Bluefield Daily Telegraph, Bluefield, WV

March 20, 2013

War on drug addiction

Sen. Joe Manchin looks to re-introduce the ‘Safe Prescribing Act of 2013’

By CHARLES OWENS
Bluefield Daily Telegraph

WASHINGTON — When he met with children at a small Wyoming County middle school in late 2011, U.S. Sen. Joe Manchin was moved by the stories of families ruined by prescription drug addiction.

“They lost everything — they lost their home. They lost their families,” Manchin, D-W.Va., said of the stories that emerged from the Oceana Middle School meeting. “These were 11-and 12-year-old boys and girls begging for help. They were asking for help. They were basically saying we’ve lost our community and our town due to this epidemic of drug abuse. Yes it (the visit) impacted me.”

The troubling stories shared by the children was one of the reasons Manchin attempted in 2012 to pass legislation aimed at placing tighter restrictions on drugs containing hydrocodone. That bill made it through the Senate, but ran into opposition in the House where it died.

Manchin, and a bipartisan group of lawmakers, will formally re-introduce the “Safe Prescribing Act of 2013” today.

Manchin is co-sponsoring the resurrected measure with U.S. Sen. Mark Kirk, R-Ill., U.S. Rep. Vern Buchanan, R-Fla., and U.S. Rep. Edward Markey, D-Mass. The legislation seeks to re-classify hydrocodone combination products as schedule II controlled substances. Hydrocodone combination products are currently classified as schedule III drugs.

“This piece of legislation has the endorsement and support of bipartisan Democrats and Republicans,” Manchin said. “They know by putting hydrocodone as a schedule II it gives us a heck of a chance to start fighting this on a more level playing field.”

Manchin said the number of citizens in West Virginia to die from drug overdoses has increased by an alarming rate over the last two years.

“I think this is why we are getting the broad-based support,” Manchin said. “I will do everything I can on the federal level to fight this war on drugs.”

When the measure was first introduced in 2012, it ran into opposition from lawmakers in the U.S. House of Representatives who heard from pharmaceutical companies and drug distributors. Since that time, efforts have been made by Manchin and other lawmakers to reach out to those who opposed the bill a year ago, and to explain how the measure would not keep patients with legitimate medical needs from receiving hydrocodone-containing narcotics.

“Basically, you had a lot of pharmaceuticals to push back and drug distributors to push back,” Manchin said. “I went and talked to all of them. We never let up. We stayed right at it. I looked at all of them and said ‘is there not anyone sitting in the room, and not sitting on the panel, who has not been affected (by prescription drug abuse?).’”

The proposed legislation also would require the Government Accountability Office to conduct an oversight study on how the change impacts legitimate use of pain medication, particularly for patients in rural areas and nursing homes.

 Manchin said the current schedule III classification of hydrocodone perpetuates the misconception that the combination products are less potent and less habit-forming and therefore less dangerous than oxycodone combination products. “In truth, they have proven to be just as dangerous when not used properly,” Manchin said.

Manchin said many physicians, law enforcement groups, addiction specialists and others have expressed support for the movement to re-classify hydrocodone combination products to a schedule II.

Area law enforcement officials Tuesday said the proposed legislation would help.

“It will be a step in the right direction,” Sgt. Hose Centeno of the West Virginia State Police said. “I agree with Mr. Manchin. But the problem we have is that drugs like water will find a path of movement.”

Centeno, commander of a local southern West Virginia drug task force, said hydrocodone is currently preferred by drug dealers because of its current schedule III classification.

“Where a schedule II controlled substance is more expensive in street value, the hydrocodone is more affordable on the streets,” Centeno said. “Hydrocodone, although it is a very strong narcotic, has proven to be highly addictive, and preferred by most of the drug users. In time, they turn to these drug dealers, and when we arrest them they explain they also resort to hydrocodone because it is less expensive and more easier to be found.”

Centeno said the proposed law would also send a message to the local medical community.

“When I say I think this is a step in the right direction, it is because this will send a message to the responsible physicians,” Centeno said. “When a drug is not working for their patients, there is always different alternatives to treating pain that may not necessarily involve narcotics. But if it involves a narcotic they have to treat it with the seriousness that is required by the public. The recklessness of some physicians that we’ve been able to detect and prosecute tells us there may be some criminal element involving medicine and that has no legitimate purpose in society.”

But the prescription drug epidemic extends far beyond just the mountains of southern West Virginia. In neighboring Southwest Virginia, Tazewell and Russell counties are currently number one and two in the Commonwealth in per capita accidental overdose deaths. Tazewell County Commonwealth Attorney Dennis Lee believes the new legislation will help.

“We see as much abuse of hydrocodone, if not more, from the schedule II narcotics such as oxycodone,” Lee said. “Although the strength of the drug may be less than oxycodone, it is abused at a far greater rate than what we see as oxycodone. Changing the schedule will do a number of things. One, it will require doctors to see patients they prescribe hydrocodone to on a more frequent basis to monitor their usage and give them drug screens and follow ups. Number two, in Virginia that would increase the punishment for the distribution of the drug quite significantly because right now to sell a schedule III drug such as hydrocodone carries a maximum sentence of up to five years. This would take it up to 40 years if it becomes a schedule II. Also, from the standpoint of public health the amount of overdose deaths involving hydrocodone is year in and year out the top two or three causes. Usually it is methadone, hydrocodone and oxycodone. Basically that is the three drugs that our overdose deaths are attributed to. And there have been years where hydrocodone has been the number one cause of overdose deaths.”

With the current schedule III classification, Lee said patients using hydrocodone can go for months without having to see a doctor, and can receive multiple refills.

“With schedule II drugs you are required to have consultations with your doctor on a more regular basis,” Lee said. “They will be required to see the person and have consultation with them on a monthly basis.”

Lee said doctor shopping by those drug dealers who travel out of town to receive pain pills, and those who operate so-called “pill mills,” are still a huge problem for Southwest Virginia.

“I say the majority of the pills being sold on the streets in Southwest Virginia right now are coming from out-of-state doctors and pain clinics that are no more than pill mills,” Lee said. “I’m not saying all of the pain clinics are illegitimate, but there are a number (of problems).”

Lee said he hopes Manchin’s bill passes the U.S. Senate for the benefit of Southwest Virginia.

Manchin said the Drug Enforcement Agency classifies drugs based on their abuse potential and addictive nature.

“The high potential for addiction and abuse posed by hydrocodone combinations indicates that they are currently misclassified as schedule III products,” Manchin said. “This misclassification sends the wrong message to patients and providers that these painkillers are less dangerous or less powerful than their schedule II counterparts.”

The legislation will not restrict access for patients with legitimate medical needs, according to Manchin. “It appropriately regulates these powerful painkillers to reflect their high potential for abuse while accommodating patients with legitimate medical needs.”

— Contact Charles Owens at cowens@bdtonline.com