Dangers of prescription drug abuse hit home – The Other Drug War — (Houston Chronicle)

SSRI Ed note: Addicted woman dies from effects of taking 9 prescriptions, including lorazepam, citalopram and a muscle relaxant.

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The Houston Chronicle


Published 5:30 am, Sunday, July 18, 2010

Two people — a husband and a wife — died of prescription drug overdoses nine years apart in the apartment in the foreground. The wife, Donna Lopez, died in 2009. Near her body were 400 pills from a variety of different prescriptions. Photo: Melissa Phillip, Chronicle

Prescription drugs have killed more than 1,200 people in Harris County since 2006 — casualties in a deadly American drug war in which dealers are often doctors and pharmaceutical companies, rather than narcotics cartels, rake in multimillion-dollar profits.

That death toll doesn’t include hundreds of others who crashed cars, fell and committed suicide all across Southeast Texas and into Louisiana while under the influence of medicines they obtained in Houston — identified as a major U.S. hub for prescription drug dealing, according to an analysis of official death records and interviews by the Houston Chronicle.
The growing body count prompted Houston-based drug enforcement officials to declare that prescription drug abuse represents a “substantial threat” to the entire state, according to a soon-to-be published intelligence report obtained by the Chronicle.

The faces and stories of the epidemic are disturbingly familiar: A 16-year-old boy celebrating his birthday with a bonfire and a barbecue. A registered nurse who battled addiction for years before his child found him slumped inside his car. A lonely widow lying dead beside a photo of her late husband on their bed. Another Houston teen discovered lifeless alongside his Bible and a shiny 24-hour sobriety chip.

Nationwide, prescription pills now regularly kill more people in the U.S. than cocaine. Pharmaceutical poisonings also claim more lives of people in their mid-30s to mid-50s than accidents involving guns or cars, the Centers for Disease Control and Prevention warns.

Nearly 250 people were accidentally poisoned by prescriptions in Harris County last year, the newspaper analysis of medical examiners records shows. Their average age was 42. Most were white. Almost half were women.

Among the dead were suburban working parents, engineers, entrepreneurs, college students, retirees, military veterans, mothers and fathers, grandparents and an amateur race car driver.

Donna Lopez, 59, was found kneeling beside her bed, her eyes cast upward as if in prayer. Her body was discovered inside the same darkened bedroom in northwest Houston where her husband died from a prescription overdose nine years before.

Richard Mallett, 45, suffered life-threatening health problems, including diabetes, congestive heart disease and kidney failure, that forced him to give up his job as a Metro employee.

But in the end, it was his medicines that killed him. Mallett’s sister found his body after he failed to show up to volunteer as he normally did at a food bank.

None of the victims was as famous as pop icon Michael Jackson, though many got their drugs the same way: from a Houston-based doctor, Harris County medical examiner’s records show.

Tina Kasper, a 41-year-old working mom, died without warning from prescription pills after a rare date night with her husband.

The couple went out for music, seafood and drinks at a restaurant in The Woodlands, then drove back to their home in a serene suburb of manicured lawns and look-alike mini-mansions.

‘A double-edged sword’

Her husband awoke the next morning to find her body already cold. Mike Kasper did not believe his wife was addicted to drugs but worried she depended on them too much.

“It’s a double-edged sword,” he said. “You start taking them and they help — but then you can’t get off of them.”

That morning, county death investigators found nine different medications for long-term medical problems prescribed by her two physicians. They included the anti-anxiety medicine lorazepam, the anti-depression drug citalopram and a muscle relaxant, all of which were later determined to have caused her death, records show.

The massive scope of the epidemic of prescription deaths remains unrecognized, partly because of a haunting stigma.

None of dozens of recent victims’ obituaries shared why they died “unexpectedly” or “quietly at home.” Several family members admit they concealed the cause of death, even from close friends and relatives.

Dr. Leonard J. Paulozzi, a prominent Centers for Disease Control and Prevention researcher based in Texas, has issued warnings and addressed Congress about responding to the threat of rapidly increasing prescription drug poisonings.

“I think most people believe prescription overdose deaths are restricted to celebrities — people like Anna Nicole Smith or Heath Ledger,” Paulozzi said.

Addicted over time

Those who died of overdoses here last year often began taking medicines for seemingly legitimate reasons: back injuries, car accidents, crippling arthritis, life-threatening depression or long-lasting psychiatric problems brought on by battlefield experience or sexual abuse, reports from the Harris County Institute of Forensic Sciences show.

Yet many grieving family members quietly confided that their loved ones had become addicted. A few who died were undergoing treatment but had relapsed.

Across Harris County, many died from a lethal mix of so-called “cocktails” that often included painkillers, popular anti-anxiety drugs and muscle relaxants.

Houston, one of America’s major legitimate medical centers, has become a regional distribution center for a common cocktail known as “The Trio” or “The Trinity,” which has left a trail of drug-related destruction.

That cocktail often includes the drugs alprazolam, hydrocodone and carisprodol (often sold as Xanax, Vicodin and Soma), a potent prescription combo that experts say is usually medically unjustified but gets distributed together for its potent buzz.

Last year, more than 144,000 prescriptions were dispensed for all three cocktail drugs at once — and almost 70 percent came from Harris County doctors, according to data from the Texas Prescription Program.

400 pills by her body

The city’s concentration of rogue pain clinics has been identified as one of three “major hubs” operating in the U.S. along with those in Los Angeles and South Florida, U.S. drug czar R. Gil Kerlikowske recently told a U.S. Senate committee.

Donna Lopez died in 2009 surrounded by 400 pills from different prescriptions. Her half-sister Pamela Melton said Lopez put too much faith in doctors and drugs to solve problems facing so many aging people, from anxiety to arthritis.

Lopez once enjoyed fixing holiday meals, but then began passing out at dinner or falling asleep by the stove leaving hot pots unattended.

“It was absolutely positively drug abuse, and I do feel like the doctors played a big part in this by getting her so many drugs,” Melton said.

Records show Lopez’s physician prescribed medicines found with four different patients who later died from accidental poisonings in 2009. That physician has no disciplinary history, Texas Medical Board records show.

Several other doctors who prescribed drugs linked to deaths last year have faced disciplinary or criminal action for irresponsible prescription practices.

A 28-year-old petroleum engineer who died in January 2009 used anesthesiologist Christina Clardy as his physician, a doctor authorities claim used cash-only clinics as a front for prescription drug dealing.

Clardy — who faces 55 counts of health care and medical fraud for billing Medicaid for services that were not provided — is accused of running two sham practices, in Humble and in Houston. After a fire at the Humble clinic, arson investigators found thousands of pre-signed prescription pads and $37,800 in cash.

Three drugs, four doctors

Another 2009 overdose victim, Melvyn Kyle Smith, 47, obtained medication from another Houston doctor with a decade of disciplinary action for irresponsible prescribing and shoddy records.

Smith, a Houston native, had long watched another relative struggle with prescription drug abuse but couldn’t save himself. He went from “the rock in the family” to a pain pill addict who lost his job, his wife and was on the verge of homelessness when he died, his brother said.

In the end, he actively sought doctors and pharmacists willing to dispense pain medications for invented illnesses, said his brother Lance Smith.

His death came days after he’d obtained “The Trio” ingredients — hydrocodone, carisprodol and alprazolam – from four different doctors, records show.

“It was almost like when he died it wasn’t that much of a surprise — it was almost like he’d died 10 years before,” his brother said.

For every death, nearly 50 other people experience potentially life-threatening overdoses, according to experts and other statistics.

Nationally, fatal prescription poisonings increased by 25 percent from 1985-1995, according to the CDC. That first wave of deaths corresponded to a change in prescription practices in which potentially addictive medications were often prescribed for nonmalignant pain, according to a 2006 report by leading researchers.

Teens became victims

The deaths have accelerated much more dramatically since then. The first victims of the epidemic were mostly middle-aged adults, the CDC has said.

But teens quickly began to party with the pills, seen as a socially acceptable and “FDA approved” alternative to illegal drugs, according to Dr. Jane Maxwell, senior research scientist at the University of Texas who produces annual reports on drug abuse trends statewide.

Marylou Erbland, the co-founder of the Center for Success and Independence, a Houston treatment center for youths, said she has noticed a “huge increase” in teens who report abusing prescription drugs like Xanax, often called “bars.”

“They take them by the handfuls, and it’s frightening,” Erbland said. “They seem to have an unlimited supply. It doesn’t seem like there’s any problem getting it anywhere, and it makes it so difficult for them in their recovery because it’s so accessible.”

Erbland lost one of her 17-year-old former patients last year to an overdose after he’d gone through weeks of prescription drug detox and months of treatment. He returned home only to relapse.

“It’s just devastating.”      lise.olsen@chron.com

Copyright 2010 Houston Chronicle