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A record number of Americans are now dying from drug overdoses. And researchers say it's not just illegal drugs. Prescription pain medicines such as Oxycontin and Vicodin now kill five times as many people as heroin and almost twice as many as cocaine. The abuse of prescription painkillers is rampant in rural states like West Virginia. There, overdoses are the leading cause of death for young adults. Scott Finn of West Virginia Public Broadcasting reports.

SCOTT FINN: Like a lot of parents who have lost a child, Kim Garner keeps a sort of shrine to her son, Justin. He died two years ago when he was just 16.

Ms. KIM GARNER (West Virginia Resident): I have this hat that he wore all the time hanging up in his room. And then I've got a little (unintelligible) wall here.

FINN: Justin's death came without warning. A friend of his stole a powerful painkiller called Fentanyl from his grandfather, who had cancer. Justin took some, then came home and fell asleep in a chair.

Ms. GARNER: And he was sitting there. You know, actually, he was sitting up; he wasn't laying down. He wasn't in bed. So it looked liked he were - had just fallen asleep. He fell asleep and just didn't wake back up.

FINN: In West Virginia, drug overdoes have become the leading cause of death for adults younger than 45. More so than car wrecks, heart attacks or cancer. People here are more likely to die from drug overdoses than residents of any other state. The vast majority of overdoses involve legal prescription drugs, mostly narcotic painkillers. And it has become a nationwide problem. The number of overdose deaths in the United States doubled between 1995 and 2005, when more than 32,000 people died. Federal researchers have tracked the increase in overdose deaths with alarm.

They call them poisonings. But nearly all of them are blamed on drugs. Lois Fingerhut is a researcher with the National Center for Health Statistics.

Ms. LOIS FINGERHUT (Special Assistant for Injury Epidemiology, National Center for Health Statistics): What most people think of when they think of poisoning is a child getting into the drain or under the sink. That's the smallest part of poisoning deaths.

FINN: In fact, Fingerhut says the nation has passed an important milestone. For as long as they have kept statistics, the leading causes of death from injuries were: number one, car accidents; number two, guns; and trailing far behind, drug overdose. But in 2004, drug overdoses and other poisonings killed more Americans than guns.

Ms. FINGERHUT: Who would ever have thought that poisoning would have risen that quickly to surpass firearms?

FINN: Fingerhut and other researchers get their information from death certificates, which give them clues as to who is dying and why. The victims are mostly young and middle-aged adults, are more likely to live in rural states, and usually overdosed by accident. Some victims have valid prescriptions for the drugs that killed them. A 2005 study showed an increase in accidental poisonings and liver failure in patients who combine a narcotic painkiller, like Vicodin, with over-the-counter acetaminophen, better known as Tylenol. It's been tough for police to crack down on the misuse of prescription drugs.

West Virginia State Police sergeant Mike Smith says that unlike illegal drugs, the mere possession of a prescription painkiller is not a crime.

Sergeant MIKE SMITH (West Virginia State Police): Let's say you're dealing with cocaine. Everybody knows that crack cocaine is taboo. If you have crack cocaine, or marijuana, or whatever in your pocket, then you know, you have marijuana - you have a drug in your pocket.

FINN: Sgt. Smith leads a three-person unit that investigates prescription-drug abuse. He says the pills are stolen from medicine cabinets, pharmacies and nursing homes, and they can be ordered illegally on the Internet. Patients also can convince doctors to write them a prescription, then sell the drugs on the street.

That's something Charleston pain specialist J.K. Lilly works hard to avoid. Lilly makes each patient fill out 18 pages of background information, and he puts them through a battery of tests. One involves an unlikely device - a tuning fork that he hits against his desk and places on a patient's wrist to gauge sensitivity to pain.

Dr. J.K. Lilly (Pain Specialist): Let me whack it.

(Soundbite of tuning fork)

Dr. LILLY: And then with the vibration, you put it against a bony prominence, and the person feels it or not.

FINN: Lilly says doctors in West Virginia have a tough job. Their patients are getting older, and many work in mining and construction, where injuries are common. Compared to 10 years ago, West Virginians now consume four times as much of the top painkillers that contribute to deaths. Pain experts agree that for years, many patients suffered because some physicians were too cautious in prescribing relief. Now, Lilly says, doctors find themselves torn between treating their patients and covering themselves.

Dr. LILLY: They're caught in a pretty tight bind. They want to treat the patients well, they want to make a decent living, and they don't want to be criminals.

FINN: And doctors don't want the drugs they prescribe to end up in the hands of teenagers, like Justin Garner. His mom says Justin wasn't a perfect kid, but he was a good kid who led his own band and planned to go into computer networking someday.

Ms. GARNER: And then just when it finally hits you, it just - bam. And it hits me pretty much every day, I can tell you. I mean, just the other day - I mean, if I start crying, you know?

FINN: For two years, Garner kept her grief to herself. Now, she's starting to speak out in the hope that others will hear her warning.

For NPR News, I'm Scott Finn in Charleston, West Virginia.

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