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The 10 Most Dangerous Meds Driving America's Pill Crisis

More Americans now die from prescription pills than car accidents. The nation's response to the trend will define an era, but corporate influence threatens reform.

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You need to look at policy, laws, individual behavior, community behavior and health care provider behavior,” says Dr. Chris Jones, a consulting pharmacist with the CDC. One of the most innovative interventions includes building a database on patients who abuse painkillers and identifying doctors who overprescribe (or do so without examining the patient or his medical history). So far, five states have adopted specific pill-mill laws to flush out such doctors. “We’re looking at these laws to evaluate them and for guidance on policy,” says Jones.

That includes sharing information from state medical licensing boards and pharmacy licensing boards to monitor prescribers and set thresholds for how many pills are hitting the street and why.

The Drug Enforcement Administration launched an annual National Prescription Take-Back Event; the third drug dump, in October, collected 188 tons of old pills nationwide. The agency also operates 26 Tactical Diversion Squads—agents specializing in identifying wholesale traffickers and suppliers of black-market pharmaceuticals.

Some 48 states have adopted  prescription monitoring programs (PMPs), which typically encourage (rather than require) doctors to record the data of every controlled drug prescribed, but only 37 are currently operational.  In 2011, Florida implemented its PMP after its Tea Party governor reversed his controversial opposition to the surveillance tool, and the Sunshine State has already seen an exodus of pill mills to Georgia, which still has no PMP.

These federal and state campaigns come not a moment too soon, either. Painkillers have become the most common drug taken by adults between the ages of 20 to 59. The trends in sales, deaths and abuse treatment admissions for oxy and the like have all risen fourfold or more since 1999, according to  a new state-by-state study. In 2009, for the first time,  emergency-room visits resulting from prescription drug ODs topped 1 million, with some 343,000 due to opiate analgesics like oxy, 363,000 due to benzodiazepines and other sedatives, and 22,000 due to stimulants. ( For a ranking of the top 10 drugs whose use or abuse led to overdose deaths or survival in ER visits in 2009, see the list at the end of the article.)

In 2010, enough prescription painkillers were sold nationwide to keep every American medicated around the clock for an entire month. Some 12 million Americans admitted that they were using painkillers without a prescription, and at least 14% of these nonmedical users met the criteria for abuse or dependence. In one recent survey, more than 5 million Americans reported using them to get high—in a single month period. The majority of those people say they obtained (or stole) them from friends or their family.

Jones does see one bright spot in the otherwise grim report. Methadone, which is used as a pain reliever as well as to treat opioid dependency, had been on the uptick for nearly a decade—from about 800 deaths in 1999 to about 5,500 in 2007. But for reasons not yet clear, that number dropped by remarkable 600 deaths in 2008. “For  many years it had been the most common opioid in overdose deaths,” says Jones. “We don’t know if it’s just that people have shifted to these other drugs of what. But it’s promising. We’ve have to wait and see what we find when we look at  2009.”

In terms of the big picture, however, the fact that prescription drugs have overtaken automobiles as the nation’s leading cause of accidental deaths marks a deeper societal transformation. One of the most defining developments in twentieth-century America was motorization; as more people bought more cars and drove more miles, more accidents, injuries and deaths were the inevitable result until government intervention bent the curve. The 21st century is shaping up to be about, among other things, the pharmaceuticalization of America, as lifelong prescription drug use starting in early childhood becomes the norm.