Overdoses of addictive prescription painkillers have increased sevenfold in New York City, says a recent study by Columbia University.

The prescription abuse epidemic is spreading throughout the state. People of all ages, income levels and races are getting addicted.

The New York Alliance Against Insurance Fraud this week called for a multifaceted approach to tackle the problem. The NYAAIF works to increase public awareness about insurance fraud and its consequences.

Corrupt doctors prescribe painkillers for addicted patients, fraudulently billing insurance companies for the unneeded medicine and doctor visits. Demand for painkillers has boosted the drugs’ street price, attracting organized criminals and growing the black market. Healthy patients become addicted to painkillers by careless doctors who overprescribe, or by people taking a friend’s pills without a prescription, thinking that medicine won’t harm them. Prescription abuse is killing people — sometimes teenagers — with overdoses.

New Yorkers aren’t waiting.

Last January, legislation enacted created a statewide database to track prescriptions and prevent doctor-shopping.

The surge in addictions has led to increased pharmacy robberies, thefts, shoplifting and healthcare fraud schemes. So NYPD is placing GPS chips in pill bottles to track stolen inventories. Physicians also must be educated to recognize drug dependency. Consumers need better information to recognize the signs of drug abuse in the home, workplace and schools.

But the road is long and reducing prescription abuse will take many weapons. This problem can’t wait, prescription overdoses are taking lives.

About the author: Jennifer Tchinnosian is communications specialist for the Coalition Against Insurance Fraud.

Last week I participated in an expert panel meeting at the Centers for Disease Control & Prevention on the issue of prescription drug abuse and its impact on Medicaid programs.

The new director of the CDC has deemed drug diversion one of six public-health issues that CDC has embraced for study and action in 2012. The meeting included some very smart people from CDC, mostly medical experts, plus representatives from a handful of state Medicaid programs and a few private payers.

Drug diversion is a huge problem for Medicaid. A third to a half of all prescription drug deaths in the U.S. are Medicaid recipients. Eighty percent of babies born addicted to prescription drugs are born to mothers on Medicaid. The prescription rate among patients on Medicaid is more than twice that of the private sector. No doubt many of those pills end up on the street.

One of the most effective tools Medicaid programs have to curb diversion is requiring patients to use only one physician and one pharmacist for their prescriptions. Such “lock-in” requirements help stem doctor shopping.

But there are two problems with such programs. First, they don’t exist in many states because doctors and pharmacists sometimes don’t like them and their lobbies help to either kill lock-in legislation or weakened the bills.

Second, lock-in programs don’t catch Medicaid patients who intentionally avoid detection by paying for their illicit prescriptions in cash. Prescription monitoring programs (PMPs) — in which doctors and pharmacists log prescription activity into a state database — can catch such transactions.

But surprisingly, all but one state Medicaid program are denied access to PMP data mostly because of privacy concerns. That’s a huge missed opportunity to catch drug abusers early, and save taxpayer dollars and perhaps a few lives.

PMPs, health regulators and state legislators need to consider giving Medicaid programs access to drug data so they can become full partners in combating fraud and abuse involving prescription drugs.

About the author: Dennis Jay is executive director for the Coalition Against Insurance Fraud.

Inside a glass case lies a corpse covered by white fabric. Across the room, a glassy brown medicine bottle labeled ‘Heroin” offers to cure cough, with one or two tablets every two or three hours. The Drug Enforcement Agency’s museum’s exhibit, Good Medicine Bad Behavior describes the national epidemic of prescription addiction and will be open through 2012 in our Nation’s Capital.

A few miles away, Karen Kelly from the Kentucky-based Operation UNITE talks at a meeting on Capitol Hill about beating the medicine cabinet epidemic. Kentucky has been fighting drug diversion for the past 10 years, and Kelly has been instrumental in organizing the addiction-prevention efforts. She has seen addiction devastate entire neighborhoods, leaving 50 percent of children in some districts to grow up without parents. As the epidemic  continues spreading across the nation, we asked Kelly a few questions.

Kentucky may be the precursor to the rest of the nation in terms of prescription abuse. You‘ve been fighting it for a decade. How did this program get started?

Operation UNITE was launched in April 2003 by U.S. Congressman Hal Rogers, who called people together to brainstorm a way to fight the prescription abuse. He called judges, social workers, parents who’d lost kids, police officers and educators, and they came up with the UNITE plan. We got a call from a grandmother raising her grandkids, and she asked if we’d come visit, so we did. She had three grandkids and she couldn’t let them play in the yard because of the drug dealer next door would offer them pills and needles, often throwing them into the yard.We spent most of 2003 just getting access to funding and hiring people, then we kicked off in 2004. We started strong in newspapers with a law-enforcement front. We started organizing one of the biggest drug roundups, and arrested 200 people in one day. We didn’t want to jam up the court system, so we began creating treatment programs to give addicts the choice of rehab. Now we have at least one drug court in every single county. So if people are arrested, they have the option of drug court, where they’re drug tested regularly, they meet with a judge, and with a treatment counselor for 18 to 20 months. From there we started our hotline, town hall meetings, building a community of volunteers.

What advice would you give to other states thinking of implementing similar programs?

First, go out of your way to educate the medical profession. Most prescribers want to do the right thing but they’re not educated about addiction. We have some volunteers on the medical advisory counsel who say, “Every 10 years I get HIV training, and I haven’t seen one HIV patient yet, but today 80 addicts walked through my door and I can’t tell who’s who.”

Second, even if you can’t organize law enforcement and education, convene a meeting and to see where you can forge key alliances, to see how these different groups can work together. For example, the largest insurer in our state offers volunteers for our drug-free summer camp, that’s a tremendous resource, they also donated lock boxes for medication.

Third, get law enforcement and treatment to start working together with education; it takes all three working together to tackle this. Law enforcement runs into a lot of addicts who need help, and they refer them for treatment. Education means using creative ways to reach the public. Ask the dry cleaners to put short anti-fraud messages on coat hangers, go to civic clubs and talk to people about locking up drugs, and know the signs that your kids are starting to struggle. We go region by region targeting the biggest employers in each county, and offering free anti-fraud training lunches. We say, “Have your employees bring lunch we can spend an hour teaching them how to recognize addiction in their kids or colleagues.” Volunteers teach that class; they want to do it because they’ve been affected by the problem somehow. You have to use all your resources.

If you could go back and change something, what would you change, or warn others against?

I wish we’d gotten our healthcare providers onboard before we made a show of law enforcement, because after that happened, the doctors didn’t trust us to talk. A lot of doctors didn’t feel a need to get involved with the issue until a doctor was killed by an addicted patient.

The prescription-drug epidemic  is escalating. What would you attribute this to?

Ease of access, and pill mills. Kentucky recently passed legislation to stop pill mills. Doctors will be educated in Kentucky. New clinics will have to be doctor-owned. The problem is not socioeconomic at all; it’s affecting every family in our region no matter what their background. Prescription abuse also is a different type of investigation,― anybody could be a drug dealer, and we have many that are wearing white coats.

You got corporate funding for some of the programs, like the summer camp sponsored by Toyota. How would you advise that other states to get funding like this?

I would say don’t give up. A lot of employers have been impacted by the problem, so our state sees it as a really good benefit for its dollars because  it  costs more money to ignore the problem. Also leave no stone unturned. Even insurers are recognizing how big a deal this is, so they’ve decided to help us fund our initiatives. Even if its not their mission, it still impacts that family or that company or that organization. And there are government dollars; we had a CDC grant to implement wellness programs. Most states get CDC funds, but don’t use them to stop prescription abuse.

What can be done about the problem nationwide?

As Florida has gotten stricter on its pill mills, people are turning to Georgia and Nashville for meds. We need a pill-mill crackdown act on the federal level, because we know that what Florida did has had an impact. Kentucky and Ohio have passed laws, but how long is it going to take for every state to get onboard? There really aren’t any good reasons to have cash-only pain clinics, with bouncers, for example. We need to  educate doctors. Everybody also has a responsibility to know what they are being prescribed, and parents have a responsibility for their children, to know where they are and who they’re with. A lot of addicted teens call us and say that if they drank alcohol, their parents could smell it. So our parents have got to be educated. We have parent trainings where kids tell the parents, “This is how I duped my parents.” Many times the parents are stunned. Then we did focus groups to find out what parents wanted to learn, and made it part of the curriculum. We warn caretakers not to wait until they have evidence or proof of the problem to address it, because by that time, these kids are so far gone that we can’t get them back.

75 Americans will die today from a prescription drug overdose. In fact, prescription drug overdose is rated as the second most frequent cause of accidental death. It’s not just a problem for adults — every hour a baby is born in the U.S. with symptoms of withdrawal from opiates — meaning 13,500 babies a year.

How did we get here?

Nowadays, almost all prescription drugs that are misused come from doctors’ prescriptions, and end up in the wrong hands through theft or sale. Insurance companies often pay for prescriptions.

But painkillers have existed long before prescriptions or insurance companies have. In 5000 B.C., Sumerian tablets named opium poppies HulGil, or “joy plant”. Egyptian Papyrus from 1550 B.C, archives instructions on using grains of poppy plant as medicine.

With pain relief came the drug’s euphoric feelings, and an onset of steady addiction. Non-addictive painkillers became the holy grail of chemists, who set about toying with molecular structures of opioids to get the perfect combination of maximum benefit with minimum risk. In time, they developed several close calls.

Codeine (1830), heroin (1874), and oxycodone (1916) were all advertised immediately after their discoveries as the perfect painkillers, noted for their ‘non-addictive’ properties, and ability to replace their antecedents in the painkiller world.

Morphine, developed in the early 1800s, remains the gold standard for treating severe pain, and is given to cancer patients to this day. The first civil war (1861 – 1865) in America largely depended on the availability of morphine, with one general quoted saying “You can’t fight wars without morphine.”

As the problem of addiction became a growing concern, the Bureau of Social Hygiene created a Committee on Drug Addiction. In 1929, the committee decided upon a research plan that involved three components — chemical, pharmacological, and clinical. After the first decade of research, 500 compounds were ready for testing in animals. Three were tested on humans for pain relief and dependence liability.

Seeking to help existing addicts and understand the root of the problem, the narcotic farm (U.S. Public Health Service Hospital) in Lexington, Ky. was opened in 1935. Prisons that had been flooded with addicts now sent drug-addicted criminals to Lexington for treatment. The Addiction Research Center (ARC) inside the farm was open until 1970 and is today known for accomplishing many of the landmark studies in the field of drug abuse.

Hundreds of prisoners were recruited to volunteer in the ARC as guinea pigs for groundbreaking drug experiments. Scientists would administer heroin, morphine, and other drugs, and take note of what effects it had on the addict. In other experiments, they abruptly stopped dispensing heroin to cause withdrawal symptoms, and then introduce dan experimental drug to see if it would effectively relieve withdrawal symptoms.

Then, Analgesic Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) was established as a “public-private partnership with the United States Food and Drug Administration (FDA) to identify, prioritize, sponsor, coordinate, and promote innovative activities — with a special interest in optimizing clinical trials — that will expedite the discovery and development of improved analgesic treatments for the benefit of the public health.”

In the 1940s, the opiate program at the National Institutes of Health (NIH) began, and has resulted in more than 750 research papers and patents. Some 59 drugs identified as painkillers were introduced from 1960 to 2009, and remain in use today. From 1960 to 2009, pain-related publications grew exponentially: The number of articles almost tripled during the first and second decades, and then doubled during each of the next three decades until 2009. Intensive research has produced thousands of publications, but none of these efforts has yielded new painkillers that can significantly change the scope of the opioid addiction problem.

Today, various laboratories are synthesizing different molecules in hope of finding the perfect cure. Though progress has been made, the answer has not yet been found. It will take a national database where researchers can share their results, more funding, and certainly more time before we may ever reach painkillers’ holy grail.

About the author: Jennifer Tchinnosian is communications specialist for the Coalition Against Insurance Fraud.

More than 600 people gathered in Orlando last week for an inaugural summit on prescription drug abuse. There were high-level government officials (including the surgeon general, congressmen and administration officials). There also were lots of medical types with impressive credentials, a bevy of vendors selling anti-drug wares, and a few stoic parents who had lost sons and daughters to drug overdoses.

Only a couple of insurers attended, even though the general consensus of attendees was that much of the illicit use of painkillers is insurer-paid.

What was evident from the week-long conference is that prescription drug abuse and fraud in the U.S. is a huge, complex problem with many facets. And the problem likely is still growing. It touches the urban core, suburban bedroom communities and rural America. Drug diversion is an equal opportunity scam perpetrated by druggies, honor society high schoolers, soccer moms, celebrities, physicians, pharmacists, and increasingly, organized criminal enterprises. The power of addiction plus high profit makes this incarnation of drug abuse perhaps the most sweeping ever.

I was asked to speak about the high cost of drug diversion — specifically painkillers — on employers and insurers. There’s a strong need for more anti-fraud measures, including prescription monitoring programs (PMPs) in states and general awareness all around, I noted. Organizations attending the conference also must get more involved in the political process to enact stronger anti-drug diversion legislation.

Then I threw out perhaps a not-novel and even naive idea: The government, medical community and insurance industry should launch a Manhattan Project to develop an effective non-addictive painkiller. It would take the profit motive out of drug diversion — yet still help those who are in pain obtain relief. Plus it might save a lot of lives.

I asked the audience, which numbered in the hundreds, if anyone was working on such an effort. One person raised her hand. Others shrugged. Perhaps it’s not such a naive idea after all.

The recent death of singer Whitney Houston is another unwelcome reminder that America is a vast emporium of addictive prescription drugs.

Several news reports say prescription sedatives may have been involved. Americans soon may be deluged by more well-meaning quotes from experts that Houston’s death is a “wakeup call” for us to turn the corner on rampant dispensing addictive prescription narcotics.

We went through similar news cycles with the drug-impelled deaths of Michael Jackson, Heath Ledger, Anna Nicole Smith, John Belushi and a parade other stars who died from toxic drug cocktails.

We risk becoming desensitized to celebrity deaths instead of alarmed by them. In the process, we risk becoming desensitized to prescription-drug abuse as the addictive epidemic that it is. And so much of this epidemic is financed by insurance money that pays for the illicit prescriptions.

Solving our problems by gulping painkillers and sedatives isn’t new, but the levels to which we’re taking quick fixes should be alarming. The Centers for Disease Control tells us this much:

• Opiod painkillers cause more overdose deaths in the U.S. than heroin and cocaine combined.
• By 2010, enough addictive painkillers were sold to medicate every American adult with a typical 5 mg dose of hydrocodone every four hours for one month.
• Three percent of physicians accounted for 62 percent of opioid painkillers in one study.
• Drug deaths outnumber traffic fatalities for the first time in 30 years, fueled by a rise in abuse of addictive prescription drugs, notes a Los Angeles Times analysis of CDC data.

Shady doctors and pharmacies are more than glad to provide the fixes, for a fee. The profits for trafficking in prescription painkillers are so large that gangs are creating sham pharmacies whose sole purpose is to process insurer-paid prescriptions for addicts and street dealers.

Whitney Houston’s death is a tragedy, but America’s real drug problem lies with the average person who has the same easy access to painkillers, sedatives and other addictive drugs.

We’re learning from the never-ending cocaine and marijuana wars that we can keep wiping out cartels in South and Central America, but more cartels will take their place as long as stateside demand makes the immense profits worth the perceived risk.

This says something about our domestic war with prescription-drug trafficking. Yes, we must work to choke off the suppliers — sleazy pain docs, dishonest pharmacies and the like. But others will take their place.

So we must also attack the epidemic at the source: Users. This  means consumer addicts, drug-buying pain patients, school kids and others. This means massively stepped-up education campaigns about the risks of overuse and consequences that can follow.

Education is a shared responsibility, especially among those with the resources to pull it off. This means the insurance and medical establishments, the business community and other stakeholders.

So when it comes to narcotic prescription drugs, maybe consumers need large doses after all: Doses of awareness and attitude change.

The author is director of communications for the Coalition Against Insurance Fraud.