Kansas City woman's opioid abuse reflects U.S. epidemic

KANSAS CITY, Mo. -- Sitting in a back room at a Kmart, Rachelle Allen came face to face with the woman she'd become.

There she was on the store's security video, shoplifting a pair of tennis shoes. The blank-faced woman on the screen had matted, unwashed hair. On that cold winter night two years ago, she wore nothing but flip-flops, tattered jeans and a hoodie. As she watched, a security guard rummaged through her purse, finding illegal pills and drug paraphernalia.

It was a moment of deep humiliation for Allen, 40, of Kansas City, who had become addicted to prescription opioid pain pills after surgery in 2005.

"I realized what I was doing was disgusting," she said. "And I needed to do something different."

America is in the throes of an epidemic of pain-pill abuse that in many cases, including Allen's, began with a doctor's prescription.

Since the early 1990s, the number of opioid prescriptions filled at U.S. drugstores nearly has tripled. In 2014, those prescriptions totaled 267 million, according to the Food and Drug Administration -- more than enough to provide every adult in the nation with a bottle of pills.

These medications, including hydrocodone, meperidine, fentanyl and oxycodone, sold under brand names such as Vicodin, Demerol and OxyContin, are chemically similar to heroin. They can cause physical dependence, addiction and -- when an overdose slows breathing to a standstill -- death.

The consequences are becoming increasingly clear.

Across Missouri, the rate of opioid-related inpatient hospital admissions and emergency-room visits more than doubled over the past decade, Missouri Hospital Association data show.

Prescription opioid-related visits to Kansas City hospital emergency rooms jumped from nine in 2004 to 64 in 2013, according to the Kansas City Health Department.

Nationwide, overdose deaths related to prescription opioids climbed 16 percent from the year before to a record 18,893 in 2014, according to the Centers for Disease Control and Prevention.

Recreational drug use is responsible for only some of this damage.

For growing numbers of people, the pain medications doctors prescribe after injuries or surgery or to ease chronic conditions such as back pain have become gateway drugs to abuse and addiction.

People suffering chronic pain and their advocates say these medications are essential for controlling pain that otherwise would be unbearable. They say they use opioids responsibly.

But many doctors, such as David Terry, a University of Kansas Hospital psychiatrist who treats many patients who have become addicted to pain medications, say their colleagues often are too quick to prescribe opioids. They're not paying enough attention to how vulnerable some patients may be to addiction, and they're failing to offer safer alternatives such as physical therapy or opioid-free pain medications.

"Doctors have fallen into this culture of 'it's easy to write a script,'" Terry said.

For Allen, the price of addiction was her home, her family and her career. She describes her decade of drug abuse as "10 years of hell."

After her third child was born in 1999, Allen underwent a tubal ligation to prevent more pregnancies.

Several years later, she met her future husband in Johnson County, Missouri. He was childless and wanted children of his own. Allen agreed to an operation to undo her sterilization.

The reversal operation in January 2005 bruised her abdomen and left her in severe pain. Ovulation also became painful.

"It was awful," Allen said.

The doctor who performed the surgery prescribed Vicodin, a combination of hydrocodone and acetaminophen, the ingredient in Tylenol. It was Allen's first experience with opioids.

About two months after her surgery, Allen noticed she became anxious when she stopped taking the pills.

She had trouble sleeping. She'd vomit. And she had an irresistible urge to move her legs -- the restless-leg syndrome that gave rise to the expression "kick the habit."

What she was going through, she realized, was drug withdrawal.

"My surgeon, he didn't warn me of that. I researched that on my own and found out," she said. "I knew that I was in trouble."

After six months, the pain was gone, but Allen kept taking the pills. She doesn't fault her doctor. She was supposed to take the pills only while she was ovulating, but she used them all the time.

"I had to have it or I couldn't function," she said.

How many people run into trouble with opioids prescribed for pain? Reliable numbers are hard to come by.

Reported rates have ranged from less than 1 percent of patients to as high as 56 percent. But the studies that produce these numbers define and measure addiction and abuse differently, making it hard to compare results.

One of the few large-scale studies interviewed 2,000 chronic-pain patients in Pennsylvania who had been receiving opioids long term. The researchers found 35 percent met criteria for "opioid use disorder," a medical term that covers symptoms associated with abuse or addiction.

Pain treatment advocates point to studies with lower numbers as evidence chronic-pain patients generally manage their use of opioids successfully. They should be considered separately from abusers, advocates said.

But drug-addiction experts said however useful the drugs are to some patients, opioids have become a public-health emergency.

Allen's doctor eventually grew skeptical of her continued demand for opioids.

She started doctor shopping. It's a common practice among opioid addicts after the doctors who initially prescribed the drugs decide a patient has had enough.

The Government Accountability Office estimated among Medicare recipients alone, 170,000 were doctor shopping, mostly seeking opioids, in 2008.

Allen would walk into doctor's offices or drive to emergency rooms, traveling as far as Springfield and Columbia. She'd use excuses -- whiplash, back pain -- "anything I could think of."

It's not just the pressures of a busy ER that may lead doctors to prescribe opioids.

Doctors say they also feel financial pressure. Many work for hospitals, and their income is based in part on how they score on patient satisfaction surveys.

After an ER doctor in South Carolina refused to prescribe unnecessary opioids, a patient threatened a lower rating on the hospital's satisfaction survey, the doctor told the South Carolina Medical Association.

The association followed up in 2012 with a survey of the state's doctors. Nearly half said they had prescribed opioids inappropriately because of satisfaction surveys.

When researchers looked recently at national data on patients who had survived an overdose of prescription opioids, they discovered 91 percent of the patients kept getting opioid prescriptions after they had overdosed, usually from the same doctors.

Lead researcher Marc LaRochelle of Boston Medical Center said the prescribing doctors may not have had any way of knowing about the overdoses. He suggested overdoses be added to the data collected by prescription-drug monitoring programs so doctors would have a clearer idea of their patients' histories.

Forty-nine states have the programs, which monitor prescriptions for drugs such as opioids and tranquilizers. The goal is to make it harder for patients to shop for doctors and for doctors to overprescribe.

The only state without a monitoring program is Missouri, where conservative libertarian lawmakers repeatedly have blocked legislation.