Sherri Carwithin was lying on the hardwood floor of her south Oklahoma City home when police found her body, clad in pajama bottoms and a T-shirt. Perched on her chest was her small dog, Patches, who growled at the arriving officers.
The 51-year-old woman, who had a history of chronic back pain and prescription drug abuse, was last seen alive four days earlier, when she asked a neighbor to give her a ride to the pharmacy.
"She'd been doing prescription drugs for a long time," said her stepbrother, Virgil Hoye. "She'd take a pill to wake up and take a pill to go to sleep. It was a constant thing. She was never in her right mind."
Oklahoma's drug scourge is shifting from the street corner to the medicine cabinet.
Drug overdoses now kill more Oklahomans than motor vehicle accidents, an average of two per day.
Four in five of the victims overdose on widely prescribed medications found in tens of thousands of Oklahoma households.
The grim statistics help explain why Oklahoma was ranked the No. 1 state in the nation in prescription painkiller abuse last year. They underscore a new reality for law-enforcement authorities, health-care professionals and public policy makers.
The casualties of drug abuse are not just hard-core addicts who buy bootleg meth, crack and heroin from street dealers.
They're middle-aged and middle-class Oklahomans who start taking pain pills for bad backs or other injuries, never dreaming they could wind up tumbling down the slippery slope of addiction, or worse yet, dying from an overdose.
They're suburban kids passing around pills they find in their parents' medicine cabinets. They're veterans returning from Iraq and Afghanistan who turn to narcotics to tame the demons of post-traumatic stress.
They're people like Austin Box, the Sooners linebacker whose promising football career was cut short by a fatal prescription drug overdose in May 2011.
"Meth - it's a problem, sure," said Hal Vorse, an addiction treatment physician in Oklahoma City. "But the fact is, you've got five times as many people dying from prescription drugs as are dying from methamphetamine."
Deadly medicine
State autopsy statistics show that the most prolific killers are the prescription painkillers hydrocodone and oxycodone, often in combination with the anti-anxiety drug alprazolam.
In 2010, hydrocodone was a factor in 153 overdose deaths in Oklahoma, followed by oxycodone at 144 deaths, according to the Bureau of Narcotics and Dangerous Drugs Control.
Both are opioid painkillers, chemical cousins of heroin and morphine. Pain meds containing hydrocodone are marketed under the brand names Lortab and Vicodin; oxycodone is the main ingredient in Percoset and OxyContin.
Alprazolam, also marketed as Xanax, was a contributor to 139 overdose deaths.
Other prescription painkillers accounted for smaller but still significant numbers of casualties. Methadone, used to help wean addicts off other narcotics, as well as to treat chronic pain, contributed to 99 overdoses. Morphine contributed to 85 and fentanyl to 53.
Nonprescription street drugs helped kill 147 Oklahomans. Meth was present in 99 overdoses and cocaine in 48.
The number of fatal drug overdoses in Oklahoma more than doubled over the past 10 years, climbing to 739 in 2010, according to the Medical Examiner's Office. The number of drug overdose deaths was higher than the number of motor vehicle fatalities, which totaled 683 that year.
Lethal cocktails
Nationwide, sales of opioid pain relievers quadrupled between 1999 and 2010, according to the Centers for Disease Control and Prevention.
More than half of all fatal overdoses involved a "cocktail" of several prescription drugs. Vorse said the combination of opioid painkillers with benzodiazepine tranquilizers such as Xanax and Valium is particularly deadly. Add alcohol to the mix, and it's even more lethal.
"People need to know that if you mix benzos and opiates, you're gonna die," Vorse said. "If that was general knowledge, we might save 100, 200 lives a year from that information alone."
Darrell Weaver, director of the Bureau of Narcotics and Dangerous Drugs Control, said the statistics suggest that much of the medication shipped into the state is being diverted from legitimate users to abusers.
"I'm of the opinion that no Oklahoman should be in pain," Weaver said. "But common sense dictates that some of this is not about pain. It's about addiction."
Nearly 240,000 Oklahomans - 8 percent of the population older than 11 - took prescription painkillers for nonmedical reasons over a 12-month period ending in 2009, according to a federal survey.
Oklahoma's rate of prescription painkiller abuse was the highest in the nation. The state also ranks in the top 10 states for the number of overdose deaths per 10,000 people in the state and the per-capita volume of prescription painkillers sold.
The survey determined that 55 percent of Americans who abused prescription painkillers got them from a friend or relative at no cost. It said 17 percent had been prescribed painkillers by a single doctor. Only 4 percent got them from a drug dealer or other stranger.
Doctor shopping
Weaver's agency tracks the legal narcotics trade in Oklahoma with an online Prescription Monitoring Program. Under a provision that took effect Jan. 1, pharmacists must enter data for every controlled drug prescription within five minutes of filling it.
Doctors, dentists and other health practitioners are not required to check the database before prescribing controlled medications, but they are encouraged to do so. About 70 percent of the state's 17,000 prescribers and pharmacies participate, the bureau said.
The system is designed to flag patients who engage in "doctor shopping" by seeking multiple prescriptions from more than one physician.
Keith Knox Simmons is alleged to be the most brazen doctor shopper snagged so far. In 2009, prosecutors accused the 28-year-old Blanchard man of obtaining 4,533 doses of prescription painkillers, mainly hydrocodone, from 195 health-care professionals and 105 pharmacies.
Possible improvements
Some state lawmakers say the Prescription Monitoring Program is not as effective as it could be. On Feb. 21, the House Public Health Committee endorsed a bill that would require Oklahoma physicians to check the database before prescribing controlled substances to new patients.
The legislation, House Bill 2468, also would place Lortab, Vicodin and other medications containing hydrocodone in a category of prescription narcotics subject to stricter controls.
If the bill becomes law, physicians would no longer be able to phone in hydrocodone prescriptions. Patients would be required to get a paper prescription from the doctor, as they do with most other opioid painkillers.
"Hydrocodone is the key. If you limit hydrocodone, the overdose deaths will go down. I guarantee it," said the bill's author, Rep. Richard Morrissette, D-Oklahoma City.
"I've seen it in my law practice," Morrissette said. "Most of my clients that got addicted to hydrocodone had back problems. Once they're addicted to the relief ... it's just overwhelming. They'll do anything to get it."
Not all lawmakers are convinced it's a good idea. Rep. Mike Ritze, a family practice doctor, voted against the bill. He said the benefits of stricter oversight need to be weighed against the legitimate needs of pain sufferers and the heavy workloads of physicians.
"The doctors know their practices. The doctors know who they're treating," said Ritze, R-Broken Arrow. "I don't think we need another regulation to tell us how to treat our patients."
Sad conclusion
Carwithin, the Oklahoma City overdose victim, tested positive for several narcotics and the anti-anxiety drug alprazolam.
She had a degenerative disk condition in her lower spine, authorities said, and she had been prescribed hydrocodone to help with the pain.
Her stepbrother, Hoye, said that before their elderly mother died in 2008, Carwithin frequently paid for her prescriptions with her mother's charge card.
"I don't know how she was getting her scripts," Hoye said. "I don't know if she was conning doctors into giving her scripts or getting refills or what ... She'd go to Target and use my mom's credit card to buy her damn drugs. How could they let that happen?"
Carwithin lived alone after her mother's death. A neighbor called police after noticing she hadn't taken a morning walk with her dog in several days. Police broke in her back door and found her body on the floor.
Carwithin was pronounced dead of an accidental overdose on Jan. 20, 2010. Her body was cremated.
Patches was sent to the pound.
DRUGS OF ABUSE
The federal government's list of controlled substances contains several hundred prescription drugs. But the Drug Enforcement Administration considers the following to be some of the more frequently abused substances. Schedule II drugs have accepted medical uses but also have a high potential for abuse and may lead to severe dependence. Schedule III and IV drugs have a lower potential for abuse but may still lead to dependence.
SCHEDULE II
| Generic name | Brand names | Type |
| amphetamine | Adderall, Dexedrine | stimulant, ADD treatment |
| fentanyl | Duragesic patches | painkiller |
| hydromorphone | Dilaudid | painkiller |
| meperidine | Demerol | painkiller |
| methadone | Dolophene, Methadose | painkiller, opiate substitute |
| methamphetamine | Desoxyn | stimulant |
| methylphenidate | Ritalin, Concerta | stimulant, ADD treatment |
| morphine | MS Contin | painkiller |
| oxycodone | Percoset, OxyContin | painkiller |
SCHEDULE III
| Generic name | Brand names | Type |
| hydrocodone* | Lortab, Vicodin | painkiller |
SCHEDULE IV
| Generic name | Brand names | Type |
| alprazolam | Xanax | anxiety relief |
| diazepam | Valium | tranquilizer |
| lorazepam | Ativan | anxiety relief |
| meprobamate | Equanil, Miltown | tranquilizer |
| zolpidem | Ambien | sleep aid |
*when combined with nonprescription painkillers such as acetaminophen; pure hydrocodone is a Schedule II drug.
Source: Drug Enforcement Administration (
tulsaworld.com/deastatement)
BIGGEST KILLERS
Deaths contributed
| Drug | to in 2010 |
| Hydrocodone | 153 |
| Oxycodone | 144 |
| Alprazolam | 139 |
| Methadone | 99 |
| Methamphetamine | 99 |
| Morphine | 85 |
| Fentanyl | 53 |
| Cocaine | 48 |
Prescription drugs are responsible for four in five overdose deaths in Oklahoma. Leading the list are the painkillers hydrocodone and oxycodone, and the anti-anxiety medication alprazolam. The figures in the table show the number of 2010 overdoses in which each drug was present. Because a majority of overdoses involve a combination of drugs, the categories overlap.
Source: Oklahoma State Bureau of Narcotics and Dangerous Drugs Control
PRESCRIPTION PAINKILLER SALES
(in kilograms)
Top 10 states
| Drug | to in 2010 |
| Florida | 12.6 |
| Nevada | 11.8 |
| Tennessee | 11.8 |
| Oregon | 11.6 |
| Delaware | 10.2 |
| Maine | 9.8 |
| Alabama | 9.7 |
| West Virginia | 9.4 |
| Oklahoma | 9.2 |
| Washington | 9.2 |
| U.S. average | 7.1 |
Oklahoma has the ninth-highest sales of prescription painkillers in the United States, with 9.2 kilograms of medication sold for every 10,000 Oklahomans in 2010. Florida has the highest sales, with 12.6 kilograms.
Source: Centers for Disease Control and Prevention (
tulsaworld.com/cdcreport.)
DRUG OVERDOSE DEATHS
Top 10 states
| Drug | to in 2010 |
| New Mexico | 27.0 |
| West Virginia | 25.8 |
| Nevada | 19.6 |
| Utah | 18.4 |
| Alaska | 18.1 |
| Kentucky | 17.9 |
| Rhode Island | 17.2 |
| Florida | 16.5 |
| Oklahoma | 15.8 |
| Ohio | 15.1 |
| U.S. average | 11.9 |
Oklahoma ranks among the top 10 states for number of drug overdose deaths, with 15.8 for every 100,000 residents in 2008. Oklahoma's rate is higher than those in surrounding states except for New Mexico.
Source: Centers for Disease Control and Prevention (
tulsaworld.com/cdcreport.)
The series
Saturday: Drug addiction costs the state of Oklahoma $7.2 billion a year, a figure that tops state government's entire budget of $6.7 billion.
Today: Read about the other addicts, the middle-aged and middle-class Oklahomans who start taking pain pills for bad backs and other injuries and tumble into addiction and even death by overdose.
Monday: Discover the science and research behind what is making some people addicted to drugs and alcohol and read stories of how some addicts are seeking help.
Tuesday: Read about how much drug abuse is costing businesses in the state and what the head of the mental health and substance abuse agency says needs to be spent on an effective prevention and treatment system.
Wednesday: Find out how many veterans are becoming addicted to prescription painkillers after returning from combat and what faith communities are doing to address addiction problems.
March 18: Find out in Sunday's Tulsa World what treatment options are available in the public and private sectors.
240,000
Approximate number of Oklahomans above age 11 who took prescription painkillers for nonmedical reasons over a 12-month period ending in 2009
739
Number of people in Oklahoma who died from drug overdoses in 2010
4 of 5
Number of overdose victims who overdose on widely prescribed medications
153
Overdose deaths in 2010 with the painkiller hydrocodone as a contributor
No. 1
Oklahoma's rank nationally for prescription drug abuse
Doctor-shopping arrest is 'wake-up call' for coach
In some cases, the Oklahoma Bureau of Narcotics and Dangerous Drugs Control can intervene when someone is caught doctor shopping or trying to illegally obtain prescriptions - and potentially save a life.
In 2010, former Oklahoma State University men's basketball coach Sean Sutton was struggling with addiction when state drug agents began investigating him for fraudulently obtaining prescription medication.
Sutton pleaded guilty to four felonies and spent four months in a treatment center. He refers to that arrest and pleading as his "wake-up call."
Now living in Tulsa and working as an assistant coach for the Oral Roberts University basketball team, Sutton regularly speaks at public events about his recovery and the dangers of addiction.
State of Addiction
This is the second part of a series exploring drug addiction in Oklahoma.
It is produced by the staffs of the Tulsa World, The Oklahoman, Oklahoma Watch, State Impact Oklahoma, OETA, and Griffin Communications
The project reporting on addiction seeks to undercover reasons leading to Oklahoma's top ranking in prescription drug abuse and high use of other substances, current efforts to address the problem and possible solutions.
Monday: Discover the science and research behind what is making some people addicted to drugs and alcohol and read stories of how some addicts are seeking help.
Original Print Headline: Prescription problem
