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CASPER, Wyo. — Cody Ruiz struggles to feel sympathy for the man he found lying at the bottom of a cliff. The man, who said he lost his footing and fell down White Mountain, was disturbingly pristine.

His reported pathway down the slope seemed unscathed, as well; dirt and vegetation from top to bottom remained intact.

And despite his claim of tumbling “head over heels,” down the embankment, the man’s baseball cap managed to stay in place.

“At first, he was saying he couldn’t move his body, couldn’t move his legs,” Ruiz, the first responder as a deputy sheriff, recalled of the September 2010 incident. “Then he started tapping his toe, like there was a song in his head. It just didn’t seem like he was in that much pain.”

Ruiz said the man specifically asked for a shot of morphine upon being lifted and advised rescuers that he was allergic to nonopiate medications.

When he said his pain failed to subside with four milligrams, he was given six more. Fifteen minutes later, he was administered four milligrams of Zofran, then two 50-milligram doses of Fentanyl.

Reports soon came in of a similar rescue mission that was performed a year earlier with a victim that turned out to be the same man, bolstering the officer’s concerns. Now a member of the Division of Criminal Investigations, Ruiz read other agents’ reviews and the situation came full circle.

The man, or at least his name, was already notorious around the medical community, particularly to those manning the state’s prescription drug monitoring program. In one year, the “frequent flier,” as reports labeled him, had managed to obtain 2,913 opiate pain medications through prescriptions — an average of nearly 250 per month.

The story is one extreme example of an increasing trend of prescription drug fraud in Wyoming, say officials at DCI. Deputy Director Kebin Haller said an increasing number of the department’s arrests and investigations are related to opiate painkillers, in particular.

On par with national statistics, a sharp, steady increase in deaths related to prescription drug overdoses were reported in Wyoming in recent years.

Between 2004 and 2005, five people in Wyoming died because of an accidental overdose of prescription medications, according to the state’s vital statistics. That number jumped to 28 between 2006 and 2007; 45 between 2008 and 2009; and 69 between 2010 and 2011.

Meanwhile, after a slight increase in the past seven years, 2010 to 2011 held the smallest number of deaths related to overdoses of illicit drugs since 2004 to 2005, dropping from eight to three.

In the past year, physicians at Wyoming Medical Center treated 112 cases of poisoning related to opiate medications, up from 95 the previous year and 82 the year before that.

Second to meth?

A few years ago, methamphetamine prices began to sharply increase in Wyoming, said Haller. The inflation was due in part to heightened controls on pseudoephedrine, a key ingredient in the drug. Mexico, a former production hotbed, placed restrictions on imports of the cold medicine in 2005 to curb cartel activity, then in 2009 cut off imports altogether.

U.S. state controls coincided with Mexico’s sudden deficiency. A 2005 Wyoming statute restricted the sales and distribution of the medicine, effectively severing the resources needed for meth labs.

Distribution

A sampling of DCI investigations reveals inconsistent tactics and and an array of demographics related to prescription drug fraud.

In several of the prescription drug fraud investigations provided by DCI, low- to mid-level drug dealers simply added opiates to their portfolio of narcotics. Many prescription drug busts were tacked onto investigations involving meth or marijuana.

Evolving methods

Since 2004, Wyoming has participated in a prescription drug monitoring program, designed to flag those who exhibit behavior related to abuse or diversion.

Wyoming Online Prescription Database Coordinator David Wills said he is notified after “doctor shoppers” visit a threshold number of physicians and pharmacists within a month. He then contacts the providers, pharmacists and, in severe cases, local law enforcement and warns them of potential fraud. Practitioners can also submit a request for a profile on a particular patient.

Doctor shopping behavior has plunged by 72 percent in recent years, he said, from 152 shoppers in the fourth quarter of 2008 to 42 in the first quarter of 2012.

Wills said he’s particularly pleased by doctors’ and pharmacists’ participation in the program. The number of requested patient profiles went from 1,500 a quarter at the beginning of the program to nearly 5,000 a quarter.

“That’s why doctor shopping is falling,” he said. “The credit has to go to the practitioners and pharmacists.” Wills said the program will soon also be available online, making profiles available for viewing at any hour of the day.

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