Two Windham County residents were arrested last fall for forging prescriptions stolen from a Rockingham doctor's office, only one recent example of abuse of prescription drugs on the rise.
More difficult to nail down than other kinds of drug misuse and abuse because many people believe that prescription drugs are more legitimate or safer, officials are left struggling to get a handle on the problem.
When formulated as prescription drugs, opioids - drugs that are chemically related to the compounds found in opium - are highly addictive. Worse, they can easily lead to abuse of their chemical relative, heroin.
The death in Burlington of a young man in 2009 from a heroin overdose became a poignant vehicle for the problem, which led to the making of a film to try to discourage college students from taking these extremely addictive drugs.
All these examples highlight the problem Vermonters face as they confront the insidious problem of prescription drug abuse.
After several months of investigation by the Vermont and New Hampshire State Police, as well as the Walpole and Keene police, two men were charged with “uttering a false prescription” using a Rockingham doctor's prescription and signature on Sept. 20.
Shaun Legasse, 32, of Bellows Falls, turned himself in to the Lebanon District Court, and Robert Phelps, also from Bellows Falls, according to a New Hampshire State Police Narcotics and Investigations Unit press release, turned himself in to the Walpole, N.H., Police Department, where they were processed and taken into custody.
“A Rockingham doctor's office notified us of their suspicions,” New Hampshire State Trooper Mark Beaudoin said. “These individuals chose that doctor's office to put together a prescription. We started to do some investigating.”
Legasse and Phelps were both allegedly caught on video surveillance using the fake prescriptions at several different pharmacies, confirming investigators' suspicions.
“Uttering a false prescription” is legalese for forging a prescription. In this case, the two men were seeking prescriptions for Oxycodone, a Schedule II drug.
Beaudoin explained that compared to other cases he has seen, however, this one was simple.
“One woman [arrested] went to 23 different doctors in six states [to obtain prescription drugs],” he said. “That one was harder to nail down.”
Detective Sgt. Shane Harris of the Bellows Falls Police Department, who has worked in the Vermont State Narcotics Unit, pointed out that Vermont is one of the few states in the country that does not require identification to pick up any prescription, let alone a Schedule II drug.
Specified drugs are regulated by the U.S. Controlled Substances Act because, though they have valid medical use (even despite severe restriction), they have the potential for abuse or have the potential to cause mental or physical harm.
Opiates, stimulants, depressants, cannabinoids, and “immediate precursors” like phenylacetone, used to manufacture methamphetamine and amphetamines, are regulated under this act.
But in Vermont, almost no measures are in place to ensure that the person picking up the drug is the one for whom the drug was prescribed, or between agencies or doctors to monitor a person's usage.
The Vermont Prescription Monitoring System (VPMS) was signed into law in 2006, and put into service in 2009 as a program of the state Department of Health's Agency of Human Services.
But there are holes in the system that result from the conflicting balance between patient confidentiality and access to the information for non-medical reasons.
The State Police is the only law enforcement agency allowed to access information, and even then only when a suspected illegal use of prescription drugs is under active investigation.
Furthermore, when providers access the system to see a patient's prescriptions or enter new information into it, they do so voluntarily.
Which means the holes in the current system are big enough to allow criminals and addicts to access Schedule Class drugs with impunity.
“What we are seeing is people are going to multiple doctors for multiple prescriptions” when the amount prescribed is no longer enough to meet their need, or addiction, Harris said.
Pain doctors know all too well that someone on opioid-based pain medications develop a tolerance to any given drug, and they regularly rotate drugs to try to keep their patient's pain under control.
“How do you tell how much pain someone can tolerate? How do you tell how much of a medication a patient needs so they can sleep at night?” Harris asked. “Doctors have to rely on signs and symptoms, and what the patient tells them.”
Signs and symptoms that a doctor recognizes as worthy of managing with one of the Schedule II drugs can also be found online.
“Addicts get really good at telling the doctor the right words to get what they want,” Harris said. “And if they don't, they'll find a way.”
The street value of almost any drug is higher than what one pays at the pharmacy, so someone who has obtained the drugs legitimately might “share” their prescription with someone. In economic hard times, it's also an easy, quick source of income.
“People think because it's a legally prescribed drug, it must be okay,” Harris said. “Our society has grown tolerant of using drugs to cure what ails them.”
“So when someone is visiting someone and complains of pain, a person with leftover Vicodin [an opioid with acetaminophen] from a surgery or other legitimately prescribed pain medication will think nothing of offering them a pill. And no one reports it. It's okay in their eyes.”
But it's illegal.
“Unlike street drugs, many teenagers and adults mistakenly believe that prescription medications are safe to use since they are manufactured and legally sold to the public,” said United States Attorney General Eric Holder as he addressed the Vermont Opiate Drug Abuse Conference in September 2010.
At the time, Holder said the number of prescription drug abusers in the country had surpassed the number of marijuana abusers.
According to Robert Bick, director of mental health and substance abuse services at the Howard Center in Burlington, ”80 percent [of clients] identify prescription drugs as the drug they abuse.”
Within just four years, the nation saw a 400-percent increase in the number of treatment admissions for prescription drug abuse, and the number of emergency department visits nationwide related to non-medical use of prescription drugs jumped by 111 percent.
Within two decades, U.S. prescriptions for opiate medications rose from 40 million to 180 million.
“Today, one in seven teenagers admits to abusing prescription drugs, and opiate medication misuse is the leading cause of drug-related injuries among adults 65 and older,” Holder noted.
“Anyone passing or selling a Schedule II drug to an unauthorized person can be arrested. It doesn't matter how many, or what their motivation was, in giving that person the drug,” Harris explained. “It doesn't matter if they hand them one or two, or more for free, or sell it.”
Henry “Skip” Gates Jr., formerly of Brattleboro and now of Skowhegan, Maine, said his son, William, could talk when he was five months old, and “he was completing sentences at one year.”
His son was an athlete and excellent ski racer, and “always liked to push the edge.”
William, he said, “was brilliant.”
“We supported and encouraged him. When he wanted to take up motocross in high school, we got him a moped and said if he could rebuild it, we would get him him a motocross bike. The next day, he walked in and said, 'Dad, it's done. Now can I have my bike?”
Gates's son graduated high school and entered the University of Vermont, where he was accepted into its cutting-edge molecular genetics program, one among only a handful of students in the program, “and he loved it. He thrived there,” his father said.
William Gates was found dead in March 2009 of a heroin overdose. He was 20 years old.
“We trusted his judgment,” Gates said. “When we would ask him about drugs, he would say, 'No way, Dad. I'm a scientist. I know what that stuff does to my brain and my body.'”
“And we believed him,” Gates said.
“He was passionate about everything he did,” said Gates, who thinks that is what led William to take heroin the night he died.
The Opiate Effect is a short film directed by Derek Hallquist, and commissioned by Tristram Coffin, U.S. attorney for the District of Vermont.
The film focuses on prescription drug abuse and uses William Gates's death as the focal point. Everyone involved in the film has been touched personally by prescription drug abuse, directly or indirectly.
“When they came to me about doing the film and using William as an example, I realized I had to say yes,” Gates said. “It wasn't easy. Especially when they wanted to film at the ski hill.”
“I was in close to tears the whole time,” he said. “But if this film saves just one family from the pain ours has experienced, it's worth it.”
Gates said the only thing that helps him is talking about it.
“So don't be afraid to ask me questions. I need to do this,” said Gates, who speaks throughout New England about his son and effects of opiates.
William Gates's status as a talented athlete and above-average intelligence did not make him immune. Skip Gates doesn't know when his son started using opiates, or even if the night he died, the heroin was a one-time use. He was told by the detective on the case that “William was not an habitual user.”
Statistics indicate that if that detective was correct, that would be a rare case.
According to Harris, as well as one young recovering addict in the film, once a person is hooked on a prescription like Oxycodone, a synthetic opioid often sold under the trade name Oxycontin, many addicts see it as a natural step to using the chemically similar heroin.
As the drugs take over the addict's life, “everything else falls away. If it's a choice between whether you buy food or drugs, it's going to be the drugs every time.”
Another addict in the film said, “At some point, it becomes a financial consideration. Heroin is cheaper.”
We now know where William Gates got the heroin on which he overdosed: from two men from New York who are serving jail time. But we will never know what convinced him it was okay to take the fatal step to using the heroin that killed him.
“He thought he could do it and get away with it,” said Sam Gates, William's brother. “He was wrong.”