, nurses, pharmacists and others on prescription drug-related charges.

“We’ve seen an increase in forgery of prescriptions and an increase of thefts within settings that are supposed to be secured,” Myrick said.

Dodd was a person amongst all those numbers. Luckily for her she is now back to being, officially anyway, just a person.

The charges against her have been expunged from her record because Dodd attended treatment classes at Circle Park for her painkiller addiction. To combat anxiety and a diagnosis of bipolar disorder (which Dodd no longer believes was correct) she was placed on antipyschotics and sedatives which lead to another tough battle that she eventually won a year ago through treatment at Reformers Unanimous.

Unfortunately, not every story like Dodd’s has as happy an ending.

Read the rest of the series online. Part 1: the cost of prescription drug additction, and part 3, Treating prescription drug addiction.