Huntington, West Virginia Â- It's 4am and cars snake around three blocks. People stand outside their vehicles chatting. If it wasn't for the hour you would think they were waiting to get into a sports stadium, instead it's a methadone clinic, they're getting their fix before getting the kids ready for school and going to work.
Seventy percent of those at the Huntington Treatment Center, a private methadone clinic, are employed, and all are white. They pay $12 a day for a hit of methadone or suboxone, supposedly to reduce addiction to opioid painkillers. For the man in the new SUV next to me, it's a way to get an added high. He smoothes a piece of paper before sprinkling a crushed pill onto it, probably OxyContin, the opioid painkiller which is the drug of choice for many, and inhaling.
At $80 for the average 80mg OxyContin, you need to have a good job and the medical insurance with it or receive Medicaid or Medicare (the U.S.'s crumbling national health insurers).
Three miles away, Professor Ahmet Ozturk, a clinical professor at the Marshall University School of Medicine and head of Huntington Hospital Pain Clinic agrees with the assessment of a nurse at the Treatment Center that methadone or suboxone is little more than "a Band-Aid."
Edith Urner, supervisor of the Chemical Dependency Recovery Center at Huntington Memorial Hospital across the country in wealthy Pasadena, California is cutting: "It's easier to go through four to seven days of withdrawal from heroin than the absolute hell of three weeks to get off methadone or suboxone so-called treatment. They are potent and long acting." But Urner says, not enough doctors know enough about helping addicts. "It's not dangerous to stop opioids abruptly, but it is dangerous to try the same with benzodiazepines (e.g. Valium) or barbiturates."
And while there are many outpatient clinics, an inpatient facility like the CDRC in Pasadena costs $1,000 a day. Ten days is needed to address opioid addiction. The most attention is given to the most vital process Â- teaching addicts non-drug alternatives.
The two hospitals, one in a wealthy area, and the other in an economically depressed zone have nothing in common but for the challenge of dealing with what the White House in April called "an epidemic" of prescription drug abuse.
Already 27,000 Americans are dying every year because of prescription drug overdoses Â- a far higher toll than ever caused by illegal drugs. Almost as many Americans die in a single month of prescription drug overdoses than the toll in the terrorist attack of September 11, 2001. In Florida where pill-mills are common, there are seven overdose deaths a day and around 20 percent of babies are born addicted.
There is little doubt that the primary dealers are doctors, yet when they are arrested, usually after multiple fatal overdoses among patients, their sentences are low, perhaps a $15 000 fine or a suspended sentence.
Most doctors overprescribe because of ignorance. Dr David Kloth of the American Society of Interventional Pain Physicians blames a lack of training in pain management at medical schools. "Most spinal surgeons have no formal training in pain management, nor do radiologists. Of those who are certified to do intervention pain management, there are maybe only 7 000 to 8 000 across the USA.
"There are a lot of doctors prescribing medications that do not have the proper expertise; these are highly addictive substances that interact with other medications."
Prescription drug addiction in the USA has all but killed the cocaine trade and has ousted marijuana as the gateway drug for teens. The National Survey on Drug Use and Health reported in 2010, "a marked decrease in the use of some illegal drugs like cocaine." The quantity of cocaine seized in El Salvador and destined for the United States plummeted from 4,074 kg in 2007 to 394 kg in 2009, according to the International Narcotics Control Board.
The INCB observed that in 2009, 4.8 million Americans used cocaine compared to 12.4 million Americans who abused prescription pain relievers. The number of emergency room visits involving legal drugs more than doubled from 2004 to 2008, mainly as a result of the abuse of hydrocodone, methadone and oxycodone.
And too, the world prescription drug market almost doubled in value in a decade to $856 billion in 2010. In the United States prescription drugs netted a cool $307.4 billion for pharmaceutical companies in 2010. By far the biggest seller is hydrocodone Â- or Vicodin, the drug loved by television character, Dr. House. It is a Schedule Three painkiller and cough syrup, which netted $131.2 million in legal sales in 2010.
Hillbilly Heroin, as addiction to opioid painkillers is referred to outside the U.S.A. is filtering into other countries too, most notably Canada, the United Kingdom and Australia. Prof Charles Parry, director of the Alcohol & Drug Abuse Research Unit at the South African Medical Research Council says prescription drug abuse in South Africa is "absolutely" a problem. "And one that is somewhat hidden. The prime prescription drugs of abuse are benzodiazepines (e.g. Valium, Ativan, Alzam), analgesics (containing codeine Â- though many can be bought without prescription) and stimulant drugs such as Ritalin (methylphenidate) used to treat ADHD. Among physicians, abuse of pethidine (an analgesic) has been an issue.
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