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West Virginians are more likely to die from drug overdoses than people in any other state, a joint Sunday Gazette-Mail/West Virginia Public Broadcasting investigation has found.Overdose has become the leading cause of death here for adults younger than 45 — more than car wrecks, heart attacks or cancer, according to a Sunday Gazette-Mail/WVPB analysis of data from the West Virginia Medical Examiner’s Office, West Virginia Health Statistics Center and National Center for Health Statistics.Usually, the drugs that kill aren’t cocaine or heroin. They are medicines you can get from your doctor.Seven of the top 10 drugs that helped to kill West Virginians last year were prescription drugs, according to state medical examiner data.These deaths started to skyrocket in West Virginia less than 10 years ago, the analysis found. In 1998, poisonings — mostly overdoses — killed 21 West Virginians.Last year, they killed 460 West Virginians.At the same time, the amount of certain prescription painkillers per man, woman and child in West Virginia has quadrupled, according to an analysis of data obtained from the U.S. Drug Enforcement Administration. They’re the top painkillers that contribute to West Virginia deaths — methadone, hydrocodone, oxycodone, morphine and fentanyl. You might know them by their brand names: Dolophine. Lortab. Vicodin. Percodan. OxyContin. MS Contin. Duragesic.West Virginia’s overdose death rate is the nation’s worst, but overdoses have become a nationwide problem. For the first time, poisonings — mostly overdoses — now kill more Americans than guns (see accompanying story
).Usually, the victims overdose by accident. Sometimes, they have a valid prescription for the drugs that killed them, but often they don’t.The victims are mostly young.In November 2005, two 16-year-old St. Albans high school students overdosed on prescription painkillers within four days of each other.Abby Young’s obituary remembered her as a church member who had worked at a day care. She reportedly took morphine pills at a Thanksgiving night party. She died in her sleep.Justin Garner played in a band with his friends. He was already taking outside classes to help him toward a computer career. He mowed grass to earn money. He had just bought his mom a jewelry box for a present, and hid little notes all over the house to make her search for it.
“That’s just the way he was,” remembered Kim Garner, Justin’s mom. “He was sweet. He was my boy.”One evening, Justin was hanging out with some other kids at one of their houses. One of the kids had some prescription pain patches. The teenagers froze the patches and sucked out the fentanyl.Then Justin went home and fell asleep in a chair.“He fell asleep,” his mom said, “and just didn’t wake back up.”‘Are you selling your drugs for sex?’
At one point, you had to wait six weeks if you wanted an appointment with Dr. J.K. Lilly.
Lilly was West Virginia’s first board-certified pain specialist. For almost 30 years, the Charleston doctor has been treating people with pain.Sometimes, he said, patients come to him because their regular doctors are reluctant to prescribe painkillers at all.“Nancy Reagan’s drug abuse prevention statement was, ‘Just say no,’” Lilly said. At the time, she was talking to potential drug abusers — not doctors.“Unfortunately, a lot of the physicians will say, ‘I don’t want to go there. I don’t want to prescribe [painkillers]. I don’t want to put up with it.’“They’ll just say no.”They simply send their patients to Lilly’s pain clinic. Lilly added a nurse and a physician’s assistant to help with the glut, but patients still have a two- to three-week wait for an appointment.Lilly said he can’t criticize his fellow doctors. It’s a huge hassle: To try to keep pain pills out of the wrong hands, Lilly said he conducts random pill counts and urine drug tests on his patients.“We’ll ask a patient, ‘Are you selling your drugs for sex? Are you trading your drugs for car payments?’ The patient will be shaking his head, but the wife will sit there and ‘Mmm hmmm.’ They narc on them.”At the same time, Lilly said, people who truly need pain medicine must have access to it.Sgt. Michael Baylous of the West Virginia State Police couldn’t agree more.
“We’re not looking for terminally ill cancer patients to keep them from getting their medications,” Baylous said. “That’s not what we’re after.”What State Police are after are the doctor-shoppers who lie to doctor after doctor, collecting prescriptions for pain pills they can sell on the street.Or the drug company that talked doctors across the nation into prescribing OxyContin, without stressing how addictive it can be.Or the Internet drug sellers who pose as doctors, shipping pain pills to patients who don’t have a real doctor to make sure their dose won’t kill them.State Police investigations have largely shut down the Internet drug trade in West Virginia, and were instrumental in bringing the OxyContin executives to justice. They keep an eye on a statewide computer database that lists every patient who fills a pain pill prescription, so they can find out if John Doe is playing two doctors to feed his habit.Sgt. Mike Smith, who investigates drug diversion for the State Police, recalled the case of podiatrist Dan Johnson of Logan. Smith said Johnson was selling prescriptions for powerful painkillers for $90 cash — sometimes without even seeing the patient, and often for minor ailments.“Most of the complaints when we interviewed the people seemed to stem around bunions and corns on their feet, calluses, and things of that nature,” Smith said. “And what was happening was the narcotics that were prescribed were powerful painkilling narcotics. It clearly shouldn’t have been going on.”There’s another source of drug diversion that’s hard to stop: the teenager in the medicine cabinet.“They see Grandma takes OxyContin or hydrocodone,” Baylous said. “They think, ‘Well, she can handle it. Surely I can handle it.’”The teenager in the medicine cabinet
Not long after her son’s death, investigators told Kim Garner where the pain patch that killed him came from.A boy at the party had stolen from his grandfather, who had cancer.“Now why was he [the boy] able to get to these?” Garner said. She had never even heard of the drug fentanyl before. She scoured the Internet and found report after report of fentanyl overdose deaths.The drug is 50 to 100 times stronger than morphine.“From what I understand, this drug is supposed to be kept under lock and key,” she said.“Nobody should have had access to it,” she said. “Especially a teenage person.”In Baylous’ example, “Grandma” might be able to handle the drug because her doctor carefully and slowly built her tolerance to narcotics, raising her dose to a level that would kill her pain.But just one of Grandma’s pills might easily kill a grown man.“They told me they could tell Justin wasn’t a drug addict, because it was such a tiny amount in his system that killed him,” Garner said.Doctors must make sure patients understand their painkillers could kill somebody, Lilly said.“You don’t have the latitude to dose yourself the way you want, and share it the way you want, and sort of give yourself a pretend medical license,” he said.“Tell them, ‘Lock this up. Tell your kids they can’t take your medicine.’ It’s not good to hide it. They’ll find it.”Teenagers throw “pharma parties,” Lilly said. They raid their parents’ medicine cabinets for any pills they can find, throw them all into a bowl and everybody grabs a handful.“You get these bizarre combinations of medicine,” Lilly said. “It’s like playing Russian roulette.”Smith, of the State Police, said he sees a growing number of these parties.“And that is probably one of the stupidest things I have ever heard about, as far as not knowing what’s going to happen,” he said. “I mean, they’re deadly.”Kim Garner still keeps her son’s battered ball cap on the wall in his room.His favorite sweatshirt hangs in the closet. His baby photos hang on the wall. She kept everything — the lopsided clay ashtray he made for her, and every “Love you mom” he ever scrawled on a note.“I wake up in the morning, and that’s exactly where my mind goes,” she said. “It’s every day when I wake up. It’s every day before I go to bed....“It was a stupid mistake. Just a very stupid mistake — that he paid for.”This article is part of a joint investigation by the Sunday Gazette-Mail and West Virginia Public Broadcasting. To reach Gazette-Mail staff writer Tara Tuckwiller, firstname.lastname@example.org or call 348-5189. To reach Public Radio reporter Scott Finn, e-mail email@example.com or call 556-4933.