Less than a decade after a 2002 U.S. Justice Department survey labeled crack cocaine the “greatest drug threat” to the region, Metro Police say dealers peddling the narcotic are actually scarce.
But that’s where the good news ends. While Nashville’s crack trade isn’t what is used to be, dealers, who have simply changed their business plans, are cashing in. Undercover Metro cops say they’re uncovering a healthy, and growing, prescription pill trade.
“When we go out on the street and try and buy crack, there’s hardly anybody out there anymore because everyone is doing [pills],” said Detective Michael Donaldson. A veteran of the Metro Police drug unit, Donaldson is the only officer assigned full-time to prescription drug abuse — and he’s busier than ever.
“Everybody is selling, abusing, diverting, sharing and casually exchanging — everyone is doing pills. All over the place it’s just pills, pills, pills.”
Thanks to their availability, painkillers like Oxycontin (a time-release from of oxycodone), hydrocodone (brand name Lortab) and tranquilizers like Xanax are now a mainstay of the illegal drug trade, with both buyers and sellers preferring pills to street drugs.
Dealers are drawn now to painkillers because the drugs fetch a significant financial yield, Donaldson said. On the street, Oxycontin sells at $1 per milligram, with the average single pill containing 80 milligrams.
If a dealer can get his or her hands on a standard prescription of 60 to 90 pills, he can sell each at $80 a tablet and potentially pocket a profit of $4,800 to $7,200 per bottle — a serious intake considering the average prescription costs a patient $1,200 without coverage. With coverage, a dealer could get the same product for as little as a $10 co-pay.
Longtime drug addicts are also shelving their crack cocaine and heroin habits in favor of prescription painkillers. Unlike their street counterparts, pharmaceuticals are concocted in professional labs and pre-dosed, meaning users don’t have to worry if the drugs were properly cooked or cut with another substance, Donaldson said.
“These numbers are going to continue to skyrocket as people start realizing they can do more with some Oxys than they can with a hit of crack,” he added.
As the police watch more addicts turn to prescription medications, state health officials say they’re seeing an increase on the treatment end. Over the past five years, the volume of prescription drug addicts filing into state clinics has risen significantly, according to Rodney Bragg, the director of addictions treatment and recovery services at the Tennessee Department of Mental Health and Developmental Disabilities.
“In the past, methadone clinics have typically been associated with people who use heroin, but one thing we are starting to see is more and more people come in and seek treatment for prescription opiate abuse,” Bragg said.
Also, as users move away from crack cocaine and other street drugs and take up pharmaceuticals, police say they’ve witnessed organized crime entities becoming involved in the trade. Nashville’s street gangs and other groups have begun to organize selling operations, Donaldson said. Some even run “pain trains,” a scam wherein dealers hire vans and offer to take groups of senior citizens to pharmacies to fill their prescriptions. On the ride back, the drivers buy the drugs from the seniors.
Abuse above average
Prescription drug abuse is on a rapid rise nationally, edging out marijuana and cocaine as the recreational drug of choice. Recent studies have determined almost 50 percent of the overall drug abuse in the United States comes from pharmaceuticals, and the drug-prevention organization D.A.R.E. estimates pill usage in young adults went up 3,000 percent between 2005 and 2007.
The data also show the users are increasingly younger: Every day about 2,500 people between the ages of 12 and 17 swallow their first recreational prescription drug, D.A.R.E. says.
And if the country is experiencing an epidemic, Tennessee is a veritable hotbed — with its own startling stats. That’s because the Volunteer State historically issues more prescriptions than any other; it was ranked No. 1 in a 2007 Novartis Pharmacy report on prescriptions per capita, with a rate 1.5 times the national norm. It follows that Tennessee, then, would boast a pharmaceutical drug overdose rate 26 percent higher than the national average.
But despite its chart-topping trend in prescription drug abuse, Tennessee is actually about 10 years behind other states in terms of enforcement, according to Donaldson. Metro detectives have been working pharmaceutical cases since the 1990s, but until recently the state lacked the necessary laws to collar people who obtain drugs for street resale.
Further complicating Tennessee’s problem is incoming pressure from surrounding states. Kentucky in particular — a longtime epicenter of the pill problem — has recently tightened up its prescription system, which police say is steering users toward Tennessee to buy illegally.
But the greatest challenge facing Metro Police as they wage the war on what was once only a suburban drug problem is that the drugs themselves aren’t illegal – only many of the methods for buying and selling — and abusers and dealers are often obtaining them from health care professionals, illegally and otherwise.
“What happens if you find a guy on the street with a bottle of pills with his name on it? What can you do? Nothing,” Donaldson explained. “This is not [solely] a criminal issue. It’s more of a behavioral issue that’s become criminalized.”
Donaldson said police often catch abusers committing crimes connected to their addictions, such as forging prescriptions, stealing identities, making fraudulent TennCare claims or selling pills stolen from pharmacies; as the user population grows, so does the frequency of these secondary crimes.
And this isn’t a problem that’s likely to fade, police say. Pharmaceutical abuse is an ever-present and equal-opportunity problem, one that has found its way into every zip code and socioeconomic class: gang-infested neighborhoods, hospitals, health care institutions, supermarket pharmacies, wealthy homes and rural areas.
Dude, it’s only a Lortab
Health care and police officials say among the biggest factors driving prescription drug abuse are the general misconceptions about the medications. The U.S. Drug Enforcement Administration divides controlled substances into a scheduling system. Schedule I substances are the hardest drugs with no medical application, such as heroin, PCP and LSD.
The most commonly abused types of prescription drugs, oxycodone and hydrocodone, are Schedule II and III, respectively. But they carry the same addictive risks as their Schedule I siblings. Oxycodone in particular — the most popular street drug — is chemically similar to heroin and has the same effect on the body.
Because they are manufactured by pharmaceutical companies and regulated by the FDA, people mistakenly believe they’re safe, according to Jason Carter, the chief of pharmacy with the state Department of Mental Health and Developmental Disabilities.
“If you ask anybody, ‘If you use heroin, is that a problem?’ I think they’re going to say ‘yes,’ ” Carter said. “But I don’t know that they see the risk is there with these prescription medications.”
Patients often take their prescriptions without knowing the true pharmaceutical punch the drugs pack. And patients can quickly fall into addiction. The cases of notable figures such as NFL quarterback Brett Favre and conservative radio titan Rush Limbaugh are prime examples of medical use snowballing into outright self-destruction.
But prescribers aren’t completely innocent. While some ailments do require high dosages to provide relief, authorities say there is a troubling trend toward overprescription — which, to compound the problem, often isn’t a crime.
But part of Donaldson’s job is to track down dirty doctors. He currently has complaints open on more than two dozen locally. Once he sets his sights on a physician recklessly issuing prescriptions, criminal charges aren’t the only recourse. Donaldson brings together representatives of the federal Drug Enforcement Agency and the medical and pharmacy boards to put a full-court press on bad prescribers.
All told, there are 18,900 doctors and qualified practitioners in Tennessee who can write scripts.
“There are doctors trying to do it the right way, and they have three people [sitting] in their lobby,” he said. “[Bad doctors] have 300 people in theirs.”
But when Nashville’s one-man prescription drug task force can make a case, he makes it hard.
“You get charged criminally, we take your DEA number, we take your medical license, we put you out of business,” Donaldson said. “When we come, we zero you out completely.”
Finding the bad guys
Earlier this year, Metro Police were involved in the takedown of a husband-and-wife physician team working out of a clinic on Charlotte Pike. Dr. Visu Vilvarajah and Dr. Mirielle Lalanne were arrested in February and extradited to Harlan County, Ky., where they were accused of illegally supplying more than 350 people with prescriptions.
In addition to charges of organized crime and wanton endangerment, the couple is accused of providing painkillers to a pregnant woman whose child was born with a drug dependency.
Although reckless prescribers are an integral part of the problem, they’re only half of the equation. Good doctors can be gamed by addicted users who bounce from one practitioner to another, faking aliments to score the stuff. The tactic — known as doctor shopping — has been seen so frequently in Tennessee that the legislature recently stepped in.
A new doctor shopping law, which took effect in July, makes it a violation for a patient to obtain the same controlled substance from more than one doctor, and requires health care professionals to report any patients they suspect of gaming the system.
Another aspect of Tennessee’s growing problem with prescription drug abuse is that the addiction is no longer confined to traditional demographics. Because accessibility is tied to health care access, middle- and upper-class patients with insurance plans were once the most likely abusers.
But pill addiction has shed its white-collar connotation thanks to abuse of TennCare. A growing number of users who can’t afford insurance but are enrolled in the statewide health system have been tapping the program to access medications that they turn around and sell, according to Donaldson. As a result, TennCare is constantly bombarded with forged prescriptions and false claims.
Donaldson believes prescription drugs have completely overhauled the drug game for dealers, users and police.
“The day of the street corner crack dealer is really passed now,” he said.
Police and health officials believe Tennessee can properly address its problem only by following the trails blazed by other states that have successfully dealt with rampant abuse. The state took a first step a few years ago when it instituted internal safeguards in pharmacies, and the new doctor shopping law is a further move toward stanching the flow.
Donaldson eventually would like to see the state institute a program like Kentucky’s KASPER (Kentucky All-Schedule Prescription Electronic Reporting) system, an extensive database that keeps tabs on both prescribers and all prescriptions issued to an individual over a period of time. Because the program streamlined the data system, it’s credited with helping corral that state’s abuse.
But the most dramatic step the state can take toward curbing pharmaceutical addiction is more of a cultural shift: recognizing pill abuse for what it is, Donaldson said.
“Everybody thinks this is without victims because you don’t hear about Xanax heads or Lortab heads — you hear about crack heads,” he said. “People don’t consider prescription drug use an addiction, or users junkies, but they really are.”