Just how deadly is the “silent epidemic” of prescription drug abuse?

On a daily basis, more deadly than the Vietnam War, said Dr. Marc Mentel, medical director of the Community Physician Group at Community Medical Center in Missoula.

Nationally, the number of U.S. drug poisoning deaths involving any opioid analgesic such as oxycodone, methadone or hydrocodone more than quadrupled between 1999 and 2010 – from 4,030 to 16,651 – according to the federal Centers for Disease Control and Prevention.

That computes with Mentel’s analogy. In 1968, the height of the Vietnam War, 16,589 American soldiers lost their lives.

The CDC’s most recent state statistics date to 2008, when the agency noted that the number of poisoning deaths – with nine of 10 caused by drugs – had tripled in the past decade. Opioid analgesics were involved in more than 40 percent of the deaths.

“Misuse of prescription drugs, including opioid analgesic pain relievers, is responsible for much of the increase in drug poisoning deaths,” the agency said then. Also in 2008, the number of poisoning deaths exceeded that of motor vehicle traffic deaths for the first time since at least 1980, according to the agency.

While the agency listed Montana’s problem as worse than the national average, Montana was not among the top 30 states for deaths from prescription drug overdoses in 2008.

Five years later, it remains difficult to say with precision exactly how many people die each year from abusing prescription drugs.

Consider: State and federal agencies often extract their statistics from coroner’s reports. But less than 10 percent of people who die in Montana are autopsied, according to Bruce Schwartz of the Montana Department of Public Health and Human Services.

Of those, an even lower percentage have prescription drugs in their system – which could be there legitimately, as with people who died of cancer, he said.

And even people abusing prescription drugs might have been able to do so safely but for, say, adding alcohol or different drugs to the mix. At that point, it’s a judgment call to note on a death certificate whether the booze, the drugs, maybe a heart attack brought on by that combination, or perhaps a car accident caused by driving impaired was the ultimate cause of death, Schwartz said.

“You’d have to be almost a pharmacist to say this (death) is due to prescription drugs, and this isn’t. If it is due to prescription drugs, is (the prescription) theirs or did they steal it from a neighbor?” he said.

State Crime Lab statistics list drugs found in “unattended deaths” – those where a doctor wasn’t on hand or nearby. Last year, for instance, the Crime Lab lists 39 people who died with oxycodone in their system, 62 with hydrocone and 28 with methadone.

But some people die with several drugs in their system. So you can’t simply add those numbers and say that 129 people in Montana died with those three drugs in their system in 2012, because some individuals may be included on more than one list.

See why Schwartz is so cautious?

He added a grim reality check. “With death certificates, you’re just seeing the tip of the iceberg” of the prescription drug problem.

“What about the people who are debilitated for life” because of their addiction? he asked.

No agency measures that statistic.

Missoulian reporter Gwen Florio can be reached at 523-5268, gwen.florio@missoulian.com, or @CopsAndCourts.

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(2) comments


Dr. Mentel,

You should check out an organization called "PROP"--the Physicians for Responsible Opioid Prescribing. They lobby congress for tougher mandates for prescribing opioids, etc. Great organization.


Yes, it is true. Many times you will see in the local obituaries the names and faces of people who have died young, in their 20s,30s, or 40s with no cause for the death. But we know what happened in many of these cases, suicide by intent, or suicide by accident (drugs).

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