Photo illustration for a prescription overdose story.WHAT'S WHATAccording to the Controlled Substances Act of 1970, drugs are classified in various "schedules" based on their potential for abuse, their accepted medical use and international treaties. [The following descriptions are verbatim from the Drug Enforcement Administration.]Schedule V: A low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics.Examples: Lyrica, Phenergan with Codeine and Robitussin AC.Schedule IV: A low potential for abuse relative to substances in Schedule III.Examples: Xanax, Soma, Klonopin, Versed, Restoril and Ativan.Schedule III: A potential for abuse less than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence.Examples: Vicodin, Tylenol with Codeine, Didrex and some anabolic steroids, such as Depo-Testosterone.Schedule II: A high potential for abuse which may lead to severe psychological or physical dependence.Examples: Demerol, OxyContin, Percocet, Ritalin, morphine, opium and codeine.Schedule I: No currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision and a high potential for abuse.Examples: Heroin, marijuana, lysergic acid diethylamide (LSD) peyote and 3-/4-methylenedioxymethamphetamine ("Ecstacy").SIGNS OF TROUBLE• She gets her prescription refilled before it's necessary.• She visits many different doctors ("doctor shopping").• She makes excuses for "lost" painkiller medication, such as it was stolen or it fell into the toilet.• She keeps painkillers after the initial condition has cleared up.GETTING HELP• Look for local pain support groups where you can find others who share your experience.• Get help for substance abuse problems through 800-662-HELP (4357).• For questions about medicines, call Poison Help at 800-222-1222 for questions about medicines.BY THE NUMBERS• Women ages 45 to 54 have the highest risk of dying from a prescription painkiller overdose (opioid or narcotic pain relievers including Vicodin, OxyContin, Opana and methadone).• More than five times as many women died from prescription painkiller overdoses in 2010 as in 1999.• For every woman who dies of a prescription painkiller overdose, 30 go to the emergency room for painkiller misuse or abuse.• Since 2007, more women have died from drug overdoses than from motor vehicle traffic injuries, and in 2010, four times as many died as a result of drug overdose as were victims of homicide.Source: Centers for Disease Control
About once every 80 minutes in 2010, an American woman made a fatal mistake.
She took medicine.
About 18 women died every day that year from prescription drug overdose, according to a study released in July by the Centers for Disease Control. In all, more than 6,600 women nationwide overdosed and died in 2010 while taking prescriptions, an increase of more than 400 percent compared to overdose fatality rates in 1999.
Between 1999 and 2010, about 48,000 women -- 6,000 more than the entire population of Cleveland, Tenn. -- died from overdoses, the CDC reports. In the same timeframe, men's overdose numbers climbed by 265 percent.
"Women are dying from prescription painkiller overdoses at rates never seen before," the CDC says.
And it's a trend showing up here.
"[Treating] people who are fresh off the streets ... we're certainly seeing a lot of women who are abusing prescription drugs," says Dr. Thomas Cable, who maintains a private practice on Market Street in addition to serving as medical director of the Volunteer Treatment Center, a methadone clinic on Rossville Boulevard.
Physicians aren't positive why the overdose rates for women are increasing, but the evidence is there, says Dr. Mitchell Mutter, a former cardiologist at Erlanger hospital. He now serves as medical director of special projects for the Tennessee Department of Health and says considers ending prescription drug abuse to be his "day job."
"I think women are coming more into the drug culture and, unless we interrupt this in some way, their overdose death rates will continue to climb," Mutter says. "We don't have hard data to prove why it's trending higher in women. We just know it's a fact."
The CDC study suggests several reasons for the discrepancy between overdose death rates for women and men. Women, findings suggest, can become dependent on prescription painkillers more quickly than men. They also are more likely to engage in "doctor shopping" -- seeking multiple prescriptions from different prescribers -- are more likely to have chronic pain, more likely to be prescribed a higher dose and tend to use medications longer than men, the CDC says.
"In general, middle-aged women are at higher risk than younger women for prescription painkiller overdose death," Dr. Karin Mack, science officer of the CDC's Injury Center and one of the authors of the report, told The Orange County Register. "Women in this age group may be more likely than younger ages to have chronic pain conditions. "
Dr. C. Philip O'Carroll, program director for the neurobehavioral medicine program at Hoag Neurosciences Institute in Newport Beach, Calif., says the problem of women and painkiller abuse "doesn't conform to the usual rules of disease."
"When you're dealing with a terminal patient in the hospital, or an older person with painful shingles, it's clear what to do," he told the Orange County Register. "But when the person sitting in front of you is complaining of chronic daily head or back pain, or TMJ, it can be a crushing dilemma."
The core of the problem could be as rooted as much in the psychological as it is the physiological, says Diane Monteleone, the program director at Focus Treatment Center, a substance addiction treatment facility on Shallowford Road.
"[Women] probably are naively introduced to [prescription drugs] through a physician or psychiatrist for a legitimate issue, and it's just easier and safer, emotionally, than going to cocaine or meth or even becoming an alcoholic," Monteleone says. "I think they probably ... walk into it and then end up just being trapped.
"It's a bigger hurdle for me to think about using cocaine than it is for me to take a pain pill. It doesn't have the stigma associated with other drugs."
'AN EPIDEMIC'
In the last two years or so, Monteleone says she has seen a 30 percent rise in the number of prescription drug users her facility treats. Of the 24 patients in Focus' current roster, 17 are recovering from prescription drug abuse, she says.
The rampant rise in prescription drug addiction in the last decade -- for both genders -- has been characterized by the Office of National Drug Control Policy and the CDC as "epidemic" and "the nation's fastest-growing drug problem."
A study released in June by the Mayo Clinic and Olmsted Medical Center found that about 70 percent of Americans take at least one prescription medication, and about half take two or more. The third most-prescribed drug class among those studied were opioids -- opiate derivatives -- such as oxycodone and hydrocodone.
According to the CDC, enough prescriptions were written in 2010 to medicate every adult in the United States around-the-clock for a month. In 2009, U.S. payments for prescription medications were about $250 billion, about 12 percent of all personal health care expenditure nationwide.
Not all prescription abuse begins legally. The 2009 National Survey on Drug Use and Health found that about one-third of those who began using drugs that year started by taking prescription substances non-medically. About 70 percent acquired their pills through friends or relatives; another 5 percent purchased them from a drug dealer or off the Internet.
IN TENNESSEE
The website for the Tennessee Bureau of Investigation describes prescription drug misuse and abuse as "a major problem in the state" and a "major concern for local, state and federal agencies."
Tennessee has had the dubious distinction of having one of the nation's highest rates of prescription drug abuse for years. In 2009, the Tennessee Department of Safety and Homeland Security reports that the state ranked second in the nation in the number of per capita prescriptions -- 17.3 per person, compared to a national average of 12. Since 2008, the top three prescription medications in the state have been the painkillers hydrocodone, alprazolam and oxycodone.
In 2010, the Office of National Drug Control Policy found that about 2,500 drug abuse treatment admissions in Tennessee were for opiates, primarily prescription drugs. That number was higher than any other reported category and equivalent to the combined number of admissions for marijuana and cocaine.
"It's just epidemic, really ... both in men and women," Cable says.
In 2004, Cable says, his methadone clinic treated 450 patients. Now, the number is closer to 1,300, including patients from throughout the corridor between North Georgia and Eastern Kentucky. Like hydrocodone or oxycodone, methadone is an opioid, but it is used to help ween patients off addiction by diminishing the effects of withdrawal, which treatment specialists say can be just as bad for prescription drugs as for "harder" opioids such as heroin.
Partly, the problem is ease of access. A burgeoning black market for otherwise legal drugs and the "unscrupulous" practice of some prescribers has made many highly abused drugs readily available without a prescription, Cable says.
"It's enormous amounts of pills that are 'prescribed' for medical conditions but which are a sort of front," he says. "Basically it's drug dealing -- buying and selling.
"There are clinics where, if you look at who they're seeing and the sheer number of capsules of hydrocodone or Percocet they're prescribing, there's no possible way that a patient would need that much medication. We're talking thousands of pills a month."
Mutter says that 1,062 people died of accidental prescription drug overdoses in Tennessee in 2010. That's about a 66 percent increase over the 644 deaths due to overdose in 2005, according to a 2012 report by The Associated Press.
"It's getting worse across the state," Mutter says. "I keep commenting that it seems like the old 'Thunder Road' situation with revenuers and moonshiners. They went from moonshine to marijuana to methamphetamine to prescription drugs down the same corridor."
Last May, the AP reported that more than 18 million prescriptions for substance such as Oxycontin and hydrocodone were issued in Tennessee in 2011, about a 25 percent increase over 2010.
In 2012, in response to the increasing rates of prescription drug use, Gov. Bill Haslam signed the Tennessee Prescription Safety Act into law, requiring all medical professionals to register with the state's Controlled Substance Monitoring Database and to check a patient's history of prescription drug use before issuing new prescriptions. Prior to the act, state law required that prescribers report their data but did not require them to check the database for signs of abuse.
Recently, the State Department of Health has sent letters to the top 50 most prolific prescribers among the 30,000 registered with the statewide database to ask for an explanation about their practices. The state is looking through their responses now.
Although Tennessee's new laws haven't been in effect long enough to collect significant hard data, they seem to be cutting down on the rates of doctor shopping, which is a step in the right direction, Mutter says.
"It looks like that is declining," he says. "We are making progress."
IN GEORGIA
In Georgia, the prescription drug abuse issue is like a leaking dam, says Dr. Rick Allen, a pharmacist and director of the State of Georgia Drugs and Narcotics Agency, which seeks to prevent the illegal distribution of prescription drugs.
"There are so many holes that you couldn't plug them all with a hand full of fingers," he says.
GDNA statistics show that 86 percent of the state's 729 deaths in 2010 due to overdose were the result of prescription drugs or a combination of prescription and illegal drugs. According to the Georgia Bureau of Investigation Medical Examiner's Office, that represents a 10 percent increase over 2009.
"Somebody's going to have to do something because too many people are dying," Allen says. "The medical and pharmacy boards in all the states are doing their best to catch up, but they got caught flat-footed.
"[Prescription drugs] have been sitting there right in front of them all along, and nobody paid much attention to it, and all the sudden people are abusing [them]."
The office of Georgia Attorney General Sam Olens describes prescription drug abuse as a crisis and a "deadly surge." On May 2, Gov. Nathan Deal signed the Georgia Pain Management Clinic Act, which gives the Georgia Composite Medical Board the authority to license and regulate pain management clinics.
That act joins several other legislative attempts in Georgia to curb prescription drug abuse during the last three years.
Contact staff writer Casey Phillips at cphillips@timesfreepress.com or 423-757-6205. Follow him on Twitter at @PhillipsCTFP.