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The pull of the pills

Many are abusing 'legal' prescriptions

Shannon's pills came after a back-fusion surgery.

Zachary needed pain relief after he shattered his hand in an ATV accident.

Tiffany's friends introduced her to the quick and easy "legal" high.

James visited Las Vegas several times a month and left the doctor's office loaded with prescriptions.

Now, James is behind bars. Shannon was just released from jail. Zachary is going through treatment and Tiffany is finally clean after a year and a half of battling her demons.

Different stories but one recurring theme — prescription drugs can take over your life.

But no one ever told James he could get hooked. After all, these pills are legal. Nobody mentioned to Tiffany that pills can be as powerful as street drugs. And Zachary never got any warning about the hell of withdrawals and trying to come clean.

It's those concerns that push these men and women to speak out, to tell their stories.

They don't want it to become your story, either.

Shannon

"I was living life well," said the curly, dark-haired woman sitting in the Utah County Jail. "But I hurt my back, and that's where it all went downhill."

She survived cancer, radiation and chemotherapy as a young teen, but it damaged her back, and by 23, Shannon needed back-fusion surgery.

To deal with the pain, doctors prescribed Lortab. Eight months later when they recommended more surgery, Shannon, who didn't want her last name used, spoke up.

"I'm a (former) meth addict; my parents are alcoholics," she told the doctor. "I'm worried this could get out of hand."

But she said the doctor insisted she needed the medication so her body could heal.

After the second surgery she was also prescribed a fentanyl patch — a patch attached to the skin that delivers high doses of pain-relieving medication — plus Lortabs and muscle relaxants. She said they didn't really help with pain, they just tricked her mind into ignoring it.

Despite Shannon's and her husband's concerns, the doctor insisted she keep taking her medications. Without them, she would never be able to complete physical therapy.

"I wasn't even doctor shopping," she said. "My doctor was aware of it."

After a fall, a broken tailbone, another surgery and more prescriptions, Shannon had to do something. She checked herself into a treatment center without telling her doctor, afraid he would prescribe more pills.

She clung on through excruciating withdrawals and made it out of treatment, rid of the prescription addiction.

But by then her marriage had crumbled. And without a job or a clean record, she lost custody of her two children.

She began drinking to drown her tears, and after seven years meth-free, slipped back into old habits.

She sold her remaining pain pills for drug money, started hanging around meth-using friends and began bouncing in and out of jail.

"I actually got married in the (LDS) temple," she said of her life before the pills and after giving up meth. "I (had) cleaned my whole life up. I was very happy. We owned our own home. It all started with the damn pill, and now I have nothing."

A growing problem

Shannon isn't alone.

Nearly 5.2 million people ages 12 and over reported using prescription pain relievers nonmedically during 2007, according to the National Survey on Drug Use and Health, published by the Substance Abuse and Mental Health Services Administration.

A large chunk of those users are in Utah.

From 2005 to 2006, Utah was fourth in the nation for nonmedical use of pain relievers. That's a drop from 2004 to 2005 when Utah led the nation in pain-reliever abuse, according to the survey.

Officials' concerns about prescription pills are that they don't look dangerous.

There are teal pills the size of Ibuprofen and large white ones that look like Altoids. Oval-shaped orange pills could pass as a fiber supplement, except for the numbers 3 and 0 on one side.

And of course, they all come in the familiar orange prescription bottles.

Far from innocuous, these pills are OxyContin 80s, Somas and Adderal XR 20 mg — legal drugs that can be just as dangerous as marijuana, meth or crack cocaine.

"We're always taught the bad man is going to come up and say, 'Hey, buy some heroin,' " said defense attorney Richard Gale. "It's easy to say no. (But when) you hold a pill, it looks like just a harmless little pill you've seen hundreds of times. It looks like a Tylenol, a baby aspirin."

That's the mindset of an alarming number of teens, studies show.

In fact, one-third of teens believe there's "nothing wrong" with using prescription medicines without a prescription once in a while, according to the 2008 report "Prescription for Danger" from the Office of National Drug Control Policy.

But that's the fatal mistake, Gale said.

He knows. He works with men and women who face jail or prison because they misused and abused pain pills.

Tiffany

It was a friend who got Tiffany, 24, hooked on OxyContin. She was having fun and Tiffany didn't see anything wrong with taking a doctor-prescribed pill.

"I was just using them every once in a while," she said. "I never thought I was addicted."

Soon, she was taking them more often, still convincing herself they were fine.

"It's cleaner … we tell ourselves," Tiffany said. "It's not a street drug."

"Taking a pill doesn't have the same stigma as smoking crack or injecting heroin," Gale said. "(But) once they get addicted (to pills), it's the same thing as heroin, and their actions are out of control."

Tiffany learned the hard way.

"The longer I did the pills, my conscience went away," she said. "When I got offered heroin, I didn't even blink."

After struggling for a year and a half with harder addictions, Tiffany's parents turned her in for stealing money from them to buy drugs.

"I hated them at the time, but they saved my life," she said. Now 18 months later, after treatment and drug court, she's clean. And her relationship with her parents? "Never been better."

Knowing opponents

Oxycodone, a highly addictive pain reliever synthesized from natural opium sources, was developed in 1916 in Germany as an alternative to morphine or codeine, said Dr. Glen Hanson, a professor at the University of Utah's Department of Pharmacology and Toxicology and director of the Utah Addiction Center.

OxyContin is one brand-name oxycodone drug with a slow-release function for pain relief over several hours.

Percodan is oxycodone with aspirin, and Percocet is oxycodone mixed with acetaminophen.

The abuse starts when addicts crush the pills to destroy the time-release capabilities and snort the powder for an instant high. A crushed oxycodone-based pill mirrors a heroin high and creates an equally powerful addiction, Hanson said.

But if pills aren't available, the pull is so strong addicts will often digress to heroin, a much cheaper option.

A single OxyContin 80 can cost nearly $80 on the street, whereas a quarter-ounce bag of heroin is only $10 to $20.

Lt. Phil Murphy, director of the Utah County Major Crimes Task Force, watches addicts bounce back and forth between pills and street drugs, depending on which one they can get. His job, along with confiscating street drugs, is identifying how prescription drugs end up on the streets and getting them off.

From July to September 2008, officers from that task force pulled 2,361 pills off Utah County streets. From October to December the number dipped to 679, but by January to March 2009, it was back up to 1,789. And those were only a few big dealers, not the everyday users, Murphy said.

A large percentage of Utah's pills come from out of state: Arizona, Las Vegas, Mexico.

"We're really in an epidemic," Murphy said. "Don't tell me about legalizing marijuana and meth. We can't even deal with the problem that's legal here. It's perfectly legal, and look how much it's killing us."

Erin

She really shouldn't be here.

The 24-year-old has already lost nearly a dozen friends to drug overdoses and even "flat-lined" a few times herself.

"All those times, it didn't even scare me," Erin Flygare said. "It just blows my mind (that) it didn't scare me. I would go right back. It's crazy how powerful (addiction) is."

It's been an almost seven-year battle for Flygare, who began using OxyContin at the age of 18 and soon slid into cocaine and ecstasy.

"All of them come with it when you get into the drug world, it seems," she said.

Flygare bounced in and out of jail and in and out of rehab centers, racking up bills of nearly $50,000 and breaking her parents' hearts, but never making any progress because she wasn't ready to quit.

She is now. She has given up all her old friends, her old hangouts and her old habits. She stays busy working and rebuilding the family bridges she burned while high.

"I never thought my life would be where it is," she said. "A road of heartache and sadness, that's all (drugs) bring."

Cultural factors?

Members of The Church of Jesus Christ of Latter-day Saints adhere to the Word of Wisdom, which discourages the use of coffee, tea, tobacco and alcohol and of course drugs like heroin and meth, because of the potential to create an addiction. But there's no official mention of prescription pills.

When used correctly, pills have legitimate uses and don't need to cause problems. The problem comes when a prescription runs out but the desire to take it remains.

"There are people who are going to self-medicate," said Dr. Don Fairbanks. "If you're not LDS, you may self-medicate with alcohol, maybe try some illegal stuff. But if you're LDS and trying to self-medicate, you'll go to what you think is legal."

However, Fairbanks said the LDS culture alone doesn't explain why there are three other states that rank higher than Utah for prescription abuse.

Others wonder if it has less to do with religion and more to do with Utah's authority-respecting residents.

"This is a law-abiding community that has been taught … that people in a professional capacity, when they tell you to do something, we usually do it," said Frank Smith, Drug Enforcement Administration assistant special agent in charge, Rocky Mountain Field Division, which includes Utah. "When a physician prescribes something, maybe we don't ask enough questions, we just think, 'They know best.' I think everyone knows their own body better."

Kristie

At first there was nothing wrong with taking a few Percocets to deal with the pain from a bone infection surgery. But then Kristie started taking the pills to deal with her growing depression. Soon, she was taking more than just pills — she was stealing prescription pads, doctor shopping and diverting her family's rent payments for the drugs.

During the growing addiction, Kristie was still attending her LDS ward each week and teaching Primary classes, convinced there was nothing wrong with taking doctor-prescribed medication.

"I had never used marijuana, never used anything stronger than the prescriptions," the 27-year-old mother of two said. "In my mind, prescriptions are legal. I thought I was doing nothing wrong, until I started writing the prescriptions."

Then she got arrested and was shocked back into reality. "It was 'oh my gosh, what was I thinking?' " she said. "Doctor shopping is illegal. I could have died, I was taking so many (pills)."

When Kristie came back to her church after her arrest, she said she was immediately released from her calling as a Primary teacher, shunned by neighbors and ostracized for her past choices.

But after hearing her story, some people confided to her they had the same problem, or their mother did. Or their sister.

"I just think (people) are scared (to talk about it)," she said. "They don't want people to judge them."

But Kristie talks about it. Openness is the first step to solving a problem, she said.

That's what she learned in classes through LDS Family Services. Now, instead of bottling up her emotional concerns and looking for help from a pill, she talks to people. And she asks for help if she needs it. That's the best advice she has to offer.

"(People) don't want to go through what I did," she said. "I'm 27, I have two kids and probation for two years. I have felonies. Ten of them. You don't want to be there."

Sam

Sam was 13 years old when he began snorting the crushed-up pain pills he got from friends, many of whom got the pills from raids on their parents' unlocked medicine cabinets. A few years later he had graduated to heroin.

"I had no idea what I was getting myself into," he wrote in a letter to his younger sister Suzy as he sat in an out-of-state jail. "I developed a pretty bad habit."

He racked up criminal charges, served jail time and slept in Dumpsters. It was a constant battle to stay drug-free.

"I'd like to say I'll stay clean forever," he wrote to Suzy. "But I can't. Drug addiction is hell on earth."

Sam's parents, Roger and Barbara, put Sam in programs and matched him up with counselors and treatment centers, hoping something would work.

"I'm sure our story isn't too different," Roger said. "You do what you can do for your child. The whole drug thing is so insidious, consuming. You lose focus about family, responsibilities, care for self. It carries you away. (Sam) strove hard at times to overcome, which he did before he died."

Sam died Aug. 12, 2008. He had been drinking and fell and hit his head, never regaining consciousness. He was 31.

He had finally pulled free of the drugs but compensated with alcohol, which brought on a slew of health problems.

"When he was into his addiction, it made him into a person he wasn't," Sam's older brother, Greg, said. "(His actions) could have made us all angry, but (they) didn't. I look back and am so glad … I wasn't there to judge him, just there to love him."

Medical viewpoints

Every day for three and a half years, someone would try to con Fairbanks out of prescription medication. The doctor would pull up their medical history in his Salt Lake clinic and ask them to explain. When their story and records clashed, he would ask them to try again.

Half of the clients would say, "I need the pills," and insist it was the truth, he said.

Another quarter would break down in tears and admit an addiction, while the remainder would concoct another elaborate story.

"Doctors are a real control point," Fairbanks said. "It's hard to get doctors to do things that are going to negatively impact their cash flow, but we need to take more time with people."

Rather than getting angry with a patient who tries to siphon medication for a blossoming addiction, doctors need to focus on the underlying problem, he said.

Fairbanks said some people may need guidance toward addiction treatment, or simply more information about their prescription.

"If (they've) got a narcotic problem, our job is to help people, not to say 'You're a bad person,' " he said.

As manager of Timpview Pharmacy at the Utah Valley Regional Medical Center, Chuck Stubbs takes time to watch for signs of addiction.

"If I see things that don't make sense, I'll slow it down," he said. "And if I can intervene, I will."

One protection Stubbs relies on is that insurance companies won't pay for refills before a certain time period has elapsed, thus preventing a client from filling a prescription, using all the pills that night and going back the next morning for more.

Because clients can get around that by paying the full amount in cash, Stubbs also monitors how people pay.

Printed, not hand-written prescriptions that use numbers and words to describe prescription amounts, also help cut down on fraud.

But if something looks strange, Stubbs can check the Controlled Substances Database managed by the Division of Occupational and Professional Licensing under the Utah Department of Commerce, which lists all of an individual's prior prescriptions.

Christie

As a dental assistant, no one questioned when Christie called in prescription after prescription.

Her battle with pain pills began when she went to the dentist to get a tooth pulled and walked out with a prescription for Lortab. She had just lost her husband to suicide and discovered that the pill took care of physical and emotional pain. And she liked it.

While in dental assisting school, she "doctor shopped" to get more Lortab, then when working full time, she would call in 30-pill Lortab prescriptions for herself every other day.

Although she called different pharmacies each time, in a few months they figured her out and she was arrested.

"It was actually a blessing," she said, because her arrest led to her detox treatment.

For 11 months, she was a drug-free, productive member of society. Her new husband, a "clean and sober, good man," is in the military and got home in January from serving a year overseas. Because of a back injury, he had Lortab in the house.

"He didn't take them," Christie said. "I did. I knew if I didn't, they'd (still) be there."

She slipped, violated her probation agreement and was sentenced to another 90 days in jail.

"I can't believe I screwed up," she said. "My husband and family are so much more important. I waited a long time for my husband to get home, I'm mad at myself for being here."

James

Unfortunately, James Warner has learned that not all doctors and pharmacists are concerned about keeping people addiction-free.

After getting hooked on his wife's Lortabs, Warner would frequently drive down to Las Vegas to visit a sleazy doctor. He and his friends would all walk out with 120 OxyContin 80s, ready to sell them for as much as $80 a pill. That doctor connection was how he supported his own $16,000 a month habit, he said.

He never graduated to heroin because he had seen friends die from overdoses, but he couldn't keep himself off the pills.

"I stopped selling OxyContin when I watched people give me their utility money, their rent money," said Warner, 30. "Everything they owned would go to support their habit."

Despite his previous successful efforts to quit pills, he's still worried about slipping and returning to the Utah County Jail — for the 29th time.

"(Pills) will control your life," he said.

Zachary

Zachary Winters, 22, began taking Demerol after a hand surgery for his four-wheeling accident.

A friend also gave him a Lortab when he was in pain, and he quickly discovered he liked the pills. He bought Lortab, OxyContin or Demerol off the street or got them from friends, who got them from "dirty doctors" in St. George.

"It was kind of a game," Winters said. "They would go see (the doctor), give them their co-pay and the doctor knew they just wanted the pain pills. He would just send them a prescription in the mail, then we'd have the pain pills we needed."

Winters never made the jump to heroin, but he did try cocaine a few times.

"When I very first started (pills), no, I didn't think they'd be at all addictive," Winters said. "But they are, they're just as bad as meth or cocaine. You have to go to rehab to come off them. And there are some messed-up doctors that will give them to you. I've had a few doctors, I'll go in for a sunburn or something and they'd kind of know what you want and they'll give them to you. Doctors are the ones that kept me in the game, I guess."

After years of struggling, he was ready to change. He's been in recovery for about two months. Now he wants to educate people about how quickly pills can become an addiction and how long it takes to get off them.

"I feel a lot better," Winters said of his life now. "I thought I felt good while I was getting high, but … I feel so much better being off of drugs and the pills. They're just as bad as cocaine or meth. When you're addicted, you're addicted."

E-mail: sisraelsen@desnews.com

How to fight back

Reducing prescription narcotic misuse and abuse must be a team effort, officials say. Because the problem is so widespread and far-reaching, it will take the support of numerous different agencies, especially parents, to really make a difference.

Here are two groups fighting to end prescription addictions:

SMART: Substance Misuse and Abuse Reduction Team, a part of the Utah County Division of Substance Abuse.

Composed of community leaders, county employees, social, health service and medical professionals, parents, law enforcement, business leaders and religious leaders.

Funded by a four-year, up to $1 million federal grant.

The group has conducted surveys and focus groups to determine areas in the county with the greatest concerns and the prevailing perceptions surrounding prescription drugs.

Future goals include increasing the group size, reaching out to the community through a grassroots education effort and implementing proven strategic plans to reduce prescription misuse and abuse.

For more information, contact Kye Nordfelt at 801-851-7181 or visit smartutahcounty.blogspot.com.

Utah Pharmaceutical Drug Crime Project

Composed of federal agents from the Drug Enforcement Administration, the FBI, Utah officials from the Departments of Human Services, Health, Commerce, the governor's office, local police and sheriff's offices, the U.S. Attorney's Office District of Utah, the Utah Attorney General's Office, medical professionals, treatment providers, pharmacists and educators.

Funded by the DEA and in-kind donations from the participating groups.

Main goals are to prosecute traffickers, decrease the availability of prescription drugs for abuse, increase the perception of risk associated with prescription drugs and encourage the public to be less tolerant of using pharmaceutical drugs nonmedically.

"It's that education, not enforcement, that will really make a difference, said Frank Smith, Drug Enforcement Administration assistant special agent in charge, Rocky Mountain Field Division. "Law enforcement gets involved after the fact. The damage is already done. If we're not involved, that's a very, very positive thing. We have a tough hill to climb, but I do think that the general population will recognize (prescription abuse) for what it is after awhile.

The group has already conducted training and will next be focusing on a statewide awareness campaign.

"I take my hat off to Utah for being on the front side of this," Smith said, who is also the assistant agent for Montana, Wyoming and Colorado. "Even though there's a huge issue here, I feel confident we'll get it under control."

For more information, visit: www.useonlyasdirected.org

Dos and don'ts of prescription drugs

Be completely honest with the physician about drug problems you or members of your family have experienced.

If you don't really need it, don't ask for it. Don't apply unnecessary pressure on your physician to prescribe unnecessarily.

Make sure you fully understand why you need the pills, what to expect while taking them, if there are warning signs of trouble, what is withdrawal and how you can minimize its impact.

Ask questions if instructions are confusing.

Properly dispose of the pills when you are finished. Don't let them accumulate or sit around.

Never use longer than necessary.

Follow the physician's instruction precisely — don't get creative with the drugs.

Guard these drugs carefully so they can't be used by other members of the family or unintended persons.

— Dr. Glen Hanson