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Sounding The Alarm As Prescription Drug Abusers Turn To Heroin

By Lisa Girion, Los Angeles Times (TNS)

LOS ANGELES — Standing in the pulpit above Austin Klimusko’s casket three years ago, his mother used his death to draw the connection between pills from a pharmacy and drugs from the street.

“When his prescriptions dried up, he turned to heroin,” Susan Klimusko said in a frank eulogy meant as a warning to the young mourners at Simi Valley’s Cornerstone Church.

Last week, the nation’s top public health official used the bully pulpit to sound the same alarm. The prescription drug epidemic is stoking the nation’s appetite for heroin with disastrous results, Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, told reporters in a teleconference.

“We are priming people to addiction to heroin with overuse of prescription opiates, which are, after all, essentially the same chemical with the same impact on the brain,” he said.

Frieden made his comments as he announced that heroin use had increased 62 percent and related deaths had nearly quadrupled since 2002.

The biggest increases were among groups associated with a parallel rise in the use of prescription painkillers, such as OxyContin and Vicodin. Today’s heroin user is increasingly likely to be wealthy, privately insured and between the ages of 18 and 25, according to the study by researchers at the CDC and the U.S. Food and Drug Administration.

heroin use on the rise

Graphic showing the rise in heroin use and that overdose deaths have quadrupled from 2002-2013.

It is a phenomenon familiar to people on the front lines of the crisis from Simi Valley to San Diego.

“The face of the heroin addict has changed very much to that of an 18- to 25-year-old surfer kind of guy,” said Susan Bower, a San Diego County health official who noted the shift there a few years ago.

And the prescription painkiller has become the new gateway drug to heroin use, eclipsing marijuana, cocaine and alcohol, the study found. People addicted to narcotic painkillers are 40 times more likely to misuse heroin, it reported.

At the same time, Frieden said, the flow of cheap heroin from Mexico has surged, offering users a ready supply of an inexpensive substitute to prescription painkillers.

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“It’s really a one-two punch,” he said. “Those two factors are driving the increase and will drive the strategies we need to turn this around.”

Frieden called for a series of responses, including a crackdown on heroin, more treatment and more judicious prescribing. “For prescription opiates, the risks are very palpable,” he said. “A few doses and someone can have a life of addiction. A few pills too many and someone can die of an overdose.”

The findings offer a glimpse into the “real devastation the epidemic is causing to communities across the country,” Frieden said.

One affected area is Ventura County, where heroin-involved deaths more than doubled between 2009 and 2012 to 43. But in 2013, heroin deaths retreated, while deaths involving prescription painkillers jumped to 69. The shift coincided with a law enforcement push against heroin trafficking and may be further evidence of the interchangeability of legal and illegal drugs.

“You work one side of the problem, but then you see a ballooning on the other side,” said Patrick Zarate, who manages alcohol and drug programs for Ventura County. “We will probably continue to see a bit of back and forth over time.”

Simi Valley, on Ventura County’s eastern edge, is emblematic of the tandem crisis of pills and heroin. Austin Klimusko was one of several young overdose victims whose deaths brought the community to Cornerstone Church in 2012. Less than a week after his funeral, another family was planning a service for a daughter. And Austin, 23, was buried in the same cemetery as another victim who died at 21.

At his funeral, the Rev. Pat McCoy summed up the devastation.

“All of us, everyone sitting in this room has been affected by what happened,” McCoy said. “We don’t want that to keep happening. This is the fourth time I’ve done this in the last eight months. And I don’t want to do it anymore.”

Austin’s death illustrates heroin’s new reach. He grew up in a comfortable ranch home with a swimming pool and three dogs. He hung out with his older brother and the boys in the neighborhood. He liked to make them laugh. He loved Harry Potter books. He was enrolled in gifted classes. His mother is a hospital nurse; his father owned an electronics manufacturing plant. The family traveled to Mexico and Europe, and enjoyed skiing and fishing.

After high school, Austin moved to San Diego with friends. Susan Klimusko realized that her son had a serious drug problem when he accidentally “pocket dialed” her one night and she overheard him pressuring a friend to take drugs. She demanded he move back home in the belief that she could help him stop. Instead, he found a new supplier for his oxycodone habit, a medical clinic in Reseda.

“It just got worse and worse and worse,” she recalled. “He was a walking zombie.”

His parents convinced him to check into the Malibu Beach Recovery Center on his 21st birthday. He stayed sober, working in his father’s plant, for more than a year. But then, he slipped. Before long, Susan Klimusko said, he was spending his entire paycheck on prescriptions for oxycodone and other pills. At some point, he switched to heroin, pawning family valuables for cash. His parents locked their wallets in a safe when they went to bed.

His parents pleaded with Austin to give rehab another try. He agreed, driving himself to a facility in Bakersfield. “We were so hopeful,” Susan Klimusko said.

Sober for almost 90 days, Austin came home for Christmas, hung out and exchanged gifts. His parents gave him a purple and gold Lakers’ Snuggie. Austin headed back to Bakersfield, where he had a new job and a new girlfriend. It looked like a fresh start. But a few days later, he was dead of a heroin overdose.

Charts showing number of overdose deaths from various drugs. Tribune News Service

Charts showing number of overdose deaths from various drugs. Tribune News Service

Susan Klimusko viewed her son’s addiction as a battle that she lost. But she hasn’t stopped fighting a bigger war. Beginning with her son’s eulogy, she has been working to help other families struggling with addiction. She consoles grieving mothers and she counsels addicts who end up in the hospital where she works.

“Healing from heroin is a very long process,” she tells them. “I say, ‘I’m a mom. I lost my kid. I understand.'”

Photo: Susan Klimusko spent hours pouring through her son Austin’s phone logs and texts following his final moves before dying of a heroin overdose. This self-portrait is one of the last he took before passing away. He was 23. His opiate addiction began with prescription narcotics, according to his mother. Originally sent to his girlfriend, his mother says this picture now serves as a symbolic goodbye kiss to all his friends, family and loved ones.  (Liz O. Baylen/Los Angeles Times/TNS)

Heroin Use And Addiction Are Surging In The U.S., CDC Report Says

By Lisa Girion, Los Angeles Times (TNS)

Heroin use surged over the past decade, and the wave of addiction and overdose is closely related to the nation’s ongoing prescription drug epidemic, federal health officials said Tuesday.

A new report says that 2.6 out of every 1,000 U.S. residents 12 and older used heroin in the years 2011 to 2013. That’s a 63 percent increase in the rate of heroin use since the years 2002 to 2004.

The rate of heroin abuse or dependence climbed 90 percent over the same period, according to the study by researchers from the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention.

Deaths caused by heroin overdoses nearly quadrupled between 2002 and 2013, claiming 8,257 lives in 2013.

In all, more than half a million people used heroin in 2013, up nearly 150 percent since 2007, the report said.

Heroin use remained highest for the historically hardest-hit group: poor young men living in cities. But increases were spread across all demographic groups, including women and people with private insurance and high incomes _ groups associated with the parallel rise in prescription drug use over the past decade.

The findings appear in a Vital Signs report published in the CDC’s Morbidity and Mortality Weekly Report.

“As a doctor who started my career taking care of patients with HIV and other complications from injection drugs, it’s heartbreaking to see injection drug use making a comeback in the U.S.,” said Dr. Tom Frieden, director of the CDC.

All but 4 percent of the people who used heroin in the past year also used another drug, such as cocaine, marijuana or alcohol, according to the report. Indeed, 61 percent of heroin users used at least three different drugs.

The authors of the new study highlighted a “particularly strong” relationship between the use of prescription painkillers and heroin. People who are addicted to narcotic painkillers are 40 times more likely to misuse heroin, according to the study.

Once reserved for cancer and end-of-life pain, these narcotics now are widely prescribed for conditions ranging from dental work to chronic back pain.

“We are priming people to addiction to heroin with overuse of prescription opiates,” Frieden said at a news conference Tuesday. “More people are primed for heroin addiction because they are addicted to prescription opiates, which are, after all, essentially the same chemical with the same impact on the brain.”

Frieden said the increase in heroin use was contributing to other health problems, including rising rates of new HIV infections, cases of newborns addicted to opiates and car accidents. He called for reforms in the way opioid painkillers are prescribed, a crackdown on the flow of cheap heroin and more treatment for those who are addicted.

(c)2015 Los Angeles Times. Distributed by Tribune Content Agency, LLC.

Photo: JoshNV via Flickr

Rate Of Fatal Overdoses Involving Pain Medications Slows, CDC Says

By Lisa Girion, Los Angeles Times

Fatal overdoses involving prescription painkillers have increased every year for more than a decade, but a government study has found for the first time that the rate is slowing.

Before 2006, the age-adjusted rate of painkiller-involved deaths grew by 18 percent per year, according to a report issued Tuesday by the National Center for Health Statistics. Since then, however, the death rate increased by 3 percent per year, the study found.

But the encouraging trend was not uniform. The number of deaths involving OxyContin, Vicodin, and other widely prescribed opioid painkillers continued their steady and steep climb through 2011, the last year included in the analysis.

The slowdown was driven largely by a decrease in overdoses involving methadone, the study said. Methadone is an opioid that is both prescribed by doctors for pain relief and dispensed at clinics to help recovering addicts stay off heroin and other narcotics.

Over the 12-year period from 1999 to 2011, the age-adjusted rate of painkiller deaths nearly quadrupled, reaching 5.4 per 100,000, according to the report. That translated to 16,917 deaths in 2011.

The greatest increases occurred among people aged 55 to 64 and non-Latino whites.

The study also highlighted the growing role of anti-anxiety drugs, known as benzodiazepines. Xanax, Valium, and other benzodiazepines were involved in 31 percent of the painkiller deaths, up from 13 percent in 1999.

The National Center for Health Statistics is part of the Centers for Disease Control and Prevention.

Photo: epSos.de via Flickr

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DEA Tightens Controls On Hydrocodone Painkiller Drugs

By Lisa Girion, Los Angeles Times

The U.S. Drug Enforcement Administration is putting tighter controls on the nation’s most widely prescribed narcotic painkiller in a move to stem an epidemic of addiction, overdose, and death.
The agency said it would publish a rule Friday to place hydrocodone combination products, such as Vicodin and Norco, in the same category as other frequently abused medications, including OxyContin and fentanyl.

Once the rule takes effect in 45 days, all hydrocodone products will be considered Schedule II drugs — pharmaceuticals with accepted medical uses but also the highest potential for harm and abuse. Patients will see new restrictions on prescriptions and refills, and pharmacies will have to follow stricter procedures for handling and storage of the drugs.

Hydrocodone products are among the most commonly prescribed drugs in the United States. Americans consume 99 percent of the hydrocodone produced worldwide, according to the International Narcotics Control Board.

But these drugs and other narcotic painkillers cause or contribute to more than 16,000 deaths annually, a death toll greater than for heroin and cocaine combined. As a result of a surge in prescription overdoses, drug fatalities have surpassed deaths from motor vehicle crashes, long the leading cause of accidental death in the United States, according to the U.S. Centers for Disease Control and Prevention.

A Los Angeles Times analysis of 3,733 prescription-drug-related fatalities in Southern California from 2006 through 2011 found that hydrocodone was involved in 945 of the deaths, more than any other prescription medication.

Doctors have prescribed painkillers containing hydrocodone and acetaminophen with few restrictions since the combination drugs were introduced four decades ago. Because of the perception that products such as Vicodin are less risky than other narcotic painkillers, they are widely prescribed by general practitioners and dentists.

But drug enforcement officials have long complained that hydrocodone is widely abused.

“Almost 7 million Americans abuse controlled-substance prescription medications, including opioid painkillers,” DEA Administrator Michele Leonhart said Thursday. “Today’s action recognizes that these products are some of the most addictive and potentially dangerous prescription medications available.”

For years, the U.S. Food and Drug Administration resisted tighter rules on hydrocodone products out of concern that they would make it more difficult for patients with legitimate pain to obtain the medication. The DEA asked the agency to reconsider its position in light of the drug’s widespread availability on the black market.

In early 2013, the American Academy of Pain Medicine sent an FDA advisory panel a letter saying that although it had some concern that tighter rules could curtail legitimate prescribing, it did not oppose moving hydrocodone to Schedule II.

Days later, the advisory panel voted 19-10 in favor of greater restrictions, setting the rescheduling process in motion.

In seeking to stem the increase in fatal drug overdoses, authorities have focused on how addicts and drug dealers obtain prescription narcotics illegally, such as by stealing from pharmacies or relatives’ medicine cabinets. The Times investigation, however, found that many fatal overdoses were caused by drugs prescribed for the deceased by a doctor.

In nearly half of the prescription drug fatalities in four Southern California counties, medications prescribed by physicians caused or contributed to the death, according to the Times analysis of coroners’ records.

In response to the investigation, Gov. Jerry Brown signed two bills aimed at cracking down on reckless prescribing. And Proposition 46, a ballot initiative that will go before California voters in November, would require doctors to check the state’s prescription drug monitoring program, known as CURES, before prescribing powerful drugs such as Vicodin.

Photo: massdistraction via Flickr

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Crackdown On Florida ‘Pill Mills’ Leads To Decline In Deaths, Report Finds

By Lisa Girion, Los Angeles Times

Public health officials have identified a sharp decline in overdose deaths involving prescription painkillers for the first time in a decade.

Deaths involving OxyContin, Vicodin, and other narcotic painkillers dropped by 26 percent over two years in Florida after a crackdown on pain clinics that dispensed high volumes of the medications, according to a government study released this week.

Lawmakers there barred doctors in these “pill mills” from selling the drugs they prescribed.

“The results from Florida show that state action can make a difference, and confirms the tight correlation between prescribing and deaths,” Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, wrote in an email to Michael Botticelli, acting head of the White House Office of National Drug Control Policy.

Nationwide, fatal overdoses involving narcotic painkillers have escalated dramatically since 1999 to more than 16,000 a year. The increase in overdose deaths mirrors an expansion in prescriptions for the powerful drugs.

The surge in prescription overdoses pushed drugs past traffic accidents as a leading cause of preventable deaths in 2009 and prompted the CDC to declare an epidemic in 2011.

Amid the concern, doctors have written fewer prescriptions for some of the most popular painkillers in recent years, according to data compiled by IMS Health.

The decline in painkiller deaths in Florida is one of the first signs that efforts to address the crisis may be gaining ground, Frieden said.

“These changes might represent the first documented substantial decline in drug overdose mortality in any state in the past 10 years,” he wrote to Botticelli.

The report, published Tuesday in the CDC’s Morbidity and Mortality Weekly Report, echoes a 2012 Los Angeles Times study of 3,733 fatal prescription overdoses in Southern California. It found that drugs prescribed by physicians to victims played a role in nearly half of these deaths.

The Times study identified 71 doctors who prescribed drugs that led to three or more deaths. The doctor at the top of the list, a Huntington Beach pain specialist, has had 17 patients die of overdoses of drugs he prescribed, coroners’ records show.

In the wake of the Times investigation, the Medical Board of California convened a task force that recently proposed new guidelines to advise doctors on the proper use of narcotic painkillers, and the state Legislature enacted laws giving the board more power to investigate potentially reckless prescribing.

The type of pill mills that were a problem in Florida have not been identified as an issue in California.

In a second study released Tuesday, the CDC found that doctors in Alabama and West Virginia wrote more than twice as many prescriptions for narcotic painkillers in 2012 as their counterparts in California and Hawaii.

But it’s not because there is so much more pain in one state than another, the study found. Instead, researchers attributed the variance to regional differences in attitudes toward treatment, as well as the prevalence of narcotics abuse and of pill mills.

Photo: massdistraction via Flickr

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