Sustained Outrage

Beer-sale comments at WVU released

West Virginia University on Monday released the 326 comments it has received concerning a proposed policy change that would allow beer sales at football games and other athletic events.

Many people who commented are adamantly opposed to alcohol consumption at Milan Puskar Stadium at Mountaineer Field. Ed Dicken simply wrote “NO!” in large type. His was among one of the first comments that WVU received between April 8 and May 13.

“Enough money is being made off football games without throwing alcohol into the equation,” wrote Mike Snyder of Harman.

Other fans say it would further a negative image of WVU as a “party school” and make Mountaineer Field even less family-friendly.

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Who writes the prescriptions?

Last week, the Center for Public Integrity published an interesting piece that noted that fraud in the form of misuse of doctors’ ID numbers is so rampant that Medicare cannot identify the top prescribers of certain drugs, particularly Ritalin and oxycodone, both of which are addictive and prone to be abused.

According to a U.S. Department of Health and Human Services Office of Inspector General (OIG) report released last week , the Centers for Medicare and Medicaid Services are not checking to make sure that prescriptions paid by the health insurance plans that contract with Medicare are written by real doctors.

The new report, based on 2007 data, said invalid physician prescriber numbers are so common in Medicare records that the program cannot identify the doctors who prescribed the most oxycodone and Ritalin. Both are highly addictive and frequently trafficked on the street.

The OIG also said the Centers for Medicare and Medicaid Services could not indentify the second-highest prescriber of methadone, a drug used to treat heroin addiction that is also sometimes diverted to street markets. The new report, which supplements a similar effort published by the OIG last June, focuses just on drugs with potential for abuse, which are known as Schedule II.

Pharmaceutical drugs and suicide attempts

Here’s yet another reason to be extra careful with what’s in your medicine cabinet: When young adults try to kill themselves, the suicide attempt almost always involves pharmaceutical drugs.

More than 92 percent of suicide attempts by people between the ages of 18 and 24 included some kind of pharmaceutical drug use, according to this new analysis of emergency department visits in 2008 by the Substance Abuse and Mental Health Services Administration.

Which is not to say that the pharmaceuticals were the method that every young adult used to try to kill him or herself (most likely herself: 57.6 percent of drug related suicide attempts in this age group were by women). But it does put drugs into the mix, with potentially devastating results. According to the study, suicide was the third leading cause of death in this age group in 2006. This age group was three times more likely to attempt suicide than adults in other age groups, with 1.2 percent of adults between the ages of 18 and 25 having made an attempt.

Of the 600,000-plus emergency room visits by adults aged 18 to 24 in 2008, more than 38,000 — or 6.3 percent — involved a suicide attempt. Of the suicide attempts, the combination of alcohol and drugs is involved roughly three times out of ten.

You can read more about other SAMHSA reports here, here and here.

Tracking felonies

Sometimes, covering crime and courts, the media gets so focused on a particular case that we forget to take a step back and look at the bigger picture. Thankfully, reports like this study from the Bureau of Justice Statistics provide a compelling snapshot of how felonies work their way through the justice system.

The report, Felony Defendants in Large Urban Counties, 2006, looked at the 58,100 felony cases initiated in May 2006. Here are some of the key findings:

— Since 1990, violent crimes have inched downward, from 27 percent of felonies to 23 percent in 2006. The percentage charged with drug crimes have gone up, from 34 percent in 1990 (with a quick dip to 30 percent in 1992) to 37 percent in 2006. Property crimes have also gone down, from a high of 35 percent in 1994 to 29 percent in 2006.

— Defendants seem to be getting older. In 1990, only 10 percent of defendants were 40 or older, and that has risen steadily to 25 percent in 2006. The percentage of defendants under 25 has decreased, from 40 percent in 1990 to 33 percent in 2006.

— More defendants have criminal histories and convictions. In 1992, 55 percent of defendants had a previous felony arrest, compared with 64 percent in 2006. Those with prior felony convictions rose from 36 percent in 1990 to 43 percent in 2006.

— Almost one in three of the defendants charged, 31 percent, were already involved with the criminal justice system, either by being in custody, awaiting trial, or on probation or parole, when they were arrested on the new offense.

— Roughly three out of five defendants charged were released before the case was resolved. Of those, 33 percent engaged in some sort of pretrial misconduct. People facing drug offenses were more likely to have issues during their release (37 percent) than those with pending violent felony charges (26 percent).

The study also looked at typical outcomes for 100 defendants facing charges. Of those, 42 would remain in custody pending trial, while 58 would be released. Eight typically enter into a pretrial diversion with prosecutors, 23 have their cases dismissed, and 69 are prosecuted. Of those 69, four typically go to trial and 65 plead guilty. Of the trials, three result in convictions, and one ends in an acquittal. Of the 68 defendants who are convicted, 56 end in felony convictions, with 11 resulting in misdemeanor convictions. Two dozen will be sentenced to prison, two dozen sentenced to jail, 17 put on probation, and three have other sentences.

Let’s think about that: 95 percent of the convictions come from guilty pleas. Of those people who were convicted, 72 percent were convicted on the original charge for which they were arrested. Seven out of 10 of those convicted ended up incarcerated, either in prison or jail.

Remember, the study only looked at the 75 biggest counties in America, which naturally include some pretty big cities. At 191,000 people, West Virginia’s biggest county, Kanawha, doesn’t even come close. (El Paso County, Texas, is #75, and it has 750,000 residents.) But it still provides an interesting window into how felony cases are handled.

So, what kind of offenses were most likely to end in conviction? The answer may surprise you.

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Drug use and pregnant teens

A recent report by the Substance Abuse and Mental Health Services Administration highlights some interesting trends among pregnant teenagers who seek treatment for drug and alcohol abuse. The report compared admissions from 1992 and 2007, and boy, has a lot changed over 15 years.

First of all, the demographics have shifted. In 1992, 54.5 percent of the pregnant teens admitted for treatment were white, 24 percent were black, and 15.7 percent were Hispanic. By 2007, those percentages were 50.3, 14.7 and 21.4, respectively.

The real eye-opening figures are in the primary substance abused. (A solid majority of pregnant teens admitted to treatment programs reported abusing multiple substances: 60.6 percent in 1992 and 62.5 percent in 2007). Alcohol, by far the dominant substance in 1992 at 44.1 percent, dropped to 20.3 percent in 2007. It was largely supplanted by marijuana, which jumped from 19.3 percent to 45.9 percent. Cocaine (20.2 percent to 6.8 percent) and heroin (4.5 percent to 3.1 percent) trended downwards. But the percentage of pregnant teens abusing methamphetamine more than quadrupled, from 4.3 percent in 1992 to 18.8 percent in 2007.

I also find it interesting that fewer teens are self-reporting (28.5 percent to 17.2 percent), or being referred by alcohol/drug abuse care providers (11.9 percent to 7.6 percent) other health care providers (15.1 percent to 4.7 percent) and schools (6.8 percent to 4.1 percent). Instead, many more are getting caught up in the criminal justice system (21.6 percent in 1992 to 43.3 percent in 2007).

Here’s the conclusion reached by the report:

First, the increased proportion of Hispanic pregnant teen admissions indicates a need for culturally sensitive substance abuse prevention and intervention programs, including culturally appropriate messaging, outreach, and engagement. Second, the quadruple increase in primary methamphetamine abuse highlights the need for educating teachers, primary care physicians, and obstetric and gynecologic specialists about the increased use among pregnant teens, especially in areas where methamphetamine abuse is a large problem or emerging concern, so they can provide the screening, counseling, and interventions necessary to help ensure the delivery of a full-term, healthy infant and the long-term health and well-being of the mother.

Pain pills and ER visits

Here’s another obvious indicator that prescription drug abuse is running rampant (as if we really needed another): emergency room visits attributed to narcotic pain relievers have doubled in just four years.

In 2004, 144,644 people went to the ER for treatment following non-medical use of pain pills, according to this study from the Substance Abuse & Mental Health Services Administration‘s Drug Abuse Warning Network, or DAWN. In 2008, that number was 305,885, an increase of 111 percent.

And here’s a frightening aspect of DAWN’s findings: no one age group or gender seems to account for the spike. The increase is roughly the same for men (110 percent), women (113 percent), people under the age of 21 (113 percent) and 21 and over (112 percent).

The study also breaks the numbers down further, including increases by drug:

— oxycodone, up 152 percent

— hydrocone, up 123 percent

— methadone, up 73 percent

— morphine, up 106 percent

— fentanyl, up 105 percent

— hydromorphone, up 259 percent

The study also splits the numbers down by drug and gender, which reveals some interesting comparisons. Again, these figures reflect an increase in ER visits.

— oxycodone for men, up 148 percent, for women, up 158 percent

— hydrocodone for men, up 137 percent, for women, up 114 percent

— methadone for men, up 59 percent, for women, up 95 percent

— morphine for men, up 124 percent, for women, up 92 percent

— fentanyl for men, up 131 percent, for women, up 87 percent

— hydromorphone for men, up 303 percent, for women, up 234 percent

The study adds:

Among patients younger than 21, the overall increase in ED visits involving the nonmedical use of narcotic pain relievers was driven by increases in visits involving hydrocodone and oxycodone products. Similar to the patterns in ED visits made by patients aged 21 or older, visits by patients younger than 21 that involved hydrocodone products increased 157 percent and those that involved oxycodone products increased 147 percent. Data for visits involving fentanyl products, hydromorphone products, morphine products, and methadone for the younger than 21 age group were either suppressed because of low precision or had percent changes that were not statistically significant (data for drug involvement by age group are not shown).

Pain pills and other narcotic medication were the second leading form of drug abuse in 2008 among Americans 12 and older, behind marijuana, according to the report. The study concludes:

The findings reported here highlight the need to strengthen prevention and education programs designed to reduce the misuse of prescription drugs. Increased efforts are needed to educate the public about the risks of misusing narcotic pain relievers and how to recognize possible symptoms of abuse. Prevention and education campaigns should continue to focus on the dangers of sharing prescription medications, the importance of preventing others from having access to personal prescription medications, and methods for properly disposing of remaining dosage units once the need for medication has passed. Additionally, ongoing efforts are needed to keep doctors and other health care professionals informed about emerging drug problems and to help them understand the importance of exercising care in prescribing pain relievers and monitoring their patients or clients for signs of misuse.

And, just to remind folks, more Americans are dying from drug overdoses than ever before; drug abuse in rural areas is deadlier than in its urban counterpart; and older Americans seem to be abusing drugs more than ever.

Drug abuse and older Americans

The pattern of drug abuse by older Americans may be changing, trending towards hard drugs. According to this study by the Substance Abuse and Mental Health Services Administration, the proportion of older Americans — defined as people 50 and older — admitted to treatment programs almost doubled (from 6.6 percent to 12.2 percent) between 1992 and 2008.

And the reasons older American are seeking treatment in the first place are changing, too. Look at the changes in the primary substance abuse listed as the reason treatment is needed. Alcohol is down, from 84.6 percent (1992) to 59.9 percent (2008), but drugs have soared across the board:

— heroin has more than doubled, from 7.2 percent to 16 percent;

— cocaine has increased from 2.8 percent to 11.4 percent;

— pescription pain relievers jumped from 0.7 percent to 3.5 percent;

— marijuana shot up from 0.6 percent to 2.9 percent;

— and amphetamines skyrocketed from 0.2 percent to 2.5 percent.

The percentage of older people who reported multiple substances as the reason for their treatment also saw a huge increase, from 13.7 percent in 1992 to 39.7 percent in 2008.

Also, the proportion of older Americans who began using within the last five years went down for alcohol (from 42.9 percent to 9.9 percent) and cocaine (29.5 percent to 26.2 percent) but jumped for heroin (11.4 percent to 16.8 percent), pain medication (5.4 percent to 25.8 percent), and amphetamines (1.3 percent to 8.6 percent).

The study concluded:

Policymakers also need to be aware that older adults are a growing proportion of substance abusers and are increasingly abusing substances other than alcohol. In addition, physicians should learn to recognize the signs of substance abuse in their older patients and should be prepared to refer them to treatment when necessary.

When coupled with the fact that deaths from drug overdoses have quintupled over roughly the same period, and that rural drug use is deadlier than urban drug use, and that West Virginia’s population is generally older than in other states, these numbers should be a call to action for those who treat and protect the Mountain State’s older citizens.

Judges and prison sentences

I promise I didn’t set out to make this Prison Week here at Sustained Outrage, but I keep finding interesting information about America’s exploding prison population. Today’s installment comes via the U.S. Sentencing Commission, which in 2007 voted to reduce sentences for crack cocaine violations.

This month, the commission published the results of a survey of federal judges it conducted between January and March of this year. So, how do the group of people tasked with deciding how much time convicted offenders spend behind bars feel about the sentences they hand out?

Well, the answers may surprise you.

When asked if the mandatory minimum sentences associated with various offenses were appropriate, a solid majority of 62 percent said that they are two high in general. When asked about minimums associated with specific crimes, most judges said they were appropriate, with three notable exceptions: For drug trafficking crack cocaine, 76 percent said the minimums are too high. For marijuana crimes, 54 percent said they were too high. And for receiving child pornography, 71 percent of judges surveyed answered that the minimum sentences are too high. This was not the case for production (only 23 percent said too high) or distribution (37 percent) of child pornography.

These results were echoed when the judges were asked about the appropriateness of the ranges suggested by the federal guidelines, which the U.S. Supreme Court ruled are advisory in important opinions in Kimbrough and Gall.

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More on drug overdoses in West Virginia

Last week, the Centers for Disease Control and Prevention released some pretty disturbing figures about overdose deaths in America. The number of deaths from drug overdoses has never been higher, according to CDC figures.

This reinforces earlier information that recreational drug use in rural areas, while not as prevalent as urban and suburban drug use, is deadlier.

Other key findings:

  • In 2006, 26,400 unintentional drug overdose deaths occurred in the United States.
  • Drug overdose deaths were second only to motor vehicle crash deaths among leading causes of unintentional injury death in 2006 in the United States.
  • Rates of drug overdose fatalities have quintupled since 1990.
  • Among deaths attributed to drugs, the most common drug categories are cocaine, heroin, and a type of prescription drug called opioid painkillers.
  • “Opioids” are synthetic versions of opium. They have the ability to reduce pain but can also suppress breathing to a fatal degree when taken in excess. Examples of opioids are oxycodone (OxyContin®), hydrocodone (Vicodin®), and methadone.
  • There has been at least a 10-fold increase in the medical use of opioid painkillers during the last 15 years because of a movement toward more aggressive management of pain.
  • By 2006, opioids were involved in more overdose deaths than heroin and cocaine combined.
  • States in the Appalachian region and the Southwest have the highest death rates.

Alarmingly, in 2006 West Virginia tied with New Mexico for the highest rate of overdose deaths (at 19.1 deaths per 100,000 population). West Virginia fares worse than Kentucky (15.7), Tennessee (14.0), Pennsylvania (12.3), Ohio (11.6) and Virginia (6.4).

More information from the CDC on drug overdoses can be found here, including:

  • From 1999 through 2006, the number of fatal poisonings involving opioid analgesics more than tripled from 4,000 to 13,800 deaths.
  • Opioid analgesics were involved in almost 40% of all poisoning deaths in 2006.
  • In 2006, the rate of poisoning deaths involving opioid analgesics was higher for males, persons aged 35-54 years, and non-Hispanic white persons than for females and those in other age and racial/ethnic groups.
  • In about one-half of the deaths involving opioid analgesics, more than one type of drug was specified as contributing to the death, with benzodiazepines specified with opioid analgesics most frequently.