Painkiller epidemic especially pronounced near Fort Bragg
Posted July 14, 2013
Fayetteville, N.C. — Fort Bragg Spc. Stephen Currier seemed to be reclaiming his life after a soldier’s bullet tore through his right leg on a gun range in Kuwait.
Nearly two years after suffering the permanent injury, Currier strapped a bulky brace on his leg and a parachute on his back.
That day in April 2010, Currier jumped out of an airplane, proving to himself and others that his bum leg would not keep him from his job in an airborne military police unit.
Joy Currier doesn’t remember ever hearing her son sound happier than he did that day. He had come so far.
Six months later, Currier was dead, a 28-year-old victim of an accidental overdose of powerful prescription pain pills that Fort Bragg doctors regularly prescribed him after his injury.
Currier is just one of the many casualties associated with the enormous increase in opium-based prescription painkillers in the Fayetteville area since the country went to war more than a decade ago.
A Fayetteville Observer analysis of state and county records found that opiate painkillers contributed to 95 deaths in Cumberland County between 2008 and 2011, more than the previous eight years combined. In the counties surrounding Fort Bragg — Hoke, Harnett, Lee, Moore and Cumberland — prescription opiates have been a contributing factor in at least 395 deaths since 2000.
The deaths represent the heaviest loss in the larger struggle with prescription painkillers — a struggle of addiction, rising crime and grieving families felt across America.
In few places is painkiller abuse as out of control as it is locally, where a combination of pain-wracked soldiers and a broken system for monitoring prescriptions has flooded the market with pills that can kill.
|Read more from The Fayetteville Observer’s five-day investigative series, including interactive graphics illustrating the problem in your North Carolina community, at fayobserver.com.|
Statistics show that more oxycodone — the main ingredient in Percocet and other addictive painkillers — was sold at pharmacies in the Fayetteville area than anywhere else in North Carolina in 2011. The sale of hydrocodone, a slightly less powerful but still potentially dangerous painkiller, ranked third-highest in the state.
The reason so many pills are in circulation, suggests a database kept by the Drug Enforcement Administration that tracks painkiller sales by ZIP code, is Fort Bragg’s Womack Army Medical Center and the Fayetteville Veterans Affairs Medical Center.
The DEA’s database shows that painkiller sales during the past decade spiked at higher than average rates around towns with military bases and large Veterans Affairs hospitals.
Statistics from Womack and the VA bear that out.
In 2001, the Fayetteville VA prescribed hydrocodone to 1,130 patients. Last year, that number soared to 47,586 patients — an increase of 4,100 percent in 11 years. Nationally, hydrocodone prescriptions rose by 56 percent from 2001 to 2011.
During that time, the VA saw an influx of Iraq and Afghanistan war veterans, as well as a recent uptick in older veterans who signed up for VA benefits when the economy soured. A 2011 analysis of VA data revealed that the Fayetteville area had more than 26,700 disabled veterans, the second highest in the nation.
Drug-addiction specialists in Fayetteville do not hesitate to point a finger at who they think plays the biggest role in the city’s prescription drug epidemic — Fort Bragg and the VA.
Terri Rose, executive director of the Pat Reese Fellowship Home, a halfway house for recovering addicts and homeless veterans, said that when it comes to pain pills, the VA is “the biggest dope dealer on the block.”
Prescriptions for painkillers have also soared at Fort Bragg. Last year, more than 18,000 soldiers — about a third of the installation’s active-duty population — received a total of 46,870 opiate painkiller prescriptions from Womack.
Since 2002 — the earliest full year tracked by an Army database — painkiller prescriptions written at Womack have more than tripled and the number of soldiers who received them have more than doubled.
The surge in prescriptions coincides with anonymous health surveys taken by the Department of Defense that show the rate of prescription drug misuse is three times higher in the military than among civilians. And a 2011 VA study found that veterans were twice as likely as civilians to die of a painkiller overdose.
Dr. Thomas Weber, a retired lieutenant colonel who once worked at Womack, said military and civilian doctors alike have been overprescribing pain medications to soldiers for years.
“There’s a huge problem out there with soldiers coming back — body, mind and spirit, they’re wounded across the board. People are throwing narcotics at them like crazy now,” said Weber, now a pain specialist in Durham. “These guys are dying after taking overdoses of drugs we’re prescribing them.”
About one in five of the 177 people the Observer confirmed died from an overdose of painkillers in Cumberland County since 2000 served in the military, according to an analysis of state and county death records.
Count Spc. Currier among them.
Three days before Currier died, Fort Bragg doctors wrote him another prescription — for 240 Percocet pills.
Currier’s parents don’t think their son abused the drugs; he was reluctant to take them unless the pain was unbearable. Yet as time went on, his body developed a tolerance for painkillers that meant he had to take higher doses to feel the same relief.
“I just didn’t understand how they could give so much for so long and not really offer any other alternatives. It just broke my heart,” Currier’s mother said. “I know my son never thought this would kill him.”
The abuse of prescription painkillers has become a national epidemic. It is the main reason drug overdoses have surpassed car crashes as the leading cause of accidental death in America.
According to the Centers for Disease Control and Prevention, doctors in the United States prescribed enough painkillers in 2010 for every adult to be medicated around the clock for a month.
Despite multiple efforts in recent years by federal, military and state agencies to slow the painkiller crisis, the problem continues to grow.
Experts say painkiller abuse rises in proportion with how easy it is to get a prescription.
In Fayetteville, drug counselors, recovering addicts and law officers say, it’s far too easy.
The DEA’s database shows the increase in painkillers sold in the Fayetteville area since 9/11 and the wars that followed.
According to the database, the amount of oxycodone prescribed in an area that includes Fayetteville, Fort Bragg and swaths of surrounding communities quadrupled from 66,000 grams in 2001 to a state-leading 246,000 grams in 2011. Hydrocodone sales tripled to more than 100,000 grams in the area.
Soldiers returning home wounded in war is a major reason for the increase in painkiller sales.
Fort Bragg units — including the 82nd Airborne Division and a large contingent of special operations forces — have been among the most deployed in the Army since 9/11.
Those soldiers risk injury at home, as well, jumping from planes and undergoing intense physical training.
But law enforcement and drug addiction specialists say the addictive legal pain pills given to soldiers and veterans are finding their way onto the streets of Fayetteville:
--Fayetteville police, after years of having one officer handle all prescription pill crimes, added another detective last year and plan to add two more because of the overwhelming caseload. Police say the emergence of pain pills on the black market played an increasing role in Fayetteville having the fifth-highest rate of property crimes in the country last year.
--The emergency department at Cape Fear Valley Medical Center treated 2,800 overdose patients from 2008 to 2012, tripling the number from 2000 to 2004. The overdoses were due, in large part, to painkillers and other prescription drugs.
--Cumberland County mental health services treated nearly 2,000 patients for substance abuse last year, 2.5 times as many as five years ago. The county’s addiction counselors say painkiller abuse has fueled much of the surge.
As alarming as the statistics may seem, analysts and community activists say they underestimate the severity of Fayetteville’s pill problem, which is difficult to track here because the military, VA and state do not share information.
Compounding the problem is that doctors in Fayetteville are less likely than anywhere else in North Carolina to use a state registry designed to track people being prescribed painkillers in an attempt to identify those who may be abusing them.
A large reason for that is prescribers at Womack and the VA only recently gained access to look at the North Carolina Controlled Substances Reporting System but still do not place their prescription records in it. Technology issues and privacy laws make that a challenge, said Dr. Robert Kerns, the VA’s national program director for pain management. Kerns said figuring it out is one of the VA’s top priorities, but there is no timetable for its completion.
Only 16 percent of doctors in Cumberland County are registered in the system, about half the state average and the lowest rate in the state.
That makes it easy for soldiers and veterans to get painkillers from Fort Bragg or the VA, then go to private doctors for a duplicate prescription with little chance of being caught by a doctor or a pharmacist.
It also makes it easy for civilians to get pills.
Robert Landers is one of many Fayetteville residents who used the health care system to get multiple opiate painkiller prescriptions to feed his addiction and to make money.
Landers struggled with drug addiction his whole life, but that did not stop doctors from prescribing the 51-year-old roofer painkillers when he exaggerated his back pain to get more pills.
If he ran out of painkillers before his next doctor’s appointment, Landers said, he often visited Cape Fear Valley’s emergency department to get more.
Landers said only one doctor ever correctly identified his addiction and refused to prescribe him painkillers.
But nothing happened to Landers. He said he just ditched that doctor and found another one.
That’s a common problem, said Dr. Eron Manusov, director of a family practice residency program in Fayetteville. Manusov has discharged patients he suspected were misusing painkillers. Without proof, that is all he can do.
“You can discharge all the patients you want,” he said, “but it just becomes someone else’s problem.”
The rise in the use of opiate painkillers began in the mid-1990s with a movement to treat pain as the “fifth vital sign.”
Before, doctors usually treated pain only if patients complained about it. Now they ask patients to rate their pain on a scale of 1 to 10 at the beginning of visits, while checking blood pressure, pulse, breathing and temperature.
But pain is invisible and can vary widely from patient to patient, making it one of the most difficult complaints to treat.
Pharmaceutical companies downplayed the risk of addiction, touting their new pills as a safe treatment for long-term pain. In 2007, Purdue Pharma pleaded guilty to federal charges of “misbranding” its painkillers and paid a $635 million fine.
Narcotic painkillers, which had mostly been used for patients with cancer or terminal illness, became the go-to treatment for all types of injuries, including permanent ones.
Though opiates remain an effective solution for acute pain, such as a broken leg, studies now show that long-term use increases the chance of dependency or addiction and may do more harm than good.
Pain specialists at Womack and in the community say many civilian doctors do not have enough training in managing pain and are too quick to give patients the potentially addictive drugs.
Patients — civilians, soldiers and veterans alike — often receive painkillers for long-term care with little attention given to their overall recovery.
“I’m not saying that all opiates are Mr. Hyde,” said Dr. Donald Algeo, chief of the Womack pain clinic. “I’m saying that we’re overusing (them), and we’re not monitoring the results in our patients well enough to justify continued use in all the patients that we prescribe.”
The Fayetteville VA, which routinely mails narcotic drugs to veterans, is often criticized by police and drug counselors for failing to properly follow up and monitor those patients.
Mike Thompson, the VA’s chief of pharmacy, defends home delivery.
Thompson said mailed prescriptions are a valuable convenience for many patients across the hospital’s 21-county service region. The vast majority, he said, use their medications appropriately.
“Are we going to throw (them) under the bus because of people who make a conscious decision to abuse?” Thompson said.
Some medical professionals argue that risk should trump convenience when it comes to opiate pain pills.
The risks are that mailing the drugs makes them easier to abuse or sell while avoiding oversight by doctors, and the packages can be targets for theft.
Free pharmacy services for poor and homeless people in town refuse to fill any prescriptions for narcotics because they say the risk for abuse is too high.
Yet homeless advocates say they have been amazed by the large white bags full of medicine, including opiates, that show up monthly from the VA for some homeless veterans they help.
“If you’ve got a homeless man who probably has a drinking problem, and you send him 180 of something that has a value of $10 apiece, you probably just shipped him $1,800, or you’re feeding his pill addiction,” said Nathan Runion, manager of the Hope Center, a men’s shelter on Person Street. “Either way, you fed his addiction.”
Opium addiction has plagued American combat veterans for decades.
Thousands returned home from the Civil War addicted to morphine. Thousands more came home from Vietnam addicted to heroin.
This generation’s drug of choice is prescription painkillers.
Prescription drug abuse doubled in the U.S. military from 2002 to 2005 and almost tripled from 2005 to 2008, according to military health surveys of anonymous troops.
The Defense Department and Veterans Affairs have recognized the problems associated with painkillers and are trying to solve them.
As part of those attempts, the Fayetteville VA and Womack are adopting alternative treatments for pain, including spinal cord stimulators, yoga, acupuncture and massage.
Womack and the VA say they also are trying to reduce the use of opiate painkillers. The military in November 2010 limited doctors to 30-day maximum prescriptions. The next year, the Army changed its policy to allow punishment for soldiers using opiates for more than six months after they were last prescribed.
“On the one hand, you can’t deny that there’s an increase” in prescriptions, said Thompson, the VA’s pharmacy chief. “But, at the same time, we are doing something about it.”
Despite the safety measures, government reports show that the latest efforts are falling short.
Statistics from the Centers for Disease Control show that drug deaths — largely fueled by painkiller overdoses — increased 3percent in 2010. Preliminary numbers for 2011 reveal the trend is likely to continue.
Algeo, the Womack pain chief, said prescribers are naive if they think some of their patients are not snorting, injecting or selling their pills.
If not caught, Algeo said, the behavior eventually destroys lives and has ripple effects throughout the community, fostering addiction and crime.
Lawmen and drug abuse counselors say Fayetteville has more of both than it is equipped to handle.