Montana Attorney General Steve Bullock has invited prevention, treatment and law enforcement leaders to a drug abuse summit in Helena on Nov. 17. The focus isn't methamphetamine; it's not cocaine. It's a type of substance abuse that "kind of snuck up on us," Bullock said: prescription painkiller abuse.

The volume of prescription abuse cases is already high.

"Fifty percent of my DCI (Division of Criminal Investigation) cases are prescription drugs," Bullock told The Billings Gazette last week.

Half of Montana teens surveyed abuse painkillers and think they're safe, Bullock said, quoting results of a biennial youth survey conducted by the state health department. The prescription abuse question was just added to the survey this year, he said. A recent study by the federal Substance and Mental Health Services Administration says that 10 percent of Montana youth ages 12 to 17 are abusing prescription drugs.

"We need to educate kids," Bullock said. "We need to educate parents that the medicine cabinet can be dangerous."

Bullock emphasized that prescription painkillers also have appropriate medical uses.

"These are very important, legitimate drugs and there are individuals in our communities that depend on them." Bullock said, adding that the problem is "misuse, abuse and diversion" from their lawful, medical uses.

National concerns

Montana isn't the only place where prescription painkiller abuse is on the rise. Bullock and the Utah attorney general are co-chairing an ad hoc committee of the National Association of State Attorneys General that will look into the problem.

"Law enforcement alone can't solve it," Bullock said, reiterating the importance of prevention and treatment.

Mona Sumner, chief operations officer at Rimrock Foundation, has seen a three-year trend toward increasing prescription drug abuse. Many adults are using opiates, primarily prescription drugs, but some heroin, she said.

Among adults treated in all Rimrock Foundation programs last year (including private-pay clients and and government program clients), alcohol addiction accounted for 54 percent of cases. Among the 46 percent addicted to something other than alcohol, more than two-thirds were addicted to opiates - mostly prescription painkillers. Marijuana was the the drug of choice for 22 percent of "other drug" users, cocaine 4 percent, meth 4 percent and sedatives 2 percent.

Among Billings students whom Rimrock diagnosed over the past two years with a substance use disorder, 4 percent abused prescription drugs, 41 percent marijuana, 40 percent alcohol, less than 1 percent used cocaine and 11 percent had "polysubstance use" - no primary drug among the multiple substances used.

"Even the kids are doing more of the opioids," Sumner said. Teens buy pills on the street or get them from their parents' medicine cabinets. Sumner also has had many adult clients who abused narcotics by obtaining prescriptions from emergency department physicians.

320 deadly overdoses

"Parents really need to know how dangerous opiates are," Sumner said. Last year, more Montanans (320 people) died of opiate overdoses than died in traffic accidents, she noted.

Addiction treatment can be successful for pain patients who have become addicted to their medication as well as for people who started out abusing the painkillers, Sumner said. However, access to treatment is a problem, she said. Rimrock has waiting lists of two to three months for state-funded treatment beds. The working poor, who don't qualify for public assistance, and the underinsured have the greatest struggles in accessing treatment. Sumner also has noted a recent increase in denials of insurance coverage despite a new federal law requiring parity between medical coverage and addiction treatment coverage.

Comprehensive response

The community and state response to this latest addiction problem must be comprehensive.

As Sumner said, the best drug prevention strategy is raising healthy, resilient children.

In the schools, the work needs to start in kindergarten. The factor most likely to keep kids in school and off drugs is having a positive, bonded relationship with someone in that school who cares about the students, who notices what they are doing and notices when they are absent, she said.

In the criminal justice field, the Montana Justice Department using a federal grant to place three additional state drug investigators in Billings, Missoula and Butte. In addition, the Justice Department is hiring a prosecutor who will be available to assist county attorneys with criminal cases involving prescription drugs.

On the legislative front, Bullock is talking with state lawmakers about establishing a state prescription drug registry that would allow Montana doctors to check on what other painkiller prescriptions a patient had before writing a new prescription. Such a proposal failed in the 2009 session. Bullock said 38 states have programs that can serve as models for Montana to prevent abusers from getting multiple prescriptions from multiple doctors.

Montana must ensure careful, appropriate use of these powerful medications by educating prescribing professionals and the public. A prescription registry for medications that have commonly been abused makes sense, so long as the confidentiality of individual medical information is safeguarded. Montanans who are addicted to prescription painkillers need quick access to effective treatment. Long-term, the most important strategy for combatting prescription drug abuse is to prevent the abuse of all substances.

The key to prevention is raising young citizens who have the knowledge, support and skills to make healthy choices - like staying drug-free for life. Prescription drug abuse is the newest wave in substance abuse, but it won't be the last.