Why West Virginia Has the Second Highest Prescription Drug Overdoses in Nation

Alison Bass
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Did you know that West Virginia has the second highest rate of deaths from prescription drug overdoses in the country? I didn’t, until I moved to the Mountain State to live and work and became curious as to what was behind this tragic statistic. According to a recent CDC report, drug overdoses now kill more West Virginians each year than car accidents do, which, if you’ve ever tried to navigate the treacherous mountain roads around here, is saying a lot.

Prescription drug overdoses, of course, are a national problem. As I’ve blogged about before, more Americans now die from taking too many legal drugs than from overdosing on illegal drugs like heroin and cocaine. A large part of the problem in both West Virginia and the nation is the exponential increase over the last decade in the use of legally prescribed opiate pain killers (like OyxContin and similar meds); these drugs were involved in 74 percent of the prescription drug overdoses in 2008 (the latest year stats were available), according to the CDC report. Doctors are prescribing these powerful painkillers too readily to patients who quickly become addicted to them and crave more.

However, that’s not the whole story, as a new study out of West Virginia indicates. The study, by researchers at West Virginia University (full disclosure: that’s where I teach), found that a greater proportion of people who had overdosed on prescription drugs in the Mountain State shopped around for doctors and pharmacies to fill their drug addiction. What I found surprising about this study was not that people who overdosed were doctor shoppers — that’s common sense — but that only 25 percent of those who died were shopping for prescriptions. That means that 75 percent of those who were killed by prescription drugs in West Virginia may not have been opiate drug addicts looking for a quick fix, but people who had no idea that the drugs they were legally prescribed by doctors could be lethal in some combination. Sadly, they may not have been fully informed that these drugs had dangerous side effects, side effects that could kill them.

Remember Heath Ledger, or the actress Brittany Murphy? They are among a growing army of Americans lulled by drug company marketing into thinking that legal drugs are safe and can help them sleep or feel better; after all, isn’t that what all those soothing TV ads promise? Since 1997, when Congress allowed the drug industry to market their wares directly to consumers, the number of Americans taking prescription drugs has soared nearly 40 percent and many of those people are imbibing multiple drugs, as I’ve blogged about here.

So why is the problem of prescription drug overdoses most acute in states like New Mexico, West Virginia, Nevada and Utah? I think socioeconomic factors play a big role here — in states where poverty, high unemployment and inadequate access to education may breed a sense of despair and hopelessness, there may be a greater reliance on powerful painkillers and psychoactive drugs to dull both physical and mental anguish. A health care system where some doctors hand out too many prescription drugs without fully alerting their patients to the side effects may only compound the problem. (The Charleston Gazette ran an excellent series last year on the problem and noted that many West Virginia doctors don’t use an available database to monitor prescriptions — see here and here).

Interestingly enough, Massachusetts (the state I lived in for many years before moving to West Virginia) has the lowest rate of prescription drug deaths — see CDC report. Again, the same factors could be at play here: the people in Massachusetts are among the most highly educated in the nation and the unemployment rate there is lower than the national average. In addition, Massachusetts was the first state in the nation to adopt universal health care, which means its residents have better access to quality health care than folks in West Virginia. And quality care means doctors and nurses who don’t over-prescribe potent drugs and who monitor their patients for dangerous side effects.

It also means consumers who educate themselves about the possible risks and think twice before taking a fistful of prescription drugs or sharing them with friends.

This blog was originally posted on alison-bass.com.

 

13 COMMENTS

  1. I know someone who knows a doctor who passes out a ton of pain pills. The patients call him a candy man. When my friend asked him why he kept writing so many scripts, he said, “Well, I just want to give them the benefit of the doubt.”

    My friend thinks the doctor does it because all the addict patients come in and say, “Oh…. you’re such a good doctor… I love you so much, Dr. J.” This guy got investigated by the FDA but I don’t know what came of it. It’s easy enough to find out which doctors are candy men and women.

    Just like it’s public knowledge which docs prescribe the most antipsychotics.

    • This guy does it to make money. If he is a known pill mill operator people will come from all over the US to buy the pills and resell them. A guy by me got busted and then hired an assistant because he couldn’t write scripts anymore. However, the guy he hired knew he was selling to addicts and drug dealers so stopped writing them. The guy who hired him then said something along the lines of “are you a doctor or a cop”? Big pharma is the medical profession now.

  2. Opiates rarely ever kill people on their own. In fact humans evolved around opium in such a way that we are born with opiate receptors in our brains. It’s the combination of opiates with other drugs – including and often especially the acetaminophen that they put in the opiate pill to go with it – that cause people who abuse them to die. In any case, I don’t know why bloggers at MIA would want to attack an issue dealing with physical pain and the pain killers to treat it. It has nothing to do with mental health. In any case my aunt has rheumatoid arthritis and it’s so painful that she sometimes needs to be monitored for suicidality because doctors wont give her strong pain pills only because her illness is chronic, “you’ll get addicted!” they say. So what? What’s worse, addiction, or excruciating pain 24/7 so bad that you cant live?

    If I ever develop a painful health condition, I will demand my pain pills. It’s a patients responsibility to look out for themselves, not a doctors. It is in fact the acetaminophen that they add to vicodins and oxycontins that cause most people to “OD” and die, the DEA even once admitted that they forced drug companies to include this “tylenol” drug for no other reason but to detect and punish abusers as no good scientific studies exist even to this date that shows the combination of the two drugs works better. Acetaminophen causes rapid liver damage when taken in excess but the opiate hydrocodone can be taken in extreme excess with little to no risk of serious harm when taken alone.

    Blame acetaminophen, alcohol, benzos, ect. Don’t blame opium. Few people in history ever died from taking large amounts of opium itself. If you are ever in pain and your life revolves around “holding on” and making it to tomorrow, you will beg for this drug, regardless of your opinion of it now.

  3. Jeffrey

    “I don’t know why bloggers at MIA would want to attack an issue dealing with physical pain and pain killers to treat it. It has nothing to do with mental health.”

    “Don’t blame opium. Few people in history have died from taking large amounts of opium by itself.”

    There is often a fine line between addiction issues and those symptoms that get labeled as so-called “mental illness.” Biological Psychiatry and their disease model has had a very negative effect on understanding and treating both of these types of problems. I have written a blog contribution titled “Addiction, Biological Psychiatry and the Disease Model”; It will soon be posted on MIA. I hope you will read and comment on it.

    You are dangerously mistaken about underplaying the dangers of death from opiate overdose. In the past decade there has been an epidemic of opiate addiction and overdose deaths. In 2008 there were 36,450 drug overdose deaths; 14,800 of those deaths were from opiate overdose. Opiates BY THEMSELVES can kill people by seriously depressing respiratory function. Yes acetaminophen can damage organs but Oxycontin DOES NOT contain acetaminophen and it CAN KILL you by itself.

    Richard

  4. A good post Alison, although a difficult topic to analyze in a purely objective way. Do the statistics you point to suggest a failure of the social contract (basic security for all) and the hidden realities of human dependence needs. As you point out an obvious conclusion to a need of increased drug use is;

    “in states where poverty, high unemployment and inadequate access to education may breed a sense of despair and hopelessness, there may be a greater reliance on powerful painkillers and psychoactive drugs to dull both physical and mental anguish.”

    Is the need to dull physical and mental anguish a feature of our unique sensitivity and dependence on social attachments, severely strained by economic hardship and its threat to basic security. Jaak Panksepp points out how opiate addiction may be a reflection of internal opioid systems, as part of our human dependence needs.

    “LOVE & THE SOCIAL BOND:

    Social bonding is of enormous importance, for if it is inadequately established, the organism can suffer severe consequences for the rest of its life. A solid social bond appears to give the child sufficient confidence to explore the world and face a variety of life challenges as they emerge. As John Bowlby poignantly documented in a series of books, a child that never had a secure base during childhood may spend the rest of its life with insecurities and emotional difficulties.

    Until recently, we knew nothing about the neuro-chemical nature of social bonds. Even though all humans feel the personal intensity of their friendships, family attachments, and romantic relationships, there was practically no way of studying how these feelings might be constructed from specific brain activities. In the past score of years there have been several breakthroughs, like the discovery that neural circuits mediating separation distress are under the control of brain opioids.

    The first neurochemical system that was found to exert a powerful inhibitory effect on separation distress was the brain opioid system. This provided a powerful new way to understand social attachments. There are strong similarities between the dynamics of opiate addiction and social dependence, and it is now clear that positive social interactions derive part of their pleasure from the release of opioids in the brain.

    From this, it is tempting to hypothesize that one reason people become addicted to external opiates (i. e., alkaloids, such as morphine and heroin, that can bind to opiate receptors) is because they are able to artificially induce feelings of gratification similar those normally achieved by the socially induced release of endogenous opioids such as endorphins and enkephalins.

    In doing this, individuals are able to “pharmacologically” induce the positive feelings of connectedness which others derive from social interactions. Is it any wonder that people become intensely attached to the paraphernalia associated with their drug experiences, or that addicts tend to become socially isolated, except when they are approaching withdrawal and seeking more drugs?

    SIMILARITIES BETWEEN

    OPIATE ADDICTION & SOCIAL DEPENDENCE

    1) Drug Dependence 1) Social Bonding

    2) Drug Tolerence 2) Estrangement

    3) Drug Withrawal 3) Separation Distress

    a) PSYCHIC PAIN a) LONELINESS
    b) LACRIMATION b) CRYING
    c) ANOREXIA c) LOSS OF APPETITE
    d) DESPONDENCY d) DEPRESSION
    e) INSOMNIA e) SLEEPLESSNESS
    f) AGGRESSIVENESS f) IRRITABILITY

    Summary of the major similarities between the dynamics of opioid dependence and key features of social attachments.”

    Excepts from “Affective Neuroscience: The Foundations of Human and Animal Emotions.” by Jaak Panksepp.

    What seems so obvious to us in seeking to understand observable behaviors, may need a deeper understanding of just how our behaviors are stimulated from within. How many of us take our daily behaviors for granted, with barely any understanding of our internal functioning? Some people suggest that we have a curious tendency to shy away from such internal awareness.

    Warm regards,

    David Bates.

  5. “…a curious tendency to shy away from such internal awareness.”

    Batesy, I think you’re right. Many people on this site, including myself, tend to shy away from what you call internal awareness discussion. I’m not sure it’s because people don’t agree with you, my theory is that there is no language known by the vast majority of MIA participants on this subject.

    Let’s call it “Language of Within”

    I’ve noticed people have both a difficult time understanding you and your points as well as responding to you because they “don’t think they’re speaking your language.” I’ve joked with you before that some of the words you use are just word salad to me. That’s true, sometimes I just see a bunch of words with about an alien/foreign concept. The Within.

    I’m not sure folks like Bowen, Porges, and Joseph Campbell help clear things up much. So, as we seek to understand each other I hope a common language of the within can develop.

    Best,
    David

    • Hi David:))

      I get that people don’t understand and are most likely to dismiss and skip the comments, although as we wind on down the road, perhaps more people will come to see that this language of our internal world, shows us that we hardly know ourselves, and change will not come without more knowledge into the hidden stimulation of behaviors.

      Your perfectly right, there is no common vocabulary of internal awareness, only a ritualized social dialogue based on the sight of the external world, and mismatched to our internal reality, where our perception is created.

      Some suggest, we’re about to come to terms with the effect of the industrial revolution, and our “objectification” of the living world, no less so, our own nature. From an orthodox perspective, Teresa Brennan writes about “affects” and the denial of the body in intellectual assumptions about organic processes, in a taken for granted, “mechanistic” worldview;

      “The Transmission of Affect:

      In a time when the popularity of genetic explanations for social behavior is increasing, the transmission of affect is a conceptual oddity. If transmission takes place and has effects on behavior, it is not genes that determine social life; it is the socially induced affect that changes our biology. The transmission of affect is not understood or studied because of the distance between the concept of transmission and the reigning modes of biological explanation. No one really knows how it happens, which may explain the reluctance to acknowledge its existence. But this reluctance, historically is only recent. The transmission of affect was once common knowledge; the concept faded from the history of scientific explanation as the individual, especially the biologically determined individual, came to the fore. (p, 1-2.)

      We think that the ideas or thoughts of a given subject has, are socially constructed, dependant on cultures, times, and social groups within them. Indeed, after Karl Marx, Karl Mannheim, Michel Foucault, and any social thinker worthy of the epithet “social,” it is difficult to think anything else. But if we accept that our thoughts are not entirely independent, we are peculiarly resistant to the idea that our emotions are not altogether our own. The taken-for-grantedness of the emotionally self-contained subject is a bastion of Eurocentrism in critical thinking, the belief in the superiority of one’s own worldview over that of other cultures. The idea that progress is a modernist and Western myth are nonetheless blind to the way that non-Western as well as premodern, preindustrial cultures assume that the person is not “affectively” contained.
      Notions of the transmission of affect are suspect as non-white and colonial cultures are suspect. (p, 2.)

      But the denial is not reasonable. The denial of transmission leads to inconsistencies in theories and therapies of the subjective state. All reputable schools of psychological theory assume that the subject is energetically and affectively self-contained. At the same time, psychologists working in clinics experience affective transmission. There are many psychological clinicians ( especially the followers of Melanie Klein) who believe they experience the affects of their clients directly. (p, 2.)

      Present definitions of the affects or emotions stem mainly from Darwin’s physiological account of the emotions. Descartes, inclines us towards the isolating motions that can be verified by another observer, and this is reinforced by modern psychology. Knowledge of bodily motion, even internal bodily motion, is no longer gleaned by the path of bodily sensation, but by visual and auditory observation. Taxonomies of the emotions and affects have descended from three branches. One is ancient; another is identified with Darwin; and a third stems from James and Lange.

      Because of their observational bias, the lists descended from Darwin do not reckon with more complex affective states, such as envy, guilt, jealousy and love. Such cognitive affects are termed desires by some. In the 20th century’s cognitive psychology, a distinction between affect as a present thing–and desire–as an imagined affect, holds significance to deal with the cognitive component in desires, which involve goals and thinking. Critical to the transmission of affect though, is the moment of “judgment,” when the “projection” or “introjection” of affect/emotion takes place. By “affect,” I mean the physiological shift accompanying a judgment. By judgment I mean “any evaluative (positive or negative) orientation towards an object.”

      The evaluative or judgmental aspects of affects, is critical in distinguishing between these physiological phenomena we call affects, and the phenomena we call feeling or discernment. In other words feelings are not the same thing as affects. At present, feelings are a subset of affects, along with moods, sentiments and emotions. This distinction between affects and feelings comes into its own once the focus is on “the transmission of affect.” (p, 5.)

      There is no need to challenge an existing view that emotions are synonymous with affect, yet what needs to be borne in mind is that affects are material, physiological things. Affects have an “energetic” dimension, which is why they can enhance or deplete. They enhance when they are projected outward, when we are relieved of them; in popular parlance this is called “dumping.” Frequently, affects deplete when they are “introjected,” when we carry the “affective” burden of another, either by a straightforward transfer, or because the other’s anger becomes your depression. But other’s feeling can also enhance as affect, as when you become energized just being with loved ones or friends. Yet with some other’s you are bored or drained, tired or even depressed. All this means that we are not completely self-contained in terms of our affective energies. There is no secure distinction between the “individual” and the “environment.” (p, 6.)

      The transmission of affect questions the individuality of persons, and how our individuality is achieved and maintained. We cannot grasp what is truly distinctive about individuality, without first coming to appreciate, that it is not to be taken for granted. What is not to be taken for granted, is the distinction between the individual and the environment at the level of physical and biological exchange. At this level, the “energetic” affects of others enter the individual, as are the individuals energetic affects transmitted into the environment. Here lies the key to why people in groups, crowds and gatherings can often be “of one mind.” (p, 8.)”

      Excerpts from “The Transmission of Affect” by Teresa Brennan, PhD.

      Sorry, I know this comment appears way off topic, yet couldn’t resist David R’s invitation for further examples of our limited, yet taken for granted, superficial-awareness?

      Best wishes,

      David B.

      • David,

        This is not a criticism of you or your writing. I agree with David Ross that I don’t get the full meanings of what you write about. I catch the gist of things but not the full, resplendent whole of everything. I also agree with David R. in that a lot of this may be due to the fact that langauage, or the lack thereof, is what is causing the problem. When reading your posts I often catch myself thinking, “Put it in common terms.” When I do catch your meanings I tend to agree with you on most things. We need to develop the Language of Within. Because of you, I now questino my motives as to why I want to respond to something or respond to something that I read here on MIA. For that I say thanks.

        • Hi Stephen:))

          The whole point is, there are no common terms yet which will allow our left-brained linguistic logic to express our internal reality? Our “evolved” common terms are overwhelmingly about what we see in the external world.

          Here we in 2012, with the obvious failure of simplistic assumptions about the “chemical” world within, because we think with a clockwork logic of cause & effect motion, which anylises human function, as if we are a machine?

          We don’t understand the motivation for our critical thinking and its deductions, because we don’t examine our own body’s “sensations,” opting for a religious faith in the superiority of our mind. We have lost touch with the reality of our own nature and the sensory power of the human body.

          As Teresa Brennan points out, this false faith in the power of so-called reason, is based on a need to feel strong, safe and secure, by way of a sense of “superiority,” which also masks our need to dominate the other;

          “a bastion of Eurocentrism in critical thinking, the belief in the superiority of one’s own worldview over that of other cultures. The idea that progress is a modernist and Western myth are nonetheless blind to the way that non-Western as well as premodern, preindustrial cultures assume that the person is not “affectively” contained.
          Notions of the transmission of affect are suspect as non-white and colonial cultures are suspect.”

          Consider, Brennan’s articulation of the limits of our “objective” language, in relation to our self-awareness;

          “The Limits of Language:

          At present we only have a rudimentary language for connecting sensations, affects, and words, for connecting bodily processes and a conceptual understanding of them. The further development of such language requires an attention to the pathways of sensation in the body. We need to formulate bodily knowledge more accurately and increase the rapidity of human understanding. Extending knowledge in this way is the reverse of gathering it by “objectification,” or studying bodily processes disconnected from living sensory attention. (p, 153.)

          Extending knowledge of sensation, following it further along its pathways, means extending consciousness into the body, infusing it with the conscious understanding from which it has been split, by a subject/object orientation. That split has hardened with the sealing of the heart as an organ of sensory reception and transmission, yet it has also come under examination in all the practices and knowledge’s that, taken together, presage the resurrection of the body.

          Some of these systems of knowledge already nestle in the arms of objective science, especially those focused on the complex systems of both body and brain, while others are found in more ancient, holistic health systems. What these systems of healing have in common with the study of the body and its complexity, is the notion of systems–of language and communication, insofar as a biochemical chain or a DNA sequence can be structured like a language in another medium. (p, 154.)

          The more conscious we become of what we repress in our “subject/object” orientation (remembering that primary repression is the repression of unprocessed sensory information) or ignore, the less we think in projected and judgmental terms.

          But such conscious consciousness is only possible when we invent or reinvent the words to say it with. The transliteration into language from the minutia of sensory knowledge and its sifting, may be processes entirely unknown to present day consciousness.

          Extending consciousness sensation, finding the words or images, means grasping the nuances of fleshy grammar and alphabets. It means describing and accounting for sensations, which entails translating them into the everyday currencies of speech and so extending the range of their visualization.

          What our subject/object ego orientation represses is not available to consciousness. This ego and its repressions, present themselves as disordered flesh, when in fact the ego and its repressions are the cause of such disorder. Disorder is not inherent in the body or the flesh, which loves natural regulation. The body thrives in health when its real needs are respected, as distinct from the ego’s imaginary anxieties. (p, 155.)”

          Excerpts from “The Transmission of Affect” by Teresa Brennan, PhD.

          Look at John Hoggett’s example below, which feels nice and easy to read, yet explains nothing about how language is created within?

          Common terms described the world as so obviously flat, not so long ago, suggesting that commonsense has a history of not seeing what is right in front of its eyes, because we are not truly aware of how we do this looking?

          Get back to the “obvious” topic, John suggests, yet in my first comment, I try to point out that what seems obvious, is not a clear understanding of cause or motivation?

          Its a long & winding road that leads to your door, Stephen, that door is our body, it doesn’t have language, but does have an evolved nature, which knows but cannot speak.

          Best wishes,

          David B.

          • Shall we dance?

            If there is a yoga studio in your town, chances are NIA will be offered there, too. Neuromuscular Integrative Action is also called, somatic psychotherapy. Take a class! Take off your shoes & socks! For one hour you will mirror the movements (jazz modern dance,Duncan dance, T’ai chi , Tae kwon do, Aikido, Feldenkrais, Alexander technique, Yoga) of the instructor; you will dance to her tune (personal musical arrangement) – experience your body language and the magic of affect transmission. Whatever your level of fitness and even if you have zero dance back ground, you will , for one hour, become:

            *” Weightless ,
            Timeless measures,
            Of life surrendering
            Secret treasures …”

            This is for D.R. from my personal poetry journal… it’s a metaphor for the language within… IMHO, metaphor IS the language spoken by the body.

            Dance and vocalization rituals were a primary means for sharing affect, developing community and priming groups for specific tasks, e.g; hunting amongst all primitive cultures, anywhere on the planet. Joseph Campbell refers to the affect transmission that occurs through mirroring movements and toning, harmonizing in a group as something we are hardwired for. Both sound and movement -reverberation and resonance occur via physiological mechanisms we inherently possess. Security, unity and grounding in our own skin is the experience of these rituals– the means for community building that was essential to human survival.

            There are various group movement and/or music activities that achieve some degree of affect transmission, but the ultimate is a NIA class, IMO….. could be the barefoot element; 7,000 nerve endings on the soles of the feet innervated through dance/movement, saying:

            “I hold the keys to the many personalities that compose you…and… I can help you become any archetype that fills your form”

            TO: David Bates
            The body does indeed have a language.

            TO: David Ross
            Joseph Campbell has written ‘the language within’ , sharing myths that are timeless and universally human.

            TO: Stephen
            It takes two to Tango, but no less than five for a NIA class(counting the teacher)

            Want to speak the language? Follow Lady Ga Ga’s advice and…
            “Just Dance”

            *;-0
            Sinead

  6. Boys, boys, boys, how can you write “There is no common vocabulary of internal awareness…”

    What of poetry, popular music, literature, Opera, film and TV? What of art in general?

    What of all those clichés like, “I get a sinking feeling in my stomach every time I ….” “It’s like a dark cloud comes over me….”I was so happy I wanted to hop, skip and Jump!” and, “I felt like a wet rag.”

    To get back to the subject, Benzo’s are a known killer and many famous people have been killed by them, or they took drug combinations that included Benzo’s.

    This UK based site used to have a lot of information on this: http://www.bataid.org/
    here is a link from their site on celebs who died from drug overdoses: http://www.edrugsearch.com/edsblog/michael-jackson-to-join-tragic-list-of-accidental-prescription-drug-deaths/
    pain killers and benzo in combination feature in quite a few

  7. Where there are miners, look for Oxycontin. Where there are laid off former miners, look for still more Oxycontin. And where there are damn few doctors, there will be more Dr. Feelgoods. That’s my explanation for the painkiller epidemic in West Virginia, anyway. There is a lot of physical pain, period. Mining is an industry that grinds people up and spits them out, generally in a lot of chronic pain. (So is trucking really — especially when you drive through those mountains. I would not do it for any money.) And in most rural areas there’s a critical shortage of doctors. Some towns you will have a hard time finding someone competent to deliver your baby. Never mind an orthopedic surgeon — a safe one anyway. So a lot of the crummiest doctors have free rein.

    I think another factor, oddly enough, is that the rural inland areas have never had much of a heroin distribution network. So people who get hung up on opiates quickly turn to Oxycontin, Dilaudid, Percocet, whatever they can get. Methadone’s a biggie right now. And I don’t know for sure … would like to ask Richard Lewis … but I think some of these pills can get you hooked faster, and carry a higher OD risk, than heroin itself.