Prescription drug abuse: New laws focus on prevention

Most Montanans would be shocked to see yellow crystals of meth and a glass pipe on a neighbor's kitchen counter. But they wouldn't think twice about seeing an orange bottle of painkillers such as hydrocodone or oxycodone.

Yet prescription drugs contribute to more than 300 deaths in Montana each year –

nearly a death a day – while methamphetamine killed 20 in 2008.

That's why the state Legislature passed two bills last week to combat the growing abuse of prescription drugs. Both bills need approval from the governor before becoming law.

One measure would make it illegal to lie to physicians about prescriptions obtained from other doctors. The bill would give the state one more way to prosecute people seeking mass quantities of prescriptions for illicit purposes.

The other bill would establish a digital database of patients who are authorized to use commonly abused narcotics, stimulants and depressants.

Doctors and pharmacists could use the database to monitor "doc shopping" and signs of addiction, but law enforcement would need an investigative subpoena to access the registry. Similar legislation failed in sessions past because of privacy concerns.

This session's efforts represent progress, authorities say, but neither bill provides law enforcement with more resources to manage an already unending caseload.

The abuse of prescription drugs for recreational use accounted for 42 percent of the state's drug cases in 2009 and has been as high as 70 percent in the last two years, said Mark Long, chief of Montana's Narcotics Bureau. These crimes accounted for 7 percent of cases in 2004.

Although the number of cases has tapered some since June, Long said it's not because fewer Montanans are abusing the drugs.

"We started to get sidetracked a little with this medical marijuana mess," he said.

Even before the boom of the medical marijuana industry, the abuse of prescription drugs was rising faster than the state could focus resources and personnel on enforcement.

It's an addiction that doesn't conform to the usual stereotypes of users and suppliers.

"We can go into Billings and buy all of the illegal prescription drugs that we want," Long said. "But it's just as easy in Hobson and some of these smaller towns as it is in Billings."

It's also a drug abused by a wide range of people, from kids experimenting to the elderly who take just one extra pill on bad days and later find they are dependent.

Attorney General Steve Bullock's "Invisible Epidemic" campaign focuses largely on Montana being ranked third in the nation for abuse by children.

A 2009 survey of Montana students found that painkillers are the drug of choice for 12- and 13-year-olds and that one in 10 teens admit to abusing prescription drugs. A similar 2010 survey reported that one of every six high school seniors has abused painkillers.

Bullock secured $1.2 million in federal stimulus funds in 2009 to hire a six-person team – three investigators, a public outreach coordinator, a prosecutor and an administrative assistant — to focus on prescription drug abuse. Missoula soon appointed a fourth investigator to specialize in these cases.

But officers still see no significant dent in this growing addiction.

"We were sort of thinking that when we got these guys our other agents would have less of these cases," Long said.

Instead, he added, everyone keeps finding more cases. And these cases often take longer to unravel than other drug charges.

"It's a lot more overt because we are buying the pills from one person and now we have to go interview the pharmacist and doctors, get subpoenas and search warrants for the records," Long said. "It's a little more complicated and takes a little more finesse than some of the other cases."

He also said that many busts are isolated incidents where a person injured in a serious accident sells their extra painkillers for money or someone steals from a family's medicine cabinets for personal use.

Far fewer cases involve a chain of sellers and suppliers where catching one seller can lead to other arrests.

Nor is it easy to spot abusers. Often people who abuse painkillers seem "normal" when using and tired and unmotivated when they aren't, which is counterintuitive to many people.

But the biggest part of the seemingly endless casework is that prescription drugs are easily accessible and generally regarded by the public as safe because they have been recommended by a doctor.

Few abusers begin with recreational use. Some misuse the drug that's been legitimately prescribed with the idea that if one pill helps then two must really help. They may soon find themselves dependent. It's a danger that Bullock says is not being talked about enough with today's youth.

While 78 percent of teens reported their parents talking to them about the hazards of alcohol and marijuana, only 24 percent said they had discussed prescription drug abuse, reports a 2008 study by The Partnership for a Drug Free America.

Even some Montana prosecutors are just learning about the latest addiction trend. It's hard to convince anyone that a drug you might see in a medicine cabinet is a significant danger.

"You come in and put down three pounds of cocaine in front of them and they get right to work," Long said. "But with painkillers, it's tough. One prosecutor said, 'Yeah, this is OK, but can you get, like, real drugs from 'em?'

"They look at it as, 'Well, I have those in my medicine cabinet," Long said.

That's why education and better tools for doctors to identify potential addiction – such as the drug registry – are critical in reducing abuse on the front end.

Long said that because Montana is surrounded is by states that already have drug registries, many out-of-state abusers come here and drive from clinic to clinic, gathering several prescriptions for painkillers in a single day.

The new laws should eliminate the attraction for abusers from neighboring states and limit the amount anyone can get to one or two bottles before a pharmacist or doctor notices an unusual trend.

Long hopes the registry helps enough on the prevention side so that police will eventually have fewer cases to investigate.

"It's the same old issue," he said. "It's just that Montana has sparse resources to address dope."