Women throughout the nation are dying at an unprecedented rate from prescription drug overdoses.
So many are dying that it's been called a public health epidemic.
In fact, since 2007, more women have died annually from drug overdoses than from auto accidents, according to the Atlanta-based Centers for Disease Control and Prevention.
Although more men die from drug overdoses than women, the percentage increase in deaths since 1999 is greater among women, according to the CDC.
In 2010, the deaths of at least 15,323 women were attributed to a drug overdose, a rate of 9.8 per 100,000 population. Deaths from opioid pain relievers increased fivefold between 1999 and 2010 for women. For men, the rate increased by 3.6 times.
In 2010, some 943,365 women nationally visited an emergency room for drug misuse or abuse. The highest number of visits were for cocaine or heroin, benzodiazepines, and opioid pain relievers.
Closer to home, between January 2008 and August 2013, some 352 Montana women died from a drug overdose as defined by the CDC, the nation's public health agency. This includes prescription drugs, heroin, and cocaine. It is not possible to determine what proportion of the deaths were caused by abuse, according to the Montana Department of Public Health and Human Services.
Women are more likely than men to be prescribed painkillers, use them chronically, and acquire them in higher doses. In part, that is because women are more susceptible to chronic pain and more often use the health care system, suggested Dr. James Bentler, medical director for St. Vincent Healthcare’s Emergency Department. They will seek pain relievers for migraines, chronic pelvic pain, endometriosis, cysts, and fibromyalgia, a condition of widespread pain throughout the body.
Women are also more likely to be prescribed drugs to treat depression and anxiety, which can interfere with other medications, sometimes leading to death.
“Women are the primary health care decision-makers,” said Lenette Kosovich, CEO of Rimrock Foundation. “Always have been, always will be, whether for themselves, their husband or their family.”
Because women are so familiar with navigating the health care system, they find it easier to manipulate and abuse the system.
Women typically have smaller body masses than men, which makes them more susceptible to overdose. They are also more likely to “doctor shop” to acquire pain pills from multiple physicians, CDC officials say.
While many of the initial complaints from women about pain are legitimate and the prescription appropriate, many pain relievers are habit-forming and can lead to addiction, Bentler said. He sits on a task force of physicians and health care professionals in Billings who saw a need to address prescription drug abuse. The task force also includes representatives from RiverStone Health, Rimrock Foundation and Billings Clinic.
Many of the women who become addicted would never dream of turning to illegal drugs or alcohol, but there is no taboo associated with a prescription drug, Bentler said.
“It’s easier to hide, easier to legitimize,” said Coralee Goni, director of residential services at Rimrock Foundation. “You can put it in your Tylenol case.”
There is no single profile of women who abuse prescription drugs. They run from affluent doctors to teachers to street people.
In Billings, a School District 2 special-education teacher was fired in 2012 after being arrested a second time for prescription drug-related crimes.
Following her first arrest in 2007, the district allowed her to stay on the condition she get counseling and addiction treatment. In her most recent arrest, she was charged with four counts of fraudulently obtaining dangerous drugs through 36 prescriptions from 19 doctors.
In November, the license of a registered nurse in Billings was suspended indefinitely pending further review after she admitted she was a drug addict. Her addiction was so powerful that she would alter her urine samples during random drug testing and would leave during her shift to take prescription drugs and then return, according to state disciplinary documents. An administrator also reported that she had narcotic prescriptions filled by seven different providers at six different pharmacies.
To help curb “doctor shopping,” the 2011 Legislature passed a bill creating a statewide prescription drug registry. Montana is one of 49 states that has a drug registry.
The registry is used to monitor certain addictive prescription drugs such as opiates and narcotics, and requires pharmacies to report weekly on the prescriptions they fill for controlled substances, according to Donna Peterson, program manager for the Montana Prescription Drug Registry.
With just a few clicks, a pharmacist can check whether a patient is filling prescriptions elsewhere in the region, Peterson said.
As of this week, the registry contains more than 4.1 million prescriptions for controlled substances, based on reporting from pharmacies that represent more than 567,000 patients, according to Peterson.
The online search feature for the registry was launched in November 2012 and has been operational for more than a year. Eventually it will maintain a full three years of a patient’s prescription history.
More than 90,000 searches have been conducted since the registry launched last year, Peterson said. Between Nov. 26 and Dec. 23 of this year, health care providers conducted almost 8,000 patient history searches.
Peterson said many prescribers and pharmacists have told her that the information revealed in the registry is “invaluable.”
“Some providers thought they knew a particular patient very well, but they were surprised at the quantity of controlled substances the (registry) showed the patient was receiving from other providers,” Peterson said.
She said she also has spoken with several prescribers who identified potential prescription forgeries by using the “Prescribing History” feature of the registry, which shows all prescriptions dispensed under the prescriber’s own Drug Enforcement Administration number.
Montana has the 21st-highest drug overdose mortality rate in the United States, with 12.9 per 100,000 people fatally overdosing, according to a recent Trust for America’s Health report.
The number of drug overdose deaths, a majority of which are from prescription drugs, has more than doubled since 1999 when the rate was 4.6 per 100,000.
West Virginia has the highest number of drug overdose deaths; the study also listed New Mexico, Kentucky, Nevada and Oklahoma in the top five in terms of drug fatalities. The study found that the Dakotas have the lowest incidence of drug overdose fatalities.
The Montana Board of Pharmacy requires pharmacies doing business in the state to report to the registry. Some 763 pharmacies, including mail-order pharmacies serving Montana customers, participate by reporting all painkiller prescriptions to the confidential database.
As of October, authorized pharmacists, physicians and other prescribers had conducted 74,000 patient history searches.
“It’s scary business, so we need to be vigilant about giving them out,” Bentler said. “There’s plenty of blame to go around as to how we got to where we are. It’s only fair that since we’re the ones prescribing them that we accept some of that responsibility and try to become better at it. We just can’t blame it on the patients, though they have culpability, too.”
The prescription drug registry is not a cure-all. Of people ages 12 or older who in 2011-2012 used pain relievers for nonmedical reasons, 54 percent said they got them free from a friend or relative, according to the Substance Abuse and Mental Health Services Administration. About 15 percent bought or stole them from a friend. Other than physicians, the balance got pain relievers from drug dealers, strangers, the Internet and other sources.
Between Jan. 1 and Dec. 16, Billings police investigated 31 incidents of people fraudulently obtaining dangerous drugs, according to Lt. Kevin Iffland. Police say the suspects doctor shopped, forged prescriptions, falsified prescriptions and more.
The increase could be due in part of the Billings Police Department teaming with the Drug Enforcement Administration and having an officer assigned to work strictly with prescription drug cases, Iffland said. It is also due to the Prescription Drug Registry.
During the same period, Billings police received 170 cases of stolen prescription medications compared with 205 cases last year.
Stopping the epidemic in both women and men is everyone’s responsibility, Bentler said. Doctors need to be careful in how they prescribe medications and patients need to be judicious in how they take them.
“You need to do the right things for people and help them, but there’s a slippery slope you can go down by using these powerful medicines,” Bentler said. “It’s fascinating trying to figure out the right approach. How do you do no harm?”