Efforts seek to curb painkiller abuse

Doctors warn prescription drug problems on the rise

By Keri Brenner | The Olympian • Published March 03, 2008

LACEY – When he first started taking the prescription painkiller OxyContin for a work-related back injury five years ago, Scott Ayala's dose was 10 milligrams, twice a day.

But by last July, when Ayala crashed his truck, lost his job and almost died, he was up to 80 milligrams three times a day, or 240 milligrams daily — double the recommended risk-alert dosage level of 120 milligrams a day, according to new state guidelines for physicians.

"I gradually progressed to taking more and more, and my tolerance increased," said Ayala, 48, a former respiratory therapist. "I was getting more and more dependent on the drugs, and my pain was increasing."

Ayala, who completed a monthlong, in-patient substance abuse recovery program at Olympia's Providence St. Peter Hospital in October, is one of the lucky ones. He was able to find help.

Many others, locally and nationally, are not as fortunate. The January accidental drug poisoning death of 28-year-old actor Heath Ledger of "Brokeback Mountain" fame is an example of a larger problem, state and Thurston County medical experts say.

"It's a shame that it takes a celebrity death to focus attention on this national epidemic, which is a catastrophe," said Gary Franklin, medical director of the state Department of Labor and Industries.

He and others are calling for doctors, pain patients, parents of teenagers, pharmacies, health educators, addiction counselors and lawmakers to develop solutions.

Problems include:

• Dosages for prescription opiates taken by participants in the state's worker's compensation program have risen dramatically since 1998, when state law changed to allow doctors to give prescription opiates such as methadone, OxyContin or morphine for chronic noncancer pain. The average dosages have risen from 80 milligrams a day of morphine-equivalent medication in 1998 to more than 150 milligrams a day, Franklin said. "What's happening is a rampant tolerance, where people are taking more and more and not getting better," he said.