Pharmacists react to 'morning-after pill' ruling

Pharmacists react to 'morning-after pill' ruling

By Linda Carroll and Diane Mapes, NBC News contributors

A new federal court ruling has essentially turned the controversial “morning-after pill” into an over-the-counter drug, likely making the medication far more available to teens fearing pregnancy, even in states like Washington and Illinois where pharmacists currently can refuse to sell it.

The new ruling threw out the Food and Drug Administration’s requirement that girls younger than 17 have a prescription before a pharmacist could dispense Plan B. Because of the age requirement, pharmacists ended up controlling who received the medication because IDs had to be checked before any medication could be dispensed.

The FDA has 30 days to appeal. If it fails to get the new ruling overturned, Plan B and other emergency contraception will become, essentially, an OTC medication that could share shelf space with condoms and yeast busting medications.

Up until now, pharmacists in Washington and Illinois had been assured by the courts that they could choose not to dispense Plan B if they so chose. A federal judge ruled in February of 2012 that Washington state couldn’t force pharmacies to sell Plan B. Then in September of the same year, an Illinois appellate court affirmed a lower court’s ruling that pharmacists could not be forced by the state to sell Plan B if they had religious objections.

As an OTC drug, Plan B would not need to be kept behind the counter, meaning that pharmacists would have little control over its sales.

But with the issue still up in the air because of a possible appeal, it’s hard to know how everything will shake out.

“It will be interesting to see how the case plays out,” said Garth Reynolds, executive director of the Illinois Pharmacist Association. “I’m not sure what the immediate impact will be on current dispensing.”

Until there’s a final answer, Reynolds said, “it will be up to individual pharmacists how to deal with the new ruling. If it’s upheld, pharmacies will obey the law. ”

Even without the change, pharmacies in Illinois are required by law to fill prescriptions when they are presented, said Susan Hofer Hofer, a spokesperson for the Illinois Department of Financial and Professional Regulation, which oversees pharmacies and the professionals who work in them.

“We have a law that says that an individual pharmacist may refuse to provide any medicine they choose, but the pharmacy must make an arrangement so the patient can get served at that pharmacy,” Hofer said. “We’re in court right now with pharmacists who say they don’t want to do it.”

How does that square with the law? These are pharmacies that are owned by a pharmacist who is refusing not only to fill prescriptions for Plan B himself, but also to find someone else to do the job, Hofer explained.

In Washington state, pharmacist Steve Lee says the new ruling won’t make much of a difference.

“I think people who have a need for that should be able to buy it,” he says.

None of his pharmacists have refused to sell Plan B to any woman, however, he adds that the “morning after pill” – which sells for approximately $50 -- is not a big seller at his small pharmacy in the Ballard neighborhood of Seattle.

“We have it in the store but we’ve never sold one,” he says. “We’ve had it since it became available. We always have one but they just sit here and expire.”

Jim Krell, a pharmacist in Mt. Vernon, Wash., echoes Lee’s comments regarding the limited usage of the "morning-after pill."

“When you read about this in the press, it sounds like this product is being used a lot,” he says. “In this community – and my feeling is it’s the same statewide – the demand for Plan B is not that great. On average, we might sell it once a month, maybe. And it’s being used responsibly when it is being used. We don’t see what the big deal is.”

If the new ruling stands, individual pharmacists will have very little wiggle room when it comes to Plan B and other emergency contraception, predicted Carmen Catizone, executive director of the National Association of Boards of Pharmacy. “If it becomes an over-the-counter product, there isn’t much they can do, unless the pharmacy chooses not to stock that product. The judge cannot mandate that every pharmacy carries it.”

Even if the morning-after pill does become an OTC product, women, especially younger ones may still have trouble getting their hands on it.

“When I was 18, I tried to get Plan B but it was just so expensive that I didn’t get it,” says Melissa, a 26-year-old service industry employee from Seattle. “I went to the pharmacy to see how much it was but it was over $50. I didn’t have the money. I didn’t have insurance. And I ended up getting pregnant and then getting an abortion. It was very sad, but my boyfriend had just dumped me.”

Related stories:

Judge: Make "morning-after pill" available to all girls without prescription

Bioethicist: It's high time for "morning-after pill" ruling

Parents react to "morning-after pill's" easier access

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Number of bird flu cases rises to 20 in China

Number of bird flu cases rises to 20 in China

By The Associated Press

BEIJING -- Shanghai has reported two more cases of human infection of a new strain of bird flu, raising the number of cases in eastern China to 20. The death toll among those who contracted the virus remains at six. 

Health officials believe people are contracting the H7N9 virus through direct contact with infected fowl and say there's no evidence the virus is spreading easily between people.

China's official Xinhua News Agency reported the two new Shanghai cases Sunday, citing local authorities.

Shanghai has been ordered by the agriculture ministry to halt its live poultry trade and slaughter all fowl in markets where the virus has been found.

The capital cities of the neighboring provinces of Zhejiang and Jiangsu also have suspended sales of live poultry. Both provinces have reported H7N9 cases. 

On Friday, Dr. Tom Frieden, the director of the Centers for Disease Control and Prevention, said that the CDC has been in close contact with Chinese official and cautioned that there is no cause for widespread alarm.

“At this point, there are several things that give us confidence that this is not spreading widely from person to person,” Frieden said.

For example, Chinese authorities have tracked 100 close contacts of people who got sick, and none of them became ill. With typical influenza, perhaps 20 percent to 30 percent of family members could be expected to develop the flu, Frieden said.

CDC is working with vaccine manufacturers to develop a seed strain to produce a vaccine to protect against the H7N9 virus, but that would only occur if there appeared to be widespread transmission. If that were necessary, it would not disrupt production of the seasonal vaccine, CDC officials said.

There have been no cases reported in the United States.

NBC News' senior health reporter JoNel Aleccia contributed to this report.

Related stories:

Don't panic over bird flu outbreak, CDC cautions

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Negative vaccine tweets are 'contagious,' study suggests

Negative vaccine tweets are 'contagious,' study suggests

By Rachael Rettner, MyHealthNewsDaily

Twitter posts with anti-vaccine sentiments are "contagious," while posts with a positive take on vaccines are not, a new study suggests. 

The study analyzed more than 300,000 tweets that expressed an opinion about the H1N1 flu vaccine in 2009.

Twitter users who saw anti-vaccine posts in their Twitter feed tended to tweet anti-vaccine sentiments themselves, the results show. However, those who saw positive vaccine sentiments didn't tweet positive sentiments themselves. 

What's more, positive tweets about vaccines sometimes had the opposite effect — a high number of pro-vaccine posts seemed to encourage people to tweet negatively about vaccines, said study researcher Marcel Salathé, an assistant professor of biology at Penn State University.

"In other words, pro-vaccine messages seemed to backfire when enough of them were received," Salathé said.

The reason for this phenomenon is not clear. But it's possible that “many people had latent negative opinions about the vaccine, and when they were intensely exposed to enough positive messages, they felt the need to express their negative sentiment," Salathé said.

Future studies may reveal what it is about negative tweets that makes them contagious. The results of those studies could help public health officials “send positive messages in a way that would be more likely to have the intended effect," Salathé said.

The study was published April 4 in the journal EPJ Data Science.

More from MyHealthNewsDaily:

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Dengue cases may be 4 times more common than thought

Dengue cases may be 4 times more common than thought

Jorge Saenz / AP, file

Miriam Torres, 28, veiled by a mosquito net recovers from dengue fever at the Hospital General Barrio Obrero, in Asuncion, Paraguay, Thursday, Jan. 17, 2013.

By Maria Chen, The Associated Press

LONDON-- There may be nearly four times as many people infected with the tropical disease dengue globally than was previously believed, according to a new study.

The World Health Organization has estimated there are about 50 million to 100 million cases of dengue, also known as "break-bone fever," every year. But new research puts the number at around 390 million — though about two-thirds of those people have only mild illness and don't need medical attention. The study was published online Sunday in the journal Nature.

The data won't change how patients are handled but could prompt a speedier search for a vaccine for the mosquito-borne disease. The study was funded by the Wellcome Trust, the U.S. Department of Homeland Security and others.

WHO said it wasn't surprised by the higher estimates. "We fully agree the spectrum of dengue is very wide and there was every chance we were missing cases," said Raman Velayudhan, the agency's global dengue coordinator. WHO was not involved in the new research.

"The new numbers are not out of the realm of what was expected," said Jeremy Farrar, director of the Oxford University Clinical Research Unit in Vietnam, one of the study authors. He said the figures came from analyzing more evidence than was used in the past and included other factors that influence dengue.

Dengue causes symptoms including fever and severe joint pains. The disease mostly affects people in Asia, Africa and Latin America though it has also recently popped up in parts of Western Europe and the U.S.

There are four kinds of dengue and catching it once doesn't ensure immunity; subsequent infections raise the risk of severe dengue and may include hemorrhaging. The death rate is usually below 1 percent if patients get treated quickly, but can rise to 10 percent if not.

Clarence Tam, an infectious diseases expert at the London School of Hygiene and Tropical Medicine, said more research was needed on the significance of the nearly 300 million people who have mild dengue.

"Whether these cases are an important source of dengue infection for others is not well known," he said. "But there is clearly more dengue in the world than we thought."

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Taping of farm cruelty is becoming the crime

Taping of farm cruelty is becoming the crime

Richard A. Oppel Jr. , The New York Times   –   2 days

On one covert video, farm workers illegally burn the ankles of Tennessee walking horses with chemicals. Another captures workers in Wyoming punching and kicking pigs and flinging piglets into the air. And at one of the country’s largest egg suppliers, a video shows hens caged alongside rotting bird corpses, while workers burn and snap off the beaks of young chicks.

Each video — all shot in the last two years by undercover animal rights activists — drew a swift response: Federal prosecutors in Tennessee charged the horse trainer and other workers, who have pleaded guilty, with violating the Horse Protection Act. Local authorities in Wyoming charged nine farm employees with cruelty to animals. And the egg supplier, which operates in Iowa and other states, lost one of its biggest customers, McDonald’s, which said the video played a part in its decision.

But a dozen or so state legislatures have had a different reaction: They proposed or enacted bills that would make it illegal to covertly videotape livestock farms, or apply for a job at one without disclosing ties to animal rights groups. They have also drafted measures to require such videos to be given to the authorities almost immediately, which activists say would thwart any meaningful undercover investigation of large factory farms.

Critics call them “Ag-Gag” bills.

Some of the legislation appears inspired by the American Legislative Exchange Council, a business advocacy group with hundreds of state representatives from farm states as members. The group creates model bills, drafted by lobbyists and lawmakers, that in the past have included such things as “stand your ground” gun laws and tighter voter identification rules.

One of the group’s model bills, “The Animal and Ecological Terrorism Act,” prohibits filming or taking pictures on livestock farms to “defame the facility or its owner.” Violators would be placed on a “terrorist registry.”

Officials from the group did not respond to a request for comment.

Animal rights activists say they have not seen legislation that would require them to register as terrorists, but they say other measures — including laws passed last year in Iowa, Utah and Missouri — make it nearly impossible to produce similar undercover exposés. Some groups say that they have curtailed activism in those states.

“It definitely has had a chilling effect on our ability to conduct undercover investigations,” said Vandhana Bala, general counsel for Mercy for Animals, which has shot many videos, including the egg-farm investigation in 2011. (McDonald’s said that video showed “disturbing and completely unacceptable” behavior, but that none of the online clips were from the Iowa farm that supplied its eggs. Ms. Bala, though, said that some video showing bird carcasses in cages did come from that facility.)

The American Farm Bureau Federation, which lobbies for the agricultural and meat industries, criticized the mistreatment seen on some videos. But the group cautions that some methods represent best practices endorsed by animal-care experts.

The videos may seem troubling to someone unfamiliar with farming, said Kelli Ludlum, the group’s director of Congressional relations, but they can be like seeing open-heart surgery for the first time.

“They could be performing a perfect procedure, but you would consider it abhorrent that they were cutting a person open,” she said.

In coming weeks, Indiana and Tennessee are expected to vote on similar measures, while states from California to Pennsylvania continue to debate them.

Opponents have scored some recent victories, as a handful of bills have died, including those in New Mexico and New Hampshire. In Wyoming, the legislation stalled after loud opposition from animal rights advocates, including Bob Barker, former host of “The Price is Right.”

In Indiana, an expansive bill became one of the most controversial of the state legislative session, drawing heated opposition from labor groups and the state press association, which said the measure violated the First Amendment.

After numerous constitutional objections, the bill was redrafted and will be unveiled Monday, said Greg Steuerwald, a Republican state representative and chairman of the Judiciary Committee.

The new bill would require job applicants to disclose material information or face criminal penalties, a provision that opponents say would prevent undercover operatives from obtaining employment. And employees who do something beyond the scope of their jobs could be charged with criminal trespass.

An employee who took a video on a livestock farm with his phone and gave it to someone else would “probably” run afoul of the proposed law, Mr. Steuerwald said. The bill will apply not just to farms, but to all employers, he added.

Nancy J. Guyott, the president of the Indiana chapter of the A.F.L.-C.I.O., said she feared that the legislation would punish whistle-blowers.

Nationally, animal rights advocates fear that they will lose a valuable tool that fills the void of what they say is weak or nonexistent regulation.

Livestock companies say that their businesses have suffered financially from unfair videos that are less about protecting animals than persuading consumers to stop eating meat.

Don Lehe, a Republican state representative from a rural district in Indiana, said online videos can cast farmers in a false light and give them little opportunity to correct the record.

“That property owner is essentially guilty before they had the chance to address the issue,” Mr. Lehe said.

As for whistle-blowers, advocates for the meat industry say that they are protected from prosecution by provisions in some bills that give them 24 to 48 hours to turn over videos to legal authorities.

“If an abuse has occurred and they have evidence of it, why are they holding on to it?” said Dale Moore, executive director of public policy for the American Farm Bureau Federation.

But animal rights groups say investigations take months to complete.

Undercover workers cannot document a pattern of abuse, gather enough evidence to force a government investigation and determine whether managers condone the abuse within one to two days, said Matt Dominguez, who works on farm animal protection at the Humane Society of the United States.

“Instead of working to prevent future abuses, the factory farms want to silence them,” he said. “What they really want is for the whistle to be blown on the whistle-blower.”

The Humane Society was responsible for a number of undercover investigations, including the videos of the Wyoming pig farm and the Tennessee walking horses.

Video shot in 2011 showed workers dripping caustic chemicals onto the horses’ ankles and clasping metal chains onto the injured tissue. This illegal and excruciating technique, known as “soring,” forces the horse to thrust its front legs forward after every painful step to exaggerate the distinctive high-stepping gait favored by breeders. The video also showed a worker hitting a horse in the head with a large piece of wood.

The Humane Society first voluntarily turned over the video to law enforcement. By the time the video was publicly disclosed, federal prosecutors had filed charges. A week later, they announced guilty pleas from the horse trainer and other workers.

Prosecutors later credited the Humane Society with prompting the federal investigation and establishing “evidence instrumental to the case.”

That aid to prosecutors shows the importance of lengthy undercover investigations that would be prevented by laws requiring video to be turned over within one or two days, Mr. Dominguez said.

“At the first sign of animal cruelty, we’d have to pull our investigator out, and we wouldn’t be able to build a case that leads to charges.”

This article, "Taping of farm cruelty is becoming the crime," first appeared in The New York Times.

Copyright © 2013 The New York Times

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Bird flu team may be headed to China as death toll rises

Bird flu team may be headed to China as death toll rises

By Gillian Wong, The Associated Press

The World Health Organization is talking with the Chinese government about sending international experts to China to help investigate a new bird flu strain that has sickened at least 24 people, killing seven of them.

A 64-year-old retired man in Shanghai became the latest victim of the H7N9 bird flu virus that had previously not been known to infect humans, the city government said Monday.

The Shanghai government said the man died Sunday night, a week after first experiencing chills. He sought medical treatment last Wednesday for pneumonia-like conditions. By Sunday morning, his condition worsened, he was out of breath and was admitted to a ward for in-patient treatment. He died hours later.

Michael O'Leary, head of WHO's office in China, told reporters in Beijing on Monday that the international health organization had confidence in China's efforts to track and control the outbreak of H7N9 infections, but that growing interest in the virus globally has prompted WHO to consider sending a team.

The cases are of "great interest not only in the scientific community but in the world at large," O'Leary said at a joint press conference with China's national health agency. "WHO's responsibility in part is to make sure that we serve as liaison and linkage between China and the rest of the world."

The team would likely include epidemiological, laboratory and communications experts, but the matter was still being discussed by the two sides and it remained unclear if and when such a group would arrive, O'Leary said.

Aside from the latest fatality in Shanghai, China reported two more cases of human infection of the H7N9 bird flu virus on Monday, raising the total number of cases to 24 — all in the eastern part of the country. Most of the patients have become severely ill, and seven of them have died, however milder infections may be going undetected.

There could be additional infections, both among animals and humans, in other regions and authorities have stepped up measures to monitor cases of pneumonia with unexplained causes, said Liang Wannian, director of the Chinese health agency's H7N9 flu prevention and control office.

Liang said Chinese experts also were in the early stages of researching a possible vaccine for the virus, though it might not be needed if the virus remains only sporadically reported and if it does not spread easily among people.

The H7N9 strain previously was known only to infect birds, and officials say they do not know why the virus is infecting humans now. The virus has been detected in live poultry in several food markets where human cases have been found, leading officials to think people are most likely contracting the virus through direct contact with infected fowl.

Authorities have halted live poultry trade in cities where cases have been reported, and slaughtered fowl in markets where the virus has been detected.

Further investigations are underway and, for now, there's no evidence the virus is spreading easily between people. However, scientists are watching closely to see if the flu poses a substantial risk to public health or could potentially spark a global pandemic.

In 2003, China allowed WHO to send a five-member team to help investigate an outbreak of the fatal flu-like illness, SARS, after its own experts could not trace the source of the disease.

China's response at the time was slow. The government stayed silent for months after the first cases of an unidentified disease were reported, a cover-up that contributed to the spread of the virus to many parts of China and to two dozen other countries, killing hundreds of people.

International observers say that over the past decade, China's public health agencies have become increasingly forthcoming with information.

© 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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'Alarm fatigue' can kill, hospital group says

'Alarm fatigue' can kill, hospital group says

By Lindsey Tanner, The Associated Press

Constantly beeping alarms from devices that monitor the vital signs of the critically ill have "desensitized" hospital workers who sometimes ignore the noise, leading to at least two dozen deaths a year on average, a hospital accrediting group said Monday. 

And these cases are probably vastly underreported, said the Joint Commission in an alert to hospitals calling attention to the problem. 

The beeping devices include those that measure blood pressure and heart rate, among other things. Some beep when there's an emergency, and some beep when they're not working. That can lead to noise fatigue and the delay in treating a patient can endanger lives, the accreditation commission says. 

Complicating the situation is the abundance of technology, with no standardization for what the beeps mean, said Dr. Ana McKee, the commission's executive vice president and chief medical officer. 

The commission's estimate of possible deaths related to the problem is considerably lower than the reports it found in a U.S. Food and drug Administration database. The FDA lists more than 500 deaths potentially linked with hospital alarms between January 2005 and June 2010. But that includes mandatory reports of malfunctions and in some cases the connection to a death is only tenuous. 

The commission's own database reports 80 deaths and 13 severe injuries between January 2009 and June 2012. Hospitals voluntarily report these to the commission, which reviews them and in these cases determined there was a clear connection to the device, said McKee. 

There likely are far more problems than have been reported, partly because ignoring or misinterpreting an alarm may have set off a chain of events that led to an injury or death, she explained. But tracing back to that first oversight can be difficult, McKee said. 

Alarm-system events included patient falls, delays in treatment and medication errors that resulted in injury or death, the Joint Commission said. 

The most common factor was "alarm fatigue." But other problems included misinterpreting alarm signals, too few staffers to respond to alarms, and equipment malfunctions. 

"With the proliferation of technology, alarms, and a lack of standardization," it's more challenging for doctors and nurses to respond adequately, McKee said. 

The commission said hospital leaders need to address the problem and train staffers in safe alarm management. 

The organization accredits more than 10,000 U.S. hospital and health care organizations. Hospitals covet accreditation and following commission advice is key to maintaining it. 

McKee said the alert will help raise awareness and lead to hospital changes that may save lives. 

© 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Severe MS left Annette Funicello unable to walk, speak

Severe MS left Annette Funicello unable to walk, speak

Annette Funicello's husband describes how at age 70, the former entertainer had become unable to walk or speak, due to the effects of multiple sclerosis. CTV reports.

After battling multiple sclerosis for decades, Annette Funicello died today from complications of the disease.

That doesn’t mean that MS actually killed her, says Dr. Rhonda Voskuhl, a professor in the department of neurology at the University of California, Los Angeles and director of the UCLA MS program.

“MS does not directly shorten the lifespan,” Voskuhl explains. “It doesn’t kill people directly. If you’ve had a very severe form for a very, very long time you can have the same complications that anyone has who is immobilized. You can get pneumonia. You can get bed sores. You can have difficulty eating.”

These days the prognosis for the vast majority of MS patients is better than it was when Funicello was diagnosed because there are treatments that can slow the progression of the disease. “There was a revolution in MS drugs in the late 90s,” Voskuhl says. “Those drugs don’t stop the disease, but they slow it down.”

If you were diagnosed years ago, before there were good treatments, many brain cells could be lost.  “Early treatment is very important,” Voskuhl says.

No one understands exactly why MS strikes some people and not others. But in some, the immune system goes out of whack and begins to attack the outer covering of axons, which are the structures that function like phone lines to carry information from cell to cell in the brain.

In people with MS, immune cells chew away at the axons’ outer covering, or myelin, and that makes signals ragged. The situation is similar to a phone line with a damaged rubber coating: Voices sound ragged if the damage is minor, an unintelligible if it’s worse.  

There’s a wide variation in the type of symptoms people experience with MS. Some just feel odd sensations, like tingling, or lose feeling in body parts from time to time.

Some develop cognitive deficits. “It’s not like Alzheimer’s,” Voskuhl explains. “It’s not like everyone knows you have it. Generally the patient knows. It’s usually involves problems with processing speed. They can’t think as quickly as they used to.”

And some end up with problems moving, like Funicello did. It all depends on what area of the brain is attacked.

As it turns out, the kinds of symptoms a person experiences early on may give doctors a clue as to whether the disease will be aggressive or mild. “In that respect, it’s better to have sensory symptoms than motor problems or balance issues,” says Dr. Clyde Markowitz director of the MS Center at the University of Pennsylvania.  

While the new drugs don’t repair damaged axons, they do quiet down the immune system so there are fewer attacks.

Had Funicello been born a decade or so later, there’s a good chance that her disease might have taken a different course, experts say.

“She was diagnosed at a time when we didn’t have any therapies available,” Markowitz says. “We see much less of that guaranteed progressive phase now.”

Heart wrenching videos of Funicello in her later years show a woman trapped within an immovable body. It’s quite possible that Funicello remained cognitively intact even as her body was failing her, says Dr. Rock Heyman, director of the Pittsburgh Institute for MS care and research at the University of Pittsburgh Medical Center. “I have seen patients who are unable to move their arms or legs that are still intellectually active.”

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Deaths tied to painkillers rising in the U.S.

Deaths tied to painkillers rising in the U.S.

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Comments84 i$.require('http://cdn.gigya.com/js/socialize.js?apiKey=2_COh26GgfZDptreu0iQ9aknzT_Ig861qYxOHZVxizrZMTn81vygTB-ptN33wgCtrj', function() { var act = new gigya.socialize.UserAction(), showShareBarUI_params = { containerID: 'componentDiv_top', shareButtons: [{ provider:'Email'}, { provider:'Share'}, { provider:'twitter-tweet'}, { provider:'facebook-like', action:'like'}], userAction: act, moreEnabledProviders: 'facebook,email,pinterest,twitter,linkedin,tumblr,delicious,digg,blogger,google,stumbleupon,reddit' }; act.setTitle("Deaths tied to painkillers rising in the U.S."); act.setLinkBack("http://www.latimes.com/news/local/la-me-0330-rx-deaths-20130330,0,1604889.story"); act.setDescription("Despite efforts by law enforcement and public health officials to curb prescription drug abuse, drug-related deaths in the United States have continued to rise, the latest data show."); gigya.socialize.showShareBarUI(showShareBarUI_params); }); By Scott Glover and Lisa Girion, Los Angeles Times March 29, 2013, 5:10 p.m.

Despite efforts by law enforcement and public health officials to curb prescription drug abuse, drug-related deaths in the United States have continued to rise, the latest data show.

Figures from the U.S. Centers for Disease Control and Prevention reveal that drug fatalities increased 3% in 2010, the most recent year for which complete data are available. Preliminary data for 2011 indicate the trend has continued.

The figures reflect all drug deaths, but the increase was propelled largely by prescription painkillers such as OxyContin and Vicodin, according to just-released analyses by CDC researchers.

Also Times investigation: Legal drugs, deadly outcomes Bill aims to tighten restrictions on painkiller hydrocodone Atty. Gen. Kamala Harris urges funding for prescription tracking Parents of prescription overdose victims plead with legislators DEA official backs tighter rules on narcotic painkillers

Times investigation: Legal drugs, deadly outcomes

The numbers were a disappointment for public health officials, who had expressed hope that educational and enforcement programs would stem the rise in fatal overdoses.

"While most things are getting better in the health world, this isn't," CDC director Tom Frieden said in an interview. "It's a big problem, and it's getting worse."

Drugs overtook traffic accidents as a cause of death in the country in 2009, and the gap has continued to widen.

Overdose deaths involving prescription painkillers rose to 16,651 in 2010, the CDC researchers found. That was 43% of all fatal overdoses.

The numbers come amid mounting pressure to reduce the use of prescription painkillers. The U.S. Food and Drug Administration is considering a proposal to limit daily doses of painkillers and restrict their use to 90 days or less for non-cancer patients. The proposal also would make such drugs available to non-cancer patients only if they suffer from severe pain.

"The data supporting long-term use of opiates for pain, other than cancer pain, is scant to nonexistent," Frieden said. "These are dangerous drugs. They're not proven to have long-term benefit for non-cancer pain, and they're being used to the detriment to hundreds of thousands of people in this country."

Among the most promising tools to combat the problem, Frieden said, are computerized drug monitoring programs that track prescriptions for painkillers and other commonly abused narcotics from doctor to pharmacy to patient. Frieden said such programs should be used to monitor doctors' prescribing as well as patients' use.

"You've got to look at the data to see where the problems are," he said. "You don't want to be flying blind."

In California, officials do not use the state's prescription drug monitoring program, known as CURES, to proactively seek out problem patients or physicians. The state's medical board initiates investigations of doctors only after receiving a complaint. Legislation awaiting action in Sacramento would increase funding for CURES and provide more investigators to police excessive prescribing, among other measures.

Frieden, a physician trained at Columbia and Yale universities, said patient safety should be placed above the concerns among some doctors about scrutiny of their prescribing patterns.

"We all take an oath to, above all, do no harm," he said. "And these medications do harm. You're free to practice medicine however you want. But you're not free to do things that hurt people."

President Obama's drug czar, R. Gil Kerlikowske, echoed Frieden's call for aggressive monitoring by state medical boards.

"You can't just sit back, have a big database and then say, 'Well, we'll wait till there's a complaint that comes in,'" he said in an interview. "You have to use it proactively."

Lynn Webster, president-elect of the American Academy of Pain Medicine, said the new figures underscored the need for further action, such as educating physicians to recognize patients who are at risk for abusing painkillers.

"This is not the trend anyone wants to see," Webster said.

CDC mortality data, culled from death certificates, do not detail how the decedents obtained the drugs that killed them.

A Los Angeles Times analysis of coroners records published last year found that prescriptions from physicians played a substantial role in the death toll. Of 3,733 prescription drug-related fatalities in Southern California examined by The Times, nearly half involved at least one drug that had been prescribed to the decedent by a physician.

Seventy-one doctors prescribed drugs to three or more patients who later fatally overdosed, the analysis showed. And several of the doctors lost a dozen or more patients to overdoses.

The latest CDC figures predate a broad attack on prescription drug abuse and misuse launched by the White House in April 2011. The preliminary figure for 2011 is down slightly but is expected to grow by at least 5% — exceeding the 2010 level — when all death certificates are in and counted, experts said. That's what has happened in previous years.

Kerlikowske, who heads the White House Office of National Drug Control Policy, said efforts to hone the response to measures that show results were frustrated by the lagging mortality data. But, he said, anecdotal evidence and surveys of younger Americans suggest "there's a lot going on that's moving in the right direction."

He declined to predict when there would be downturn in deaths.

"It won't be overnight, certainly," he said. "But we didn't get here, with these kinds of numbers of deaths and overdoses, overnight."

scott.glover@latimes.com

lisa.girion@latimes.com

Copyright © 2013, Los Angeles Times

Comments84 i$.require('http://cdn.gigya.com/js/socialize.js?apiKey=2_COh26GgfZDptreu0iQ9aknzT_Ig861qYxOHZVxizrZMTn81vygTB-ptN33wgCtrj', function() { var act = new gigya.socialize.UserAction(), showShareBarUI_params = { containerID: 'componentDiv_bottom', shareButtons: [{ provider:'Email'}, { provider:'Share'}, { provider:'twitter-tweet'}, { provider:'facebook-like', action:'like'}], userAction: act, moreEnabledProviders: 'facebook,email,pinterest,twitter,linkedin,tumblr,delicious,digg,blogger,google,stumbleupon,reddit' }; act.setTitle("Deaths tied to painkillers rising in the U.S."); act.setLinkBack("http://www.latimes.com/news/local/la-me-0330-rx-deaths-20130330,0,1604889.story"); act.setDescription("Despite efforts by law enforcement and public health officials to curb prescription drug abuse, drug-related deaths in the United States have continued to rise, the latest data show."); gigya.socialize.showShareBarUI(showShareBarUI_params); });   Comments (84)Add / View comments | Discussion FAQ sharonsj at 1:53 PM April 04, 2013

If I could use medical marijuana instead of the Vicodin I've been taking for the last five years, I'd probably be a lot happier.  As it is, I'm forced to make a trip every month to get the prescription in person.  And then, because of the limited number, I have to decide how to make those 60 pills last.

The legislators worried about abuse never take into account the people who actually need these pills.

NeuroscienceAddict at 8:28 AM April 03, 2013

Addiction is a chronic, progressive brain disease. It's treatable. Perhaps not as successfully as one might like, but on a par with other chronic diseases that require substantial behavioral change, like diabetes and hypertension.

Unfortunately, many people still don't believe addiction is a disease. That's why science-based education is so important.

For a not-for-profit website that discusses the science of substance use and abuse in accessible English (how alcohol and drugs work in the brain; how addiction develops; why addiction is a chronic, progressive brain disease; what parts of the brain malfunction as a result of substance abuse; how that malfunction skews decision-making and motivation, resulting in addict behaviors; why some get addicted while others don't; how treatment works; how well treatment works; why relapse is common; what family and friends can do; etc.) please click on www.AddictScience.com.

disgusted bystander at 9:24 PM April 02, 2013

As the mother of a chronic pain patient. I'm worried..  What are the options--illegal- ones--- lots of heroin in rural ohio. On a controlled dose of pain meds he's a working functional tax payer.  Although, prescription narcotics are dangerous.  It seems the people that die from prescription narcotics are also drinking, using illegal drugs,crushing injecting and snorting their pills, or young people not under doctors care stealing methadone and other strong slow acting pills and think they need more to get high, doctor shopping ect. or are otherwise physically compromised. Rehab has about a 5% sucess rate. Look for crime to go way way up!. First these patients, then it will be no pain relief for elderly, no xanax or sleeping pills of any sort for you, forrget about adderal and amphetemines for adhd, narcolepsy ect,,. only new big pharma drugs that have lots of side effects, don't really work and cost big bucks..I would rather take a medicine that is 20 years old safer less side effects. Follow the money!

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