Reporter: Each file is a drug death I can't forget

By Chris Tisch, Times Staff Writer
Published February 24, 2008

I have seven file drawers at my desk. Each one is stuffed with green folders. Each folder is a death.

For the last year or so, I have been investigating the surge of fatal prescription drug overdoses in Tampa Bay.

That work resulted in a two-part series that concludes in today's front section. My editors asked me to write this article to offer some perspective about what I learned.

Let me start with the folders that line my file drawers.

Each contains the autopsy, toxicology and investigative reports of someone who died of a prescription drug overdose in Hillsborough, Pinellas, Pasco and Hernando counties in 2005 and 2006.

In those two years nearly 800 people fatally overdosed on prescription drugs -- most of them painkillers and antianxiety drugs. Medical examiners ruled that 645 of those deaths were accidental overdoses.

Not all the numbers for 2007 are in, but we were on pace to pass 500 deaths in Tampa Bay. Statewide, we're poised to reach nearly 2,000 deaths annually -- more than double the deaths from illegal drugs like cocaine and heroin.

The numbers are staggering. The stories of shortened lives that fill my desk drawers are sobering.

When I started this project, the pills, in my mind, were the villain. But as I researched the issue further, another side of the story emerged. Many chronic pain patients who need prescriptions say doctors are too afraid to prescribe them.

Much of that fear stems from people overdosing and dying. And from police arresting doctors. And from the media reporting only the dangers of these drugs and not the benefits.

I came to understand this dilemma personally last year when I visited my family in my home state of Wisconsin. My grandmother was in the hospital suffering from terrible neck pain.

When I walked into that hospital room and saw her clutching her neck with tears welled in her eyes, I asked my family if we could put her on fentanyl, a powerful drug that I knew would ease the hurt.

Fentanyl is far more powerful than morphine and is really designed for severe or terminal pain. Several of the files in my desk drawers include stories of people fatally overdosing on it.

It obviously wasn't the right drug for my grandmother. But I remember how powerless I felt looking at her and how much I wanted to ease her hurting, even if that meant using a drug with dangerous side affects.

Suddenly, I understood the point of view of chronic pain patients a bit better.

Back in Florida, my colleague Abbie VanSickle and I read every fatal overdose report from 2005 and 2006 and entered them into a database to track basic characteristics, including gender, age and hometown.

We also indicated in the database if each person had a documented history of pain or injury, emotional problems or substance abuse.

We basically wanted to know: Who are these people?

The fact is, 80 percent of them had substance abuse histories and the vast majority of them were abusing the prescription drugs that killed them.

A good number of them were using the drugs to get high, pure and simple.

I worried that readers would dismiss the increasing deaths by concluding that people who abuse drugs don't deserve our sympathy because they place themselves in harm's way.

Even if that were the case, science is telling us that they are not just making poor moral choices when they abuse drugs, but that they are wired to experience more pleasure from abusing substances than the rest of us. In other words, they have more temptation.

If you don't buy that, fine. But there's another layer.

Nearly 70 percent of the people who fatally overdosed had a history of physical pain, usually from back or neck injuries; or emotional pain, usually depression.

When I sat down to interview the Pinellas-Pasco medical examiner, Dr. Jon Thogmartin, he told me that when he checks the bodies of these people, he often sees scars from surgeries they had on their backs or necks -- signs that they probably suffered from pain.

I also learned that the overwhelming majority of chronic pain patients also suffer from emotional problems, usually depression. That makes sense: Wouldn't you be depressed if you hurt all the time?

The more work I did, the more I discovered not all who died were stereotypical drug abusers. Some of them were good, upstanding people who suffered an injury, were prescribed painkillers and became addicted.

Their tolerance increased and they needed more to relieve their pain, prevent withdrawal or continue a euphoric feeling. If their doctor wouldn't give them all they needed, they resorted to crimes such as doctor shopping and prescription forgery.

And some of them wound up in my file drawers.

Over the next year, Abbie and I interviewed nearly 200 people. We talked to doctors, drug treatment specialists, pain patients, family members of people who overdosed, current addicts, reformed addicts, narcotics detectives, medical examiners, prosecutors, defense lawyers, judges, pharmacists and many others.

I found that the debate around this issue is sometimes very fierce.

Some people who have lost loved ones to prescription drug overdoses want these drugs tightly monitored. They want more doctors prosecuted for over-prescribing.

On the other side, some advocates for pain patients, many who have suffered pain themselves, believe just about any restriction of the drugs or any enforcement threat to doctors causes a chilling effect that prevents true pain patients from getting drugs they need.

Those on the polar opposites of this issue are deeply entrenched.

But over the course of this investigation, this became clear to me: To prevent more deaths, we need to do a better job of treating legitimate pain. And if we treat pain better, we'll decrease deaths.

The fact is, the more people keep abusing these drugs and killing themselves, the harder it will be for true pain patients to get drugs. And if doctors don't commit themselves to treating the truly sick and weeding out the abusers, the more people are going to die.

So how do we find a balance where both can be achieved?

Well, this may sound soft and obvious, but it starts with education. Prescription drugs should now be a major part of all drug education programs in schools. Parents need to know that their medicine cabinet is this generation's drug dealer.

We often think of a doctor as the smartest guy in the room, but I learned in my research that too many of them are easily duped by drug seekers. I talked to a lot of former addicts who told me how they did it.

Doctors must learn to weed out drug seekers. And they must more carefully monitor their patients with random drug tests, pill counts or contracts.

If they do this, they can more confidently treat the truly hurting.

Nearly everyone I interviewed for these stories believes Florida needs a prescription monitoring program. There are a few exceptions -- smart people with sound arguments -- but I think the benefits outweigh the risks.

A monitoring program would allow doctors and pharmacists to look at a patient's medical history to determine if he or she obtained drugs from other doctors. Supporters say it would virtually eliminate doctor shopping, one of the major ways prescription drugs are funneled into the wrong hands.

For the last several years, some Florida lawmakers have proposed a monitoring program, which 35 other states have adopted. It's failed each time.

I understand the worries about security and cost and privacy. And maybe it is a little too Big Brother. But the fact is, insurance companies have this information already, and they use it to stop doctor shopping. But doctor shoppers get around that by paying cash.

A monitoring program will help police more quickly track down who's abusing the system and diverting drugs into the hands of our children.

It will help doctors identify drug seekers and make them more confident they are treating the truly sick. It could create a climate in which doctor shoppers are stymied and pain patients are relieved.

Fewer people would suffer needlessly. And fewer people would die.

Chris Tisch can be reached at (727) 892-2359 or tisch@sptimes.com.