FAYETTEVILLE — A 34-year-old woman told police Sept. 26 she became addicted to hydrocodone after she hurt her back, then stole pills from her mother and employer, a Walgreens Pharmacy. The woman stole about 1,600 pills from the pharmacy by the time police caught her, according to a Fayetteville preliminary police report.
Two days later, police found a 36-year-old Lowell man hunched over in his vehicle, which he left running. The man was drooling, had pinpoint pupils — a telltale sign of opiate use — and his speech was unintelligible, police said. An officer found hydrocodone pills and other drugs on the man when he was arrested, according to a preliminary police report.
The abuse of painkillers is growing in Northwest Arkansas, law enforcement, prosecutors, doctors and treatment center officials say.
Pills are more acceptable to people and opioid use is going up, said Nathan Smith, Benton County prosecuting attorney. Methamphetamine and marijuana used to be the norm, but more people are showing up in court over just pills, he said during a recent opioid abuse conference.
The same is true for Washington County, Prosecutor Matt Durrett said.
“I think that, despite the best efforts to educate the public, far too many people don’t recognize the dangers in prescription medication,” Durrett said. “They feel that if it’s something that can be legally prescribed by a doctor, it can’t be harmful to them.”
The drugs can be addictive and fatal.
Opioids are medications that relieve pain. They reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus, according to the National Institute on Drug Abuse. Medications that fall within this class include hydrocodone, oxycodone, morphine, codeine, heroin and related drugs.
The actual number of overdoses specifically attributed to opiates is not available in Benton and Washington counties, coroners said. The deaths are not tracked by drug type, said Daniel Oxford, Benton County coroner. More than 165,000 people died of overdoses related to opioids nationwide between 1999 and 2014, according to the U.S. Centers of Disease Control.
Leading to heroin
The opiate problem paves the way for heroin but already is causing harm to families and communities, police said.
“This is just such a major problem that’s been swept under the rug for so long,” said Connie Phillips, program director at Springdale Treatment Center.
Heroin hasn’t yet become a major problem in Northwest Arkansas, but as painkillers become more regulated and more expensive, addicts will turn to heroin, police and others said. Arkansans also are used to getting painkillers easily — there are more prescriptions than there are people in the state, said Michael Casillas, director of operations at Stockton Medical Group of Northwest Arkansas in Fayetteville.
“Prescription painkillers are basically legalized heroin,” Casillas said.
Heroin is cheaper — a dealer who spends $1 million on a kilo of an opiate can get the same amount of heroin for about $20,000, said Dr. Gene Shelby, Prescription Monitoring Program Advisory Committee member.
The Arkansas Department of Health oversees the monitoring program, which is a database that collects and stores prescribing and dispensing data for controlled substances, including painkillers.
This year in Fayetteville, police have arrested about five people linked to the drug. Bentonville arrested one person this year, spokesmen said.
Across the state anecdotes are popping up about family members watching loved ones die from heroin, said Denise Robertson, pharmacist and administrator for the Arkansas Prescription Monitoring Program for the state Department of Health.
Tracking the problem
It takes awhile for any surveillance system tracking drug trends to catch up to what’s happening now, Robertson said.
Addiction has hit everyone from high school students to grandparents, Phillips said. Even some medical professionals are struggling — prescribing opiates for themselves or family, records show.
Some doctors are giving patients too much opiate medication, and those drugs end up on the streets, investigators say. Some patients go from doctor to doctor getting pain prescriptions, filling them at different pharmacies and selling the drugs, said Detective Joe Pruitt, head of the narcotics division at the Benton County Sheriff’s Office.
Other times, people will steal medication from family. Police dispatch reports are routinely filled with calls about missing or stolen prescription medication — sometimes out of mailboxes.
Police categorizations and databases don’t compile data specifically linking certain crimes to opiates, spokesmen said.
Other addicts are finding mail-order routes to have medication delivered. The 4th Judicial District Drug Task Force is investigating a mail-order prescription case near Lincoln and Prairie Grove, said Detective Jason French, who leads the task force.
Pain pills fetch a steep price when resold, he said. The street value of painkillers is about 13 times what the prescription costs, said Jared Ennis, a pain management physician during a recent conference on opioid and heroin addiction.
An oxycodone pill can sell for $1 per milligram, which means one pill can be about $30, French and Pruitt said. A prescription of 5 milligram oxycodone with about 30 pills costs around $43.70, according to Drugs.com. The website is used by police to identify drugs, he said.
Prescription pill cases are climbing in Washington and Benton counties, police said. The number of people addicted to pain pills is as high as the number of people addicted to methamphetamine — if not higher, Pruitt said.
“I would say pills are probably, as case-wise, they are probably No. 2 investigations that we work with meth being No. 1,” Pruitt said. “The addiction with pills is really high.”
A state monitoring program shows Washington County is among the nine counties statewide with the highest percentage of oxycodone users, according to 2015 numbers.
“It’s all intertwined,” Robertson said. “You’ve got legitimately prescribed medications that have a high tendency to be abused and misused, but you have illegal drugs in the mix. It’s hard to get a hold of it.”
Suspensions and prescriptions
In August, the state medical board suspended the licenses of two doctors: Paul Enrico Daidone who owns the VIA Medical Clinic in Fayetteville, and Shirin Salim Issa, who recently worked at a Mercy Medical Clinic in Rogers.
The suspensions are related to drug prescriptions. Both doctors have discipline hearings scheduled in December, said Kevin O’Dwyer, attorney for the Arkansas State Medical Board.
A message left at Daidone’s office wasn’t returned Sept. 30.
Issa moved to Seattle, according to her previous office. Issa didn’t respond to a message left on social media Sept. 30.
Board records show Daidone prescribed unneeded pain medication to family or people he knew closely and self-prescribed medication, according to the state’s emergency order of suspension and notice of hearing.
The order was signed Aug. 11. Daidone’s license was listed as suspended Aug. 26, according to online documents.
Issa allowed office personnel who aren’t licensed physicians to dispense, prescribe and administer scheduled medication, according to her emergency order of suspension and notification of hearing issued Aug. 11.
The notice states Issa prescribed “medication for her patients by leaving unsigned prescriptions or by failing to date and sign on the day when the prescription was issued to the patient.” She signed prescriptions in advance and left the name of the patient, the substance and instructions for taking the drugs blank, according to the notice.
Her license was listed as suspended Aug. 22.
A third medical professional — physician assistant Thurman Gregory Smith — was issued an emergency order of suspension in February. He was accused of writing prescriptions, including tramadol, under the name of his supervising physician for his own use, according to the Emergency Order of Suspension and Notice of Hearing.
Tramadol is a pain reliever that works similarly to morphine.
Smith said Sept. 30 he didn’t want to comment.
The board also found Smith appeared to be a “habitual user of intoxicants to such an extent that he is unable to safely perform his duties as a physician assistant.”
The record shows Smith admitted to violating state statutes and regulations.
Smith was ordered to pay $875, enter into rehabilitation and monitoring with the Arkansas Medical Foundation, relinquish his U.S. Drug Enforcement Administration permit, take continuing education and get approval on where he works, among other requirements. Smith is on probation for five years, according to the order.
In August, the state medical board voted to allow Smith to work under Tom Coker, who is his new supervising physician in Fayetteville, online records show.
The three medical professionals are among about 43 statewide the board has taken actions against this year. The investigations are complaint driven and actions have been about 40 per year since 2007, according to information on the board’s website.
But, as doctors prescribed more and more opiates in the past decade, law enforcement has seen “an explosion of the amount on the streets,” French said.
The task force has investigated at least one doctor linked to over prescribing opiates, but proving a case against a doctor is nearly impossible, French said. The drugs are legal when prescribed.
Tightening rules
Doctors were pushed to prescribe opiates and aggressively treat pain in the early 2000s, Phillips said. The drugs work wonderfully for short-term pain, but there are few studies on whether the drugs work for chronic pain, according to a U.S. Centers for Disease Control and Prevention report released this year.
Federal and state governments recently tightened regulations and oversight of opioid prescriptions, police and doctors said. The CDC released guidelines earlier this year asking doctors to be more careful when prescribing opiates. The state changed possession of hydrocodone without a prescription from a misdemeanor to a felony about two years ago, French said.
Illegally possessing hydrocodone is considered in a classification with other narcotic drugs. That means a person who possesses less than 28 grams illegally can be found guilty of a felon, imprisoned for a minimum of 10 years and fined for up to $25,000.
Some doctors screen patients to make sure they aren’t selling or abusing their medication. Doctors and others involved with opiate prescriptions or investigations are joining the Prescription Monitoring Program, created by the state in 2011.
Fewer physicians are prescribing painkillers since the program began, Shelby said. More doctors are using the database, and a bill passed last year eased restrictions for law enforcement officials using the program for investigations, he said.
As of June, about 7,319 people were authorized to use the database, according to a quarterly report.
Shelby said the program is already making an impact, and fewer people are getting multiple prescriptions from multiple doctors and filling them at multiple pharmacies.
A medical disease
Opiate addiction is a medical disease, Phillips said.
Some addicts are taking opiates not to get high, but to keep functioning, she said. Many people were hurt, prescribed painkillers, then became hooked.
“Nobody gets addicted on purpose,” Phillips said. “People need to stop the stigma. They should encourage people to come in and get help.”
David Foshee, a master’s degree student and teacher at the University of Arkansas, said his addiction to oxycodone, an opiate, didn’t happen overnight.
Foshee was prescribed painkillers after he hurt his back in 2011, he said.
Over time, he needed more and more of the medication, he said. Within about three years, Foshee was “an emotional wreck” and couldn’t function without the painkiller, he said.
Foshee said he found himself wondering how he would survive withdrawal, considered suicide and looked online for medication.
“It’s a vicious circle,” Foshee said about opiate addiction. “The drug has taken over every thing about you.”
Foshee receives treatment, which includes medication, at the local Stockton Medical Group center.
The center uses a generic version of Suboxone to stop withdrawal symptoms, which can be severe, said Casillas, director of the center. Once the severe chemical, physical and emotional symptoms are no longer an issue, a patient is able to attend multiple counseling sessions, he said.
The majority of opiate addicts were traumatized in the past — this can be everything from child abuse to veterans experiencing war, Casillas said.
Foshee said he’s still addressing the “root” cause of his addiction. He was abused as a child, he said.
Foshee has been off opiates for about two years, he said.
“I’m living my dream now,” Foshee said. “Yes, you can change your life.”
Phillips and Casillas estimated thousands of addicts need help. There are no statistics, but Casillas sees about seven new patients per day at the Fayetteville facility, he said. The phone rings constantly.
“It’s not enough anywhere,” Casillas said. “In terms of the patients we see everyday, the biggest issue is we are getting more and more calls and seeing more and more patients.”
Fighting opiates
“The problem is such a societal issue,” French said. “Law enforcement has a role to play, the community has a role to play and the medical community has a large role to play as well.”
Family members must encourage treatment and stop leaving medication where addicts can find it, police said. Jails should work with treatment centers to make sure addicts have medication to resist relapses and withdrawal, Phillips said. More people should tell officials when they have concerns about opiate abuse among their friends or family, Pruitt said.
Addiction harms individuals, families and communities, police said.
“Addiction is bad in itself,” Pruitt said. “If people become addicted, they start losing track of what’s really important. They lose their kids; they lose their house; they lose everything they have ever worked for.”
That message of loss is among those Rick McLeod, chairman of Drug Free Benton County, hopes to bring to about 5,000 children across the county during Substance Abuse Awareness Month in October, he said.
“If we can reach just one kid, it makes it all worthwhile,” McLeod said.
The campaign is to prevent all types of drug abuse, but McLeod said he’s most concerned about the abuse of prescription pills.
A 2010 state survey shows about 17 percent of high school seniors that school year said they had misused prescription medication at some point. Nearly 7 percent said they used prescription medication in the past 30 days, according to the Arkansas Prevention Needs Assessment Student Survey for Benton County.
Benton County had 2,834 high school seniors during the last school year, according to the Arkansas Department of Education.
The community must have discussions about substance abuse because the problem is countywide, McLeod said.
“I don’t care if you are from an affluent area or a poor area — it’s there,” he said.
Web watch
Prescription Monitoring Program collects data that shows opioid dispensed in counties statewide. Numbers show Washington County is among nine counties with the largest percentage of oxycodone users in 2015. More information available at www.arkansaspmp.com/files/2016/2015_County_Map_Data.pdf.
Source: Staff report
Opioid drugs
Prescription opioid pain medications, such as Oxycontin and Vicodin, taken in doses or ways not prescribed can have effects similar on people as if they were taking heroin. Local police say anecdotal they see hydrocodone and oxycodone most often. The drugs are among the most commonly abused drugs in the U.S. and might open the door to heroin abuse, research shows.
Source: Staff report
Hydromorphone
Hydromorphone is a highly addictive opiate that isn’t often prescribed in Arkansas but is very potent. Northwest Arkansas, from Benton to Scott counties, is among the counties with more than twice as many hydromorphone users than the state average.
Source: Staff report
Arkansas State Medical Board
There are 6,305 active doctor licenses statewide. The Arkansas State Medical Board website lists basic information about physicians, but does not track how many can or do prescribe pain medication in Benton or Washington counties. The board’s website is www.armedicalboard.org/public/verify/default.aspx.
Source: Staff report