Summer House

The body’s reaction to the removal of a substance it has become dependent on is called withdrawal. Withdrawal causes craving for more of the substance being removed. The period of time when the body is trying to overcome its addiction is called detoxifica-tion (detox). Detox is the first step in overcoming a substance addiction such as drugs or alcohol. Detox is a pertinent step for the patient is to be successfully rehabilitated.
 

Opiate drugs such as heroin and methadone, and prescription medications including Hydrocodone, Oxycontin, Xanax, Vicodin and Lortab, require medical detox supervision. There are however, other illegal drugs such as marijuana, crystal methamphetamine, and cocaine that do not require medical detox. Since there is psychological dependence associated with these drugs, it would be wise to complete a period of stabilization. The process of drug detox requires the patient to be closely monitored by keeping vital signs, giving support and administering medications if needed. There are numerous withdrawal symptoms or side effects when a patient stops or dramatically reduces drugs after heavy or prolonged use. Those side effects include: sweating, shaking, headaches, drug cravings, nausea, vomiting, abdominal cramps, diarrhea, sleeplessness, confusion, agitation, depression, anxiety, and other behavioral changes.
There are two commonly used drugs to enable the patient to feel relief from these symptoms. First, Klonepin, which reduces physical symptoms, and Buprenophex, which is an anticonvulsant. These drugs must also be monitored as cessation produces withdrawal symptoms. Generally, the time period for drug detox is three to seven days under medically monitored supervision.
 

Alcohol detox, like drug detox, is usually accomplished in an inpatient medical facility. Duncan Raistrick identifies the key to a successful, planned detoxification is preparation. Raistrick goes further to detail that the first job of therapy is to bring the patient to a point of readiness to change their drinking behavior. Second, patients need to be given accurate information about what to expect during detoxification.
 

There are two withdrawal categories: minor, meaning early withdrawal and major, meaning late. The severity of withdrawal depends greatly on the duration of alcohol used. Alcohol Withdrawal Syndrome (AWS) falls into three main categories: central nervous system (CNS) excitation, excessive function of the autonomic nervous system (ANS), and cognitive dysfunction.5 Richard Saitz, M.D., M.P.H., states, since alcohol enhances gamma-aminobutyric acid’s (GABA) inhibitory effects on signal-receiving neurons, neuronal activity is lowered. This lowering leads to an increase in excitatory glutamate receptors. Tolerance occurs as GABA receptors become less responsive to neurotransmitters, which in turn requires more alcohol to produce the same inhibitory effect. During detox, the GABA is ineffective and unable to suppress the excitatory glutamate receptors. Detox is intended to relieve physical symptoms such as: shaking or tremors, headaches, vomiting, sweating, restlessness, loss of appetite, sleeplessness, Delirium Tremens (DT’s), hyperactivity, and convulsions. Alcohol detox medications are similar to drug detox medications: Buprenophex, certain benzodiazepines and anticonvulsant medications. Alcohol detox completion can take from three to fourteen days.
 

Norman S. Miller notes that medical management of alcohol and drug withdrawal during detoxification often is not sufficient to produce sustained abstinence from recurrent use. Therefore, further addiction treatments are needed to prevent relapse to alcohol and drug use following treatment of withdrawal.
 

In conclusion, drug and alcohol detoxification can effectively prepare the addicted abuser for rehabilitation and treatment.
 

Some physicians believe the withdrawal phase is related closely to the drug addiction - the worse the withdrawal, the more likely the continued use of the chemical to prevent withdrawal. Several factors are key to successful detoxification.
 

1. Acknowledge that there is a problem and decide to do something about it.
2. Get rid of all the drugs and paraphernalia.
3. Drop friends and associates that are tied to our drug problem.
4. Seek and accept spousal support, or support from friends, or relatives.
5. Prepare for symptoms with the support of a professional.
6. If tranquilizer drugs are needed for a few days or longer, they must be handled sensitively, as one addiction can easily replace another.

Oxycodone is a strong opioid analgeic (pain killer) drug with a high potential to cause physical and psychological dependence. Oxycodone is a semi-synthetic opioid made from the alkaloid, thebaine. It is very similar to codeine in structure and actions.The agent has been around for more than 70 years in Europe but because of the addiction and abuse potential, the drug never became popular until the late 1980s. Once the addictive problems of heroin and morphine became well known, it was decided not to make pain killers using morphine substitutes.

The preparation of hydrocodone from thebaine was done to avoid the mood altering effects that were common with morphine and heroin. Oxycodone, like morphine, acts on the brain but does not show the full spectrum of mood altering effects seen with morphine or heroin, nor are the effects long lasting. However, the drug does have some euphoric effects, lessens anxiety and gives the user a pleasant experience. This plus the relatively easy availability of the drug has made it liable to abuse. Oxycodone and its derivatives have been illicitly abused in North America for the past 20-30 years.

Oxycodone is a Schedule II narcotic analgesic and is extensively used in clinical practice. In the last decade, Oxycodone has become of great concern to the DEA and numerous adverse health effect bulletins have been released. In 2004, Food and Drug Administration (FDA) approved the marketing of generic forms of controlled release Oxycodone products (e.g. oxycontin).
 

Recently, the DEA increased regulations over the availability of oxycodone. Persons who try and obtain repeat oxycodone prescriptions and possess it for purpose of trafficking are guilty of an indictable offence and liable to imprisonment.
Therapeutic use
 

In the United States, oxycodone is a Schedule II controlled drug and requires a prescription for use.
 

Oxycodone is an excellent pain killer that can be taken orally. The drug is frequently used in clinical practice to manage pain after surgery. The drug is very effective for moderate to severe chronic pain (e.g. back pain). The drug is usually recommended for short term use not lasting more than a few weeks at a time. Generic forms like long term oxycontin are frequently administered to patients with terminal cancer.
 

Doses and Preparations
 

Oxycodone is a strong pain killer when taken orally and is prescribed in various formulations. It is often combined with aspirin (percodan, endodan, roxiprin), acetaminophen (percocet, roxicet, tylox), or ibuprofen ( combunox). Recently, a longer acting form of oxycodone, known as oxycontin, has been released. Other long release preparations include Endone, OxyIR, OxyNorm, Percolone, OxyFAST, and Roxicodone. All long release preparations are effective for 8-12 hours. Some of these long release preparations are also available in liquid form.
 

Oxycodone and all its generic formulations are available for oral, intravenous, intramuscular or intranasal use. Oral preparations are used most frequently, have a rapid onset of action and last 4-6 hours. In patients who become tolerant to the drug, higher doses of the drug are required to produce the same amount pain relief. Unfortunately, tolerance to all side effects does not occur and there is always a risk of adverse reactions with high doses.
 

Side Effects
 

Like all opioids, side effects are common with oxycodone. Common side effects include include nausea, constipation, lightheadedness, mental clouding and blanking of emotions. In a few patients, allergic reactions may produce a skin rash. Other side effects seen after long term use include a decreased levels of testosterone. This may result in impotence, which is reversible once the drug is stopped. Enlargement of the prostate has also been reported.
 

Acute overdose of Oxycodone can produce life threatening respiratory depression, skeletal muscle flaccidity, cold and clammy skin, low blood pressure and heart rate, coma, respiratory arrest, and death.
 

Contraindications
 

Oxycodone and its derivatives should be used with great caution in individuals with head trauma and meningitis.
 

Addiction
 

The major concern with the use of oxycodone and its derivatives is tolerance and physical dependence which can occur after several weeks to months of use. Oxycodone has almost similar effects to morphine, and thus appeals to the same community who abuse morphine and heroin. Reports of pharmacies being broken in for oxycodone are not uncommon.
 

Like all opioids, oxycodone use is regulated. Thus, when it is acquired illegally, the drug is expensive on the black market. Prices for black market oxycodone may range anywhere from $25 to 50 for a 50 mg tablet. With the availlability of generic brands, the cost of a pill may range from $5-10.
 

To prevent abuse of oxycodone and its dervatives, newer formulatons are being developed that will prevent excessive use and limit toxicity. Remoxy is a newer drug which is currently undergoing clinical trials.
 

The use of Oxycodone under the guidance of physicians is generally safe and rarely causes problems. When taken with due care for short term periods, the drug is a very effective pain killer.

Maryland — The lifestyles of Jean Duley’s clients run the gamut: long-time street drug users, those who were prescribed powerful painkillers after an injury or operation and are now addicted, and middle-class housewives who abuse prescriptions, to name a few.

"Prescription drug abuse is the biggest kept secret," said Duley, program director at Comprehensive Counseling Associates in Frederick. "It’s a lot more prevalent than people can imagine."

In December, Comprehensive Counseling became one of three practices in Frederick County to prescribe suboxone, which Duley calls a "miracle drug" for those addicted to pain medication. The center now prescribes suboxone to about 50 clients.

Suboxone is a partial opioid agonist, containing enough buprenorphine (an opioid) to eliminate cravings and symptoms of withdrawal. The pill also contains naloxone, an opioid antagonist, which blocks the user’s ability to get high on any other drug, Duley said.

Clients usually come to the center for suboxone in the midst of withdrawal, and with regular treatment, clients have gone from "living a nightmare, to feeling like they have a brain for the first time in a long time," said Dr. Allan Levy, a psychiatrist at Comprehensive Counseling.

Duley said while some people lie about the severity of their pain to acquire their abused prescriptions legally, physicians themselves can fuel prescription addiction. Some prescribe increasing strengths of painkillers and then abruptly stop after patients have already become dependent, forcing them to get their fixes from either prescriptions sold on the street or illegal drugs like heroin.

Others prescribe painkillers too loosely. Duley said some of the center’s suboxone clients have Percocet "handed to them like candy for every little ache and pain — it’s a culture of doctors not paying attention. The worst is OxyContin. That drug — is so highly addictive, it’s so difficult to come off of."

Some people can stop taking suboxone after a few months, but most continue for as much as a year before weaning themselves off, Levy said. For others, it becomes a lifelong maintenance drug.

While suboxone addresses the neurological aspect of addiction, Duley said giving medication without regular therapy defeats the drug’s purpose. She facilitates a support group at the center three times a week, and suboxone users are asked to attend at least once a week.

"They usually have all kinds of issues going on at the same time (as the addiction)," Duley said, including problems with employment, family and mental health. "You have to address the whole piece. The drug alone doesn’t work by itself."

And all addiction treatments should revolve around the key factor — a person’s health, Duley said.

"(Beating addiction) is a complicated issue, but it’s very doable," she said. "It’s not a moral issue, it’s not a criminal issue, it’s a health issue."

Las Vegas Sun — Nevadans consume about twice the national average of several prescription painkillers, making us among the most narcotic-addled populations in the United States, a Sun analysis has found.

The consequences are deadly. More people in Clark County die of prescription narcotics overdoses than of overdoses of illicit drugs or from vehicle accidents. In 2006, Nevadans were the No. 1 users per capita of hydrocodone — better-known by the brand names Vicodin or Lortab. 

We took enough of the drug to equal 48 Vicodin pills for every man, woman and child in the state for a year.

And the numbers are climbing. From 1997 to 2006, the most recent year for which data are available, the per capita rate of hydrocodone used in Nevada jumped by 273 percent.

Nevadans are turning to other narcotic painkillers at an even faster rate.

The per capita use of oxycodone, best-known by the brand name OxyContin, climbed sevenfold from 1997 to 2006, while methadone use jumped 12-fold.

Nevada is ranked fourth in the nation for methadone, morphine and oxycodone use per person, the Sun analysis found.

Following crack cocaine in the 1980s and methamphetamine in the past decade, prescription narcotics are “the next big drug epidemic,” said Matt Alberto, deputy chief of investigations for the Nevada Public Safety Department, the lead prescription drug policing agency in the state.

Emergency room physician Dr. Edwin “Flip” Homansky, medical director of the Valley Health System and a member of the Nevada State Board of Health, said the dramatic rise in prescription narcotic use should be examined.

“When you see increases like that, it’s a warning sign to all of us,” he said, referring to the Sun’s analysis.

The Sun reached its findings after analyzing several thousand pages of Drug Enforcement Administration reports on the state-by-state distribution of controlled substances to pharmacies and health care practitioners. (The DEA monitors the production and distribution of prescription narcotics, which fall into the highest category of regulation for prescription drugs.) After breaking down the data by state populations to reach per capita figures, the Sun determined the highest per person consumption of each prescription narcotic, as well as how consumption has changed over time.

Nevada leads a national trend in the growing use of narcotic painkillers. The National Institute on Drug Abuse reports the number of opiate prescriptions escalated from about 40 million in 1991 to 180 million in 2007 — a 350 percent increase at a time when the nation’s population increased by 19 percent.

A few doctors are doing most of the prescribing. A Sun analysis of a Nevada Pharmacy Board database that tracked all the prescriptions for controlled substances in the state, not just narcotics, showed that in 2007, 1 percent of medical practitioners in the database prescribed 51 percent of controlled substances in the database, and 5 percent of them prescribed 88 percent of the drugs.

No identifying information was made available to the Sun, but experts presume that the heaviest prescribers are pain management and cancer specialists.

Although analyzing individual prescribing habits could hint at who might be overprescribing narcotic painkillers, scrutinizing the database with that intent is banned by statute. Pharmacy board officials said that’s to allow doctors to make judgments and prescribe medicine without fear, which could compromise patient care. The database can be examined by police as part of an active investigation, but authorities can’t use it to go fishing for doctors who can be criminally prosecuted for overprescribing narcotic painkillers.

Assemblywoman Sheila Leslie, D-Reno, said it’s important to understand the factors surrounding the rise in prescription narcotic use and abuse, so legislators may need to “take a closer look” at the law that prevents analyzing the state’s highest prescribers.

Narcotic painkillers are derived from opium, a drug made from poppies that has been used medicinally for thousands of years. Opiate use was common in the United States in the 19th century, and by the early 1900s, when it was recognized that doctors were overprescribing opiates and addiction was a problem, their use was regulated and the drugs fell out of favor. They were mainly prescribed to cancer or terminal patients until the 1990s, when their use was expanded to people with chronic pain. Now we’re in a prescription narcotics boom.

The increasing use of prescription narcotic painkillers in America illustrates the evolving understanding and treatment of pain.

Among the chief challenges to doctors who prescribe potentially addictive painkillers is that pain can be described only subjectively, by the patient. It can’t be measured clinically, like blood pressure or pulse rate.

As a result, pain treatment is both an art and a science. Is the doctor to believe the patient is in pain, or is the doctor being conned by an addict or a drug dealer on the hunt for painkillers? Even the best pain management specialist will say he can’t always tell the difference.

The lines separating prescription narcotic dependence, abuse and addiction are blurry, making it difficult to say whether the skyrocketing drug use is a welcome relief, an epidemic, or something in between.

And experts disagree on how to interpret the growing use of narcotic painkillers. Law enforcement complains about the illegal activity, addiction specialists decry that more people are becoming hooked on drugs, and pain management specialists talk about the benefits of narcotics.

Research on narcotics’ effectiveness in treating pain is inconclusive. In fact, there’s some evidence they can increase pain.

Alarmed experts from all fields agree the rising rate of prescription narcotic use shows no sign of abating.

•••

The use of narcotics to treat pain got a tremendous boost in 1995 from the American Pain Society. Its corporate members include the pharmaceutical companies Purdue, maker of OxyContin; Abbott, maker of Vicodin and UCB, and Watson, maker of the hydrocodone drugs Lortab and Norco.

The society set guidelines saying proper pain management includes urging patients to report unrelieved pain. At the time studies had shown that cancer patients were suffering needlessly because they were not being given enough painkillers.

In January 1999, the Veterans Affairs Department, citing the American Pain Society’s statement that pain is one of the main reasons people consult a doctor, launched a campaign known as “Pain is the Fifth Vital Sign.”

The initiative encouraged health care providers to monitor a patient’s reported level of pain — a subjective symptom — as they did the four measurable vital signs: blood pressure, breathing rate, pulse and temperature. Health care providers asked patients to rank pain on a scale of 1 to 10, and were then urged to treat it.

Dr. Mel Pohl, a Las Vegas addiction recovery specialist, criticizes the pharmaceutical industry’s role in making pain the fifth vital sign.

“The rationale was that we don’t want people to suffer,” Pohl said. “In the best case that’s what it was about. In the worst case, somebody was working this out with the (financial) bottom line in mind. Probably both factors are part of it.”

Soon after, the methods advocated by Veterans Affairs were endorsed by the Joint Commission, the agency that monitors and regulates hospitals. Every hospital is now expected to measure pain in a similar manner.

Dr. Jim Marx, a Las Vegas addiction medicine and pain management specialist, praised the advances, saying doctors now realize they can safely treat patients for pain. This allows patients such as blue-collar workers in Las Vegas to continue in their jobs, he said.

The advent of direct-to-consumer marketing by pharmaceutical companies has also contributed to the rise of prescription narcotics. In 1997, the Food and Drug Administration allowed drug companies to hype their brand-name medicines directly to consumers, which has helped remove any stigma attached to their use. Doctors say patients are now demanding drugs by name.

Homansky, the emergency room doctor, recalled the case of a tourist who said she’d left her bottle of hydrocodone pills at home and needed more. After Homansky recommended a nonnarcotic treatment, she stormed out of the hospital, cursing the staff along the way.

“We’ve had people who get physically abusive, verbally abusive and expect that we’re just there to provide them whatever they want,” Homansky said.

The pharmaceutical companies also market their narcotic painkillers by unleashing cadres of sales representatives on doctors and hosting dinners where physicians offer testimonials about the companies’ medicines.

“There’s a lot of money in the drug industry and they push really hard,” one pain doctor said.

No one can say with certainty why so many narcotic painkillers are used in Nevada, but experts make several educated guesses. The lifestyle of night life and partying leads to more drug-seeking and abuse, doctors said. Also, pain is a complicated symptom of multiple diseases that’s intensified by psychological distress. Las Vegas is a transient place where many people are without social and family support and where the nation’s highest rate of suicide shows a population with mental health problems, doctors said.

The city’s physician shortage also likely plays a role, several experts said. Doctors stressed for time may treat the symptomatic pain rather than explore the problem that’s causing the pain. And once the treatment begins it may continue under the logic that it’s what the patient is accustomed to.

Doctors may further be predisposed to cave in to patients’ requests for narcotics because of how they are reimbursed by insurance companies: by the number of patients they see, not the time spent with each. This may lead providers to take the path of least resistance by writing a prescription. Pohl, the addiction recovery specialist, said it takes doctors “five minutes to say yes and 45 minutes to say no” to a patient’s demand for drugs.

•••

Larry Pinson was browsing in a shop recently when a greeting card caught his eye: “The best part of getting sick is Vicodin,” the card read. “So make sure you save me some, and don’t tell your doctor!”

When greeting cards joke about illegal narcotic abuse, Pinson said, “We’ve got a problem.”

The United States makes up less than 5 percent of the world’s population, but is supplied 99 percent of its hydrocodone and 71 percent of its oxycodone, according to the National Institute on Drug Abuse.

As executive director of the Nevada Pharmacy Board, Pinson presides over the licensing of thousands of pharmacists, pharmacies, technicians and wholesalers, plus about 7,000 doctors, nurse practitioners and dentists who prescribe the drugs and about 180 drug distributors.

About a decade ago the board became aware of the emerging practice of “doctor shopping,” the illegal practice of conniving patients’ visiting multiple providers to get drugs, either to feed an addiction or to sell.

So the Nevada Pharmacy Board created a database that would list every prescription written in the state for certain controlled substances, with the name of the provider and the patient, and the date of the transaction. The monitoring program would help catch patients who might be “doctor shopping.” Regulators from about three dozen other states have followed Nevada’s lead.

A growing number of health care practitioners are using the online database to track their patients’ use of prescriptions. In 1997, the first year of its existence, the database was used 480 times. The number grew exponentially to 65,372 reports in 2007, nearly double from the previous year.

The database flags patients who make a certain number of visits to doctors within an allotted time frame, though officials will not say exactly what type of patient behavior triggers the system, for fear addicts will adjust their behavior accordingly. The database then alerts the doctors to patients who may be shopping for drugs.

Pain management specialists in Las Vegas say the prescription monitoring program is one of many safeguards they use to ensure patients are not abusing painkillers.

“Our attitude is that when a patient leaves our office with a month’s worth of medication, it’s the equivalent of leaving the office with a loaded gun,” said Dr. Michael McKenna, a Harvard- and Stanford-trained pain specialist in Las Vegas.

Among the precautions pain specialists can take to guard against abuse are requiring contracts with patients that discourage doctor shopping, urine tests to verify drug use and monthly visits to track prescriptions and lessen the number of pills a patient has at a given time.

But not every provider takes these precautions.

Jennifer Hilton says that after she had a tooth filled, her dentist handed her a prescription for Vicodin even though she was not complaining about pain. She bristled at the unsolicited prescription because she’s a program coordinator for an inpatient drug addiction program for adolescent girls that’s run by Westcare, a Las Vegas nonprofit that specializes in substance abuse treatment.

Hilton admonished her dentist to ask whether his patients have addiction problems before handing them Vicodin prescriptions.

She said the dentist replied that patients should inform him if they have a drug problem.

“I’m sure some of my clients would have loved to have him as a dentist,” Hilton said, incredulous.

Las Vegas medical professionals repeatedly fail to take addiction seriously, Hilton said. On every clinic visit her teenage drug addicts hand doctors a medical feedback sheet that says: “This person is in a residential treatment facility. Please do not prescribe them anything of a narcotic or addictive nature.”

Still, about one in three kids returns with a narcotic painkiller prescription.

Las Vegas doctors say they are aware of physicians who prescribe whatever drug patients desire, so they will return. It’s good for business.

One drug addict told the Sun addicts share information about the doctors who are quick to write prescriptions.

“If you want (the drugs), you know where to go,” the woman said.

She said a few doctors ran her name through the Nevada Pharmacy Board’s database, recognized her as a doctor shopper and refused to give her drugs. But they never helped her or talked to her about treatment options, she said. Instead they sent her on her way.

The woman, who did not want to be identified, said she is trying to quit drugs and is detoxifying at home. Her only hope is her own motivation to get clean. Her only support is from fellow addicts in her 12-step program.

“I could go to the doctor tomorrow and mess it all up,” she said.

Dr. Jerry Jones, a Las Vegas obstetrician-gynecologist who is president of the Clark County Medical Society, said there may be a few unethical doctors who are overprescribing narcotics. “Most primary care doctors are extremely cautious and conservative about their narcotics prescriptions,” Jones said.

•••

Experts struggle to explain the notably high use of narcotic painkillers in Nevada. Two popular explanations are based on myths or outdated assumptions propagated in the medical community.

Every medical professional interviewed by the Sun cited what each said was Nevada’s aging population — assuming older people need more drugs because they suffer from more cancer or painful chronic conditions.

But U.S. Census figures show that Nevada is actually the 11th-youngest state in the country.

National experts said the same thing, and indeed the median U.S. age — reflecting aging Baby Boomers — rose from 35 in 1997 to 37 in 2007, according to Census figures. But the population aged 65 and older decreased in the same time frame from 12.6 percent to 12.4 percent.

The other common explanation for the high rate of narcotic use was that pain is undertreated in the United States and that Nevada doctors are prescribing more, as they should. But data suggesting the undertreatment of pain are dated and don’t reflect the exponential growth of prescription narcotic use in the past decade.

James Zacny, a psychopharmacologist at the University of Chicago who studies opiates, said the undertreatment of pain is no longer a concern for most patient populations. “I’ve heard the pendulum has swung the other way,” he said. “Now there’s some concern about overprescribing.”

The tragic irony is that painkillers may not work as well as people think. Many doctors say they’re not ideal for long-term use for chronic pain. And some studies show, paradoxically, that they can increase pain. McKenna said the research is relatively new, but shows that some patients actually improve when the medication is withdrawn.

“Pain is very complicated,” McKenna said. “But throwing opiates alone at pain is probably not the best approach.”

New York Times — From “Scarface” to “Miami Vice,”Florida’s drug problem has been portrayed as the story of a single narcotic: cocaine. But for Floridians, prescription drugs are increasingly a far more lethal habit.

An analysis of autopsies in 2007 released this week by the Florida Medical Examiners Commission found that the rate of deaths caused by prescription drugs was three times the rate of deaths caused by all illicit drugs combined.

Law enforcement officials said that the shift toward prescription-drug-abuse, which began here about eight years ago, showed no sign of letting up and that the state must do more to control it.

“You have health care providers involved, you have doctor shoppers, and then there are crimes like robbing drug shipments,” said Jeff Beasley, a drug intelligence inspector for the Florida Department of Law Enforcement, which co-sponsored the study. “There is a multitude of ways to get these drugs, and that’s what makes things complicated.”

The report’s findings track with similar studies by the federal Drug Enforcement Administration, which has found that roughly seven million Americans are abusing prescription drugs. If accurate, that would be an increase of 80 percent in six years and more than the total abusing cocaine, heroin, hallucinogens, Ecstasy and inhalants.

The Florida report analyzed 168,900 deaths statewide. Cocaine, heroin and all methamphetamines caused 989 deaths, it found, while legal opiods — strong painkillers in brand-name drugs like Vicodin and OxyContin — caused 2,328.

Drugs with benzodiazepine, mainly depressants like Valium and Xanax, led to 743 deaths. Alcohol was the most commonly occurring drug, appearing in the bodies of 4,179 of the dead and judged the cause of death of 466 — fewer than cocaine (843) but more than methamphetamine (25) and marijuana (0).

The study also found that while the number of people who died with heroin in their bodies increased 14 percent in 2007, to 110, deaths related to the opioid oxycodone increased 36 percent, to 1,253.

Florida scrutinizes drug-related deaths more closely than do other states, and so there is little basis for comparison with them.

It has also witnessed several highly publicized cases in recent years that have highlighted the problem. Only last year, an accidental prescription drug overdose killed Anna Nicole Smith in Broward County.

Still, the state has lagged in enforcement. Thirty-eight other states have approved prescription drug monitoring programs that track sales. Florida lawmakers have repeatedly considered similar legislation, but privacy concerns have kept it from passing.

As a result, federal, state and local law enforcement officials say, Florida has become a source of prescription drugs that are illegally sold across the country.

“The monitoring plan is our priority effort, but that is not enough,” William H. Janes, the Florida director of drug control, said in a statement accompanying the study. He said Florida was also looking at ways to curb illegal Internet sales and to encourage doctors and pharmacists to identify potential abusers.

Some local police departments have taken a more novel approach.

In Broward County on May 31, deputies completed a “drug takeback” in which $5 Wal-Mart, CVS or Walgreens gift cards were distributed to 150 people who cleaned out their medicine cabinets and turned in unused drugs in an effort to keep them out of young people’s hands.

“The abuse has reached epidemic proportions,” said Lisa McElhaney, a sergeant in the pharmaceutical drug diversion unit of the Broward County Sheriff’s Office. “It’s just explosive.”

Public Opinion Online — How does a doctor wean a patient from a legally prescribed painkiller that has brought on an addiction?

Doctors are trying to answer that question through a new type of addictive substance.

Opioid dependency — addiction to a substance that contains opium — is a big problem that’s prevalent even in rural communities such as Franklin County.

Opium, an addictive narcotic drug that comes from the dried juice of a poppy, is an ingredient in many prescription-strength pain relievers, such as OxyContin, Percocet and Tylenol with codeine, as well as heroin and methadone. This group of drugs is called opioids.

Specially trained physicians, including Dr. Bridget Hilliard of Antrim Family Practice in Greencastle, are having success in treating opioid-dependent people with a partial-opioid medication called Suboxone.

One of Hilliard’s patients, a Franklin County woman in her early 20s who was addicted to heroin, tried several times to get off the drug herself.

She went to a methadone clinic for a year, but then found it more difficult to quit methadone than heroin. While on methadone she felt tired and in a haze all the time, falling asleep during college classes. She had to go to a clinic six days a week to get her daily supply of methadone, which cost $12 a day. She felt so ill on the drug that she returned to heroin.

Now that she’s taking a drug called Suboxone, she feels well, is back at college and working. She expects to be weaned off Suboxone within six months and has lost the desire to take opioids, she said.

"The Suboxone has been a miracle," she said.

In her class at Greencastle-Antrim High School, the patient said that at least half the students had taken some sort of opioid for recreation at least once and about 10 percent of the students at the time of graduation were addicted to one of those drugs.

Research shows that unlike methadone, which is a full opioid and extremely addictive, Suboxone changes the brain chemistry on a long-term basis, Hilliard said. This gives addicts a better chance of staying off illegal opioids after stopping their use of Suboxone.

Hilliard has been prescribing Suboxone since last fall, and strongly encourages her patients to have drug counseling while taking it.

In order to prescribe Suboxone, doctors must acquire a Drug Enforcement Agency license. They do this by getting additional training about the chemical. Even after becoming licensed, a doctor is limited in the number of patients he or she can treat at a time, Hilliard said.

How people become opioid dependent

For half of those addicted, Hilliard said, the addiction started when they were prescribed a painkiller, such as Percocet, Vicodin, OxyContin or Tylenol with codeine. The other half initially started using the painkillers in their teen years to get a euphoric feeling.

She has talked to people who took an opioid for the first time for a migraine and got such a euphoric feeling they continued taking it because it made them feel good.

"Your body can build up a tolerance for the medication, so you need to take more to get the same effects," Hilliard said, adding extremely high levels can cause breathing problems as well as the other problems that accompany addiction. "People of any age can get addicted."

Some people can use these medications appropriately and not get addicted, but there’s no way of knowing who they are, Hilliard said, adding that doctors need to monitor their patients’ use of the drugs. Doctors also must be very detailed when charting why they are prescribing the medications, how much is being prescribed and if the patient is showing signs of psychological dependence, she said.

Those who have a history of substance abuse are more prone to becoming addicted to another substance, Hilliard said.

It isn’t foolproof, but Suboxone may be the best chance some people have.