Pubdate: Thu, 23 Aug 2007
Source: Asheville Citizen-Times (NC)
Copyright: 2007 Asheville Citizen-Times
Contact:  http://www.citizen-times.com/
Details: http://www.mapinc.org/media/863
Author: Nanci Bompey

RX PAIN DRUG SALES ON THE RISE

ASHEVILLE - Retail sales of prescription painkillers more than 
doubled in Western North Carolina over an eight-year period, 
reflecting a nationwide increase in the number of people taking 
medication for pain. The amount of five major painkillers sold at 
retail pharmacies rose 169 percent between 1997 and 2005 in Western 
North Carolina, according to Drug Enforcement Administration figures 
compiled by The Associated Press. Combined sales of codeine, 
morphine, oxycodone, hydrocodone and meperidine were higher in WNC 
and in North Carolina than the national average. Retail sales of 
these drugs increased by more than 130 percent in North Carolina, 
compared with a 90-percent increase nationwide.

Physicians and public health experts say the increasing numbers 
reflect an aging population, increased marketing and a changing 
attitude toward treating chronic pain.

While the increase in sales may mean the potential for greater abuse 
of these painkillers, most WNC physicians and drug treatment experts 
say the benefits of the medications outweigh the risks.

"The balance is the challenge," said Dr. Paul Martin, medical 
director of ARP Phoenix, an Asheville-based substance abuse treatment 
center. "On the one hand, you are getting the medications to people 
who need it for pain. On the other hand, you have to minimize the 
risk of it going out on the street. The pendulum may have gone too 
far one way and we need to get it back to center, but I wouldn't want 
to get the ball back the way it was in the '80s." Age and attitude 
The reasons for the overall increase in prescription painkiller sales 
reflect nationwide trends.

As people live longer, there is a greater need for pain medications. 
Eighteen percent of the population in WNC is 65 years and older, 
compared with 12 percent nationwide.

Asheville City Councilman Carl Mumpower said the increases in 
painkillers reflect cultural attitudes of treating the symptoms of 
diseases rather than preventing them, which have been fueled by 
pharmaceutical marketing. "We're training people to think the answer 
is in a pill," said Mumpower, who is active in combating drug abuse 
in the community.

In the past few decades, doctors and patients also have changed their 
attitudes toward treating pain.

Not only are more pain centers popping up across the state, but more 
primary care doctors are also prescribing prescription painkillers, 
said Dr. Timothy Collins, a professor at Duke University and a 
neurologist in the medical center's pain clinic.

"Pain is viewed by the federal agencies as a vital sign that is 
supposed to be managed properly," Collins said. "Physicians are told 
by regulatory agencies that pain needs to be treated, but don't 
manage it too well or you'll get in trouble. There is this 
schizophrenic attitude about it." Potential for abuse Oxycodone, the 
chemical used in OxyContin, is responsible for most of the increase. 
Retail sales of oxycodone jumped seven-fold in WNC from 1997 to 2005. 
In WNC, hydrocodone sales increased by almost 200 percent from 1997 
to 2005, while sales of morphine in the region increased by 270 
percent during the same time period.

"Over the last 15 years, people who do have chronic pain have been 
able to access medications that they need," said Dr. Anthony Burnett, 
medical director at the Julian F. Keith Alcohol and Drug Abuse 
Treatment Center in Black Mountain.

"That creates more availability, and because of great availability, 
more opportunity for people to take advantage of the system," he 
said. Like many communities across the country, Asheville and WNC are 
battling abuse and diversion of painkillers. Martin said hydrocodone 
is the most widely abused drug in WNC. Prescription painkillers are 
the most abused drug by teenagers in Asheville, according to Mumpower.

Doctors are more vigilant about prescribing these painkillers because 
of the risk of abuse.

The Asheville City Council set up a committee this week to look into 
the issue of painkiller abuse in the community. On July 1, North 
Carolina pharmacies started reporting prescriptions of controlled 
substances into a central database that can be searched by doctors.

"The medications are just like a car -- responsibility comes from 
those who prescribe them and take them," Mumpower said. "Somewhere 
between the ditch of overusing and the ditch of under-using there is 
a road. I don't think we're there yet."

The Associated Press contributed to this report.
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