Prescription-drug abuse is claiming the lives of an increasing number of Southern Arizonans, fed by an easily abused pharmaceutical system, ever-increasing availability and our proximity to Mexico.
Experts also cite the safe reputation of pills and law-enforcement agencies' difficulties in catching abusers as contributors to the trend, which is affecting a wide range of people, but especially young adults.
An average of two people have died each week in Pima County this year from the misuse or overuse of pharmaceutical drugs, according to the Pima County Medical Examiner.
Approximately two-thirds of the county's overdose fatalities are the result of pharmaceutical drugs, doctors there say, up from one-quarter a decade ago.
The Arizona Poison and Drug Information Center has seen a similar spike in cases. The trend appeared to have begun around 1999 and during the past five years, calls in a category that is largely made up of non-fatal overdoses on pharmaceutical painkillers and anti-depressants have increased 43 percent.
"There are more and more, not only exposures and overdose situations, but deaths caused by prescription pharmaceuticals," said Jude McNally, managing director of the Poison Center.
"We're seeing these in adults who are abusing these for recreational purposes and also in accidental overdoses as people are combining more and more medications."
Despite the recent death of movie star Heath Ledger and national TV and magazine messages β such as a public service announcement from the Office of National Drug Control Policy that aired during the Super Bowl β the real dangers of pharmaceutical drug abuse have yet to hit mainstream awareness the same way that dangers associated with illicit drugs have, though the use of pharmaceuticals is much more common.
Pharmaceuticals are now the second-most-abused drug in America, following marijuana, and have become popular party drugs, according to surveys. In 2006, people 26 and younger were nearly three times more likely to admit abusing painkillers within the past year than other age groups nationwide, the Substance Abuse and Mental Health Services Administration reports.
More young adults, ages 18-24, are seeking treatment for pharmaceutical painkiller abuse, too, said W. Mark Clark, president of Tucson's CODAC Behavioral Health Services Inc., though he couldn't provide exact numbers.
"It is currently the drug du jour," he said.
Easy to obtain
The rise in popularity is a result of both the drugs' effects and the ease with which they can be acquired, experts say.
Oxycodone is as addictive as heroin. Ritalin and Adderall are amphetamines, like meth. Painkillers and muscle relaxers' debilitating effects are similar to alcohol.
But because the pills come from medicine cabinets and are widely prescribed for common ailments, such as having wisdom teeth pulled and broken bones, many people think prescription medications are safer to abuse than their illegal counterparts, experts say.
"There's no dark street corner," said Ramon Delatorre, spokesman for Tucson's Counter Narcotics Alliance, a multiagency task force. "Grandma and Grandpa's medicine cabinet is full of medications; it's like a little store."
However, abusing prescription medications is just as dangerous as illicit drug abuse, McNally said.
Without communication with a doctor, the use of a prescription medication, even once, can be deadly.
Long-term abuse can cause organ damage. Mixing pills with alcohol, a popular method of abuse, not only raises the risk of overdose but also severely damages the liver.
Addiction also is a large problem, especially with painkillers. OxyContin addiction is even known to lead to heroin, a cheaper alternative.
"The longer somebody is using something, the more their body becomes tolerant and the more drug they'll need, the more they risk adverse effects," McNally said.
And above all else is the risk of overdose.
The Poison Center receives several calls daily that involve overdoses from painkillers. The agency serves all of Arizona except Maricopa County.
"While a person who takes these may initially have some euphoric sense, some sense of relief, especially if they're addicted to these substances, they can eventually get disoriented, drowsy, slow down their heart rate, slow down their respiration and coma, and in some cases even die," McNally said.
Fatal painkiller abuse
The misuse of methadone, a painkiller, was classified as a cause of death of at least 160 people in Pima County during the past seven years, according to records from the medical examiner. The misuse of oxycodone, another painkiller, has caused the death of at least 89 people. Misuse of morphine, at least 88. Hydrocodone, at least 26.
The list goes on, surpassing the 380 cocaine-related deaths and the 60 methamphetamine-related deaths recorded in the same timeframe.
Weston Foard is on the list.
The 18-year-old died of a hydrocodone overdose after a party at his student apartment complex in March 2004. His roommate found him in his room two days later.
Foard died after mixing the hydrocodone and alcohol. He was given the drugs at the party from a friend who got them illegally from his job at a doctor's office.
Pharmacies are at the forefront of medication abuse, experts say, subject to robberies, employee theft β called diversion β and fraud.
The Arizona State Board of Pharmacy regulates pharmacies' activities, but officials there say they can't find everything.
"Diversion occurs all the time," said Dean Wright, director of the Prescription Monitoring Program of the agency. What we find "is just the tip of the iceberg."
Patients also will dramatize injuries or illnesses to get prescriptions, use the same prescription to buy from multiple pharmacies β called pharmacy-shopping β or even try to manipulate or use fake prescriptions.
Dr. Peter Chase, who specializes in emergency medicine and toxicology at University Medical Center, said he sees multiple people trying to pharmacy-shop each day.
"This is without question a very prevalent problem," he said.
Pills also are common on the University of Arizona campus, said Matthew Burdine, an 18-year-old freshman. He said that Adderall, Vicodin, Xanax and OxyContin β a brand of oxycodone β are easy to find.
"All you have to do is ask someone and they will know someone or know someone who knows someone," he said.
Burdine has a legal prescription for Adderall, but pressure with school once enticed him to exceed his recommended dosage.
"I have misused my prescription and nearly overdosed. When I had to finish a paper really fast I was taking two pills at a time when I needed them. In a period of three days I took 16 to 18 pills and I am only prescribed four a day. I ended up going three days without sleeping, after which I crashed.
"It is pretty much a legal form of meth."
And Burdine said he's not the only one he knows on campus who abuses Adderall.
"Some people I know take Adderall every once in a while for schoolwork. Some overdo it a lot and get addicted."
Rx solicitations in Sonora
While U.S. pharmacies are the main source of medication, they're not the sole source, especially when Mexico is only an hour away.
Walk around downtown Nogales, Sonora, and any American, especially teens and 20-somethings, will hear the sales pitches from the dozens of pharmacies that line the streets.
"We just walked by and they invited us to come in," said John Urbanic, 28, who was visiting Nogales on a trip from Michigan in February. "They were saying the names of the drugs, sleeping pills, Vicodin."
If getting ahold of prescription medication is easy in the United States, finding it in Mexico is even easier. While legally required to sell only to people with prescriptions, the opportunity to make a quick buck has many pharmacies selling under the table.
George Contreras works as a middleman, taking Americans to farmacias and doctors for tips. He said farmacias make a large profit from selling under the table, often as much as $50.
"One day multiplied by three to ten customers, they make plenty of money," he said.
And should an American feel unsafe buying without prescription, obtaining a legal prescription is as easy as finding a man like Contreras on a corner.
Juan Pablo Verdias sells small goods and takes pictures of people on his donkey. He's worked on the same street corner for 27 years, and because of his familiarity with the area, he also works as a middleman.
"I'll take you straight to a doctor and you'll be at a pharmacy in five minutes," he said.
"What do you want?" he asked, sweeping his arm toward a nearby pharmacy.
While he said he doesn't help young people, he said other middlemen do.
After buying a prescription for as little as $20, it's legal to buy and carry prescription medications in Mexico, though it's illegal to take them back to the United States. That doesn't stop some people, though.
Customs agents on the lookout
At border crossings, Customs agents keep a keen eye out for medication smuggling and commonly ask Americans if they're taking any medications back.
"One of the high risks out there is the younger people, college- and high-school-aged, so it's something we look for," said Brian Levin, spokesman for U.S. Customs and Border Protection in Arizona.
However, looking for and finding prescription medications are two different stories.
In fiscal year 2007, Customs agents in the Tucson Sector made 56 seizures from people taking across prescription medication illegally, compared with 700 seizures of illicit drugs.
It's a common problem for law-enforcement agencies: knowing prescription-medication abuse is happening is one thing, but stopping it is another.
The legality of the medication, coupled with its lack of odor, small size and indistinguishable effects, make detection very difficult.
Police broke up Weston Foard's party that night in 2004 but were unaware hydrocodone was being passed around.
Though college-age students have one of the highest rates of abuse, finding prescription abuse on campus is almost impossible, officers say.
"It may be occurring on campus, but it's occurring in such a manner that we aren't catching it," said Sgt. Eugene Mejia of the University of Arizona Police Department. "The only way we'd find it is from an overdose."
Even if pills are found, the next move isn't always clear.
"It's difficult because if you have a kid with three to four pills, you don't know what it is," said Delatorre, with the narcotics alliance. "An officer could think it's Benadryl."
Yet, these cases are coming up more often for local police.
"Years ago, we had a few here and a few there, but now it's a normal thing," Delatorre said.
No "serious drugs" was vow
Mary Foard will never forget the day that police and a crisis counselor showed up at her house while she and her husband were washing the car.
"I became numb," she said. "I remember struggling to put one foot in front of the other."
Weston Foard was passionate about cooking. He also had a knack for technology and had built his own computer, his mother said. Around the time of his death, Weston had been looking into enrolling in local technology education programs.
His mother said she raised Weston to stay away from illicit drugs. She'd caught him with marijuana when he was younger and, as a concerned parent, had him arrested. She also had him attend group drug counseling.
But Weston told his mother he felt out of place at group therapy, with people hooked on cocaine and heroin. Mary said Weston promised he'd never do any of those "serious drugs."
To her son, prescription drugs weren't the same.
"Stay connected with your kids as much as possible," Mary Foard said, holding back tears.
Ten frequently abused and misused paramedical drugs
Name Type Intended Use Side effects of misuse
Codeine Narcotic pain reliever Intended to treat Can be habit-forming and fatal if overused or when mixed with other mild to moderate pain drugs, especially alcohol. Impairs thinking and reactions.
Hydrocodone Narcotic pain reliever Intended to treat Can be habit-forming and cause death, damage the stomach and short-term severe pain intestines and increase the risk of heart attack or stroke. Impairs thinking and reactions.
Oxycodone Narcotic pain reliever Intended to treat Can be habit-forming and fatal if overused or when mixed with other moderate to severe pain drugs, especially alcohol. Impairs thinking and reactions.
Methadone Narcotic pain reliever Intended to treat moderate Can be habit-forming and cause slowed breathing and death. to severe pain and reduce Impairs thinking and reactions. withdrawal symptoms
Morphine Narcotic pain reliever Intended to treat Can be habit-forming and fatal if overused and when mixed with other moderate to severe pain drugs, especially alcohol. Impairs thinking and reactions.
Amitriptyline Antidepressant Intended to treat symptoms Can cause thoughts of suicide and death. Seizure or coma can occur of depression when misused or when mixed with other drugs. Can impair thinking and reactions.
Lithium Antidepressant Intended to treat depression Can impair thinking and reactions and cause damage to kidneys.
Trazodone Antidepressant Intended to treat depression Can cause thoughts of suicide and may be fatal if overused. Can impair thinking and reactions, especially when mixed with alcohol.
Adderall Stimulant Intended to treat narcolepsy Can be habit-forming and cause damage to the heart or death, and attention deficit especially when mixed with other drugs. hyperactivity disorder
Ritalin Stimulant Intended to treat attention Can be habit-forming. Overuse can cause death, especially when deficit disorder, attention deficit mixed with other drugs. Can impair vision and reactions. hyperactivity disorder and narcolepsy.
Sources: Arizona Poison and Drug Information Center; Pima County Office of the Medical Examiner; Drugs.com.
