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CNN LIVE EVENT/SPECIAL

CNN Presents: Deadly Dose

Aired November 18, 2012 - 20:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


UNIDENTIFIED MALE: This so drug overdose call.

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Every 19 minutes in the United States, someone dies of an accidental overdose.

BILL CLINTON, FORMER U.S. PRESIDENT: This is crazy. Not a single solitary one of these people has to die.

S. GUPTA: We are used to thinking of it starting here, looking like this but something happened in this country. And now, increasingly, it starts here, in your own home.

DR. ALEX KAHANA, CHIEF OF PAIN MEDICINE, UNIVERSITY OF WASHINGTON: As we speak, someone is dying, right now.

S. GUPTA: And over the next hour, three people will die.

ALEX GUPTA, BENJAMIN GUPTA'S BROTHER: He went to sleep and he had no idea this was going to be his last night on earth.

S. GUPTA: From misusing perfectly legal prescription drugs. Taking a DEADLY DOSE.

UNIDENTIFIED FEMALE: Poison Center, this is Deborah.

UNIDENTIFIED FEMALE: I'm a little concerned that I may have taken something that wasn't good for me on accident.

UNIDENTIFIED MALE: I took a few methadone from my grandpa.

UNIDENTIFIED FEMALE: OK.

UNIDENTIFIED MALE: And they were 10 milligrams.

S. GUPTA: What you're listening to are actual calls.

UNIDENTIFIED FEMALE: How is he acting?

S. GUPTA: At the Washington Poison Center in Seattle.

UNIDENTIFIED FEMALE: Just drowsy? OK.

S. GUPTA: And lately, more and more of them sound something like this.

UNIDENTIFIED MALE: And today, I took about 90 milligrams of Percocet. UNIDENTIFIED FEMALE: You did?

UNIDENTIFIED MALE: It's 6:00, I wasn't really thinking and I did a bar of Xanax and I'm reading all this stuff online about how that's a very lethal combination. But I have a lot of friends who died during their sleep and I just wasn't really thinking.

UNIDENTIFIED FEMALE: Yes.

UNIDENTIFIED MALE: Now I'm wondering if I should stay up tonight.

S. GUPTA: That kind of call to me is really scary.

DR. BILL HURLEY, MEDICAL DIRECTOR, WASHINGTON POISON CENTER: Oh, it is scary.

S. GUPTA: What goes through your mind?

HURLEY: So, I'd be very frightened about that young man not making it through the night.

S. GUPTA: Dr. Bill Hurley is the medical director of the Poison Center. He is also a trauma doctor.

HURLEY: Possibly too many of his meds. They are not sure what all they've got.

S. GUPTA: We are here in Seattle, in part, because the problem is bad.

HURLEY: This bottle still has quite a bit in it.

S. GUPTA: But also because, as you will see, there are real solutions.

HURLEY: No other meds?

S. GUPTA: For Hurley it started five years ago.

HURLEY: He's got pinpoint pupils.

S. GUPTA: He started noticing overdoses, a lot of them, coming through his ER doors.

HURLEY: We thought, well, these are the guys who are on the street, maybe using heroin.

S. GUPTA: But looking deeper, he realized they weren't junkies, not at all. It usually began with a back sprain.

HURLEY: They were taking these medications not to get high but to try to control pain in most cases, back pain, and then they were mixing them with other medications and having fatal reactions to that.

S. GUPTA: I mean, a lot of people have back pain. A lot of people take pain medications for that pain. And what you're saying is a lot of those people are then dying?

HURLEY: Yes. A lot of them are dying and a lot of people in our culture right now are at risk of dying from the exact same thing.

S. GUPTA: I wanted to know more. So they allowed me to listen in.

UNIDENTIFIED FEMALE: Poison Center. May I help you?

UNIDENTIFIED MALE: Yes, my wife took Hydromet and when we checked it later, she had taken 30 millimeters instead of five.

S. GUPTA: To see the problem firsthand, I rode along with Lieutenant Craig Amman. He's been on the job for 30 years. He will tell you, when he takes an overdose call the usual suspect is a painkiller.

What sort of impact have you seen here in Seattle?

LT. CRAIG AMAN, SEATTLE FIRE DEPARTMENT: Well, I think if you pull a group of people together from this community, someone in that group is going to have had a friend, a loved one that has either had difficulty with a prescription drug or potentially died from that.

S. GUPTA: Aman's unit responds to 45 calls a month about overdoses involving these types of medications. And this is important, it can be difficult to tell whether it's a painkiller or heroin, because they come from the same ingredient and do the same sort of thing to your body.

Aside from needle tracks in the arms, someone who's had an overdose of pain medication like that or heroin, they could look very much the same?

AMAN: Absolutely. One, they could be unconscious from a medication that they think is relatively safe for them because instead of getting it on the street, they get it from a pharmacist.

UNIDENTIFIED MALE: OK. That's 36, code green.

AMAN: Possible drug overdose.

These people are suffering from chronic pain. They know that a little bit of pain medication helps, so maybe a lot would help a lot more.

S. GUPTA: When we arrive, another medic is on the scene.

Somewhere in that parking garage, there's a call about someone having a drug overdose.

The overdose victim came to and walked away, but while we're there, another call. And it's been just a few minutes.

UNIDENTIFIED MALE: We've got a 52-year-old male. He took approximately three Dilaudid, plus methadone, up to three hours ago.

S. GUPTA: I decided to ride along with Lieutenant John Fisk, who's headed to the scene. LT. JOHN FISK, SEATTLE FIRE DEPARTMENT: Yes. It sounds like he has decreased level of consciousness and some respiratory compromise. It sounds like a narcotic overdose.

S. GUPTA: Car crashes are no longer the number one reason people die accidentally in the United States. Nowadays it's actually prescription drugs. That's because on any given day people take more than the recommended dose, mix and match or take medications not prescribed to them. Maybe take pills with alcohol. And all of it can make for a deadly dose.

In fact, the most recent data shows 37,000 drug overdose deaths in one year, mostly accidental. About 21,000 involved prescription drugs. And of those 75 percent were pain killers.

By the end of this hour, I promise you, your idea of a potential overdose victim will change. To this.

HURLEY: This could be you. It could be me.

S. GUPTA: And that's the point. It could be anyone.

CLINTON: He was big, strong, handsome and smart. Wanted to make something of his life. He had no idea that he was turning off the lights. None. And if it's true of him it's got to be true of a lot of other people.

(COMMERCIAL BREAK)

S. GUPTA: On December 19th, 2011, Benjamin Gupta, a law and MBA student at George Washington University died suddenly. Mysteriously. He is no relationship to me, but when his family got word, they spent hours trading phone calls. They were in stunned disbelief.

VINOD GUPTA, BENJAMIN GUPTA'S FATHER: There was a message from his mom. And she had left three messages for me, so I knew there was something wrong.

ALEX GUPTA, BENJAMIN GUPTA'S BROTHER: I received a call from my mom. I didn't answer but then I got a text message from her, which is very unusual.

V. GUPTA: And I called her back. And I said, what happened? And she says, it's Ben. He died. I just -- I didn't have any of the information.

A. GUPTA: I finally said, how did this happen? And she said he went to sleep the night before and he just never woke up.

V. GUPTA: He's always smiling, you know. In every picture he was smiling.

S. GUPTA: Yes.

For days Ben Gupta's family was desperate for answers. What killed him? He was only 28 years old. He had recently been given a clean bill of health. How could he just not wake up?

V. GUPTA: And then the thoughts went through my mind that maybe it was some sort of a brain aneurism or something must have happened.

S. GUPTA: But his father was in for a shock after a conversation with the doctor who performed Ben's autopsy.

V. GUPTA: And he called me and said, yes, you know, they found oxycodone in his system.

S. GUPTA: He tells you he believes that your son died of a -- an overdose of narcotics?

V. GUPTA: Yes, right.

S. GUPTA: What do you think at that point?

V. GUPTA: I was just shocked at that time.

S. GUPTA: Did you think it was possible, what you knew of your son?

V. GUPTA: No. No.

STUART BRIDGE, BENJAMIN GUPTA'S FRIEND: He worked for the State Department and he, you know, was going to graduate in a year with a dual law and MBA degrees, you know, the type of person where it just doesn't even run through your head that he is having a problem because he does so well.

S. GUPTA: Stuart Bridge was a close friend of Ben's. They met in grammar school. He recalled a conversation that would later prove to be very important.

BRIDGE: He had met somebody new and he really liked this new girl that he was dating.

S. GUPTA: And Ben told Stuart that he and his new girlfriend had tried oxycodone and they thought it was no big deal.

BRIDGE: You know, I'm not doing it regularly. It's not something I'm seeking out, but it's something that I've tried.

S. GUPTA: Now anyone else might just shrug off that conversation, but Bridge wasn't just a friend. He's also a doctor. And he warned Ben about taking oxycodone and about mixing it with alcohol.

BRIDGE: I had seen people die who are on these medications or who have, you know, experimented with these medications.

S. GUPTA: From just experimenting, the reason the line between experimentation and death, it turns out, is tenuous.

Oxycodone and other pain killers like it are what's called central nervous system or CNS depressants. They slow down the body's vital functions -- breathing, heart rate, blood pressure. That's not usually a problem when the pills are prescribed for you, but when you add them to other CNS depressants, like alcohol or other prescription drugs, the effect is multiplied. The nervous system slows and slows until breathing, heart rate, brain function, all grind to a halt.

Ben's deadly dose, according to his girlfriend, was drinking beer and scotch throughout the day along with an unknown quantity of oxycodone. When his blood alcohol level was tested it registered .04. That's relatively low, less than half the legal limit.

Here is the implication, it may not take much alcohol to tip the balance toward death.

Ben fell asleep in front of the TV and by the next morning, he had stopped breathing.

A. GUPTA: It almost what makes it even more frightening, that he went to sleep and he had no idea this was going to be his last night on earth. I mean, he had no idea that this was going to be it.

BRIDGE: It just seems so preventable and so stupid. It just didn't have to happen like this. It didn't have to be, you know, like that.

CLINTON: You explained what happened to my friend to me in two sentences. If people get something that simple, that direct, then it almost doesn't matter how boozed up they get before they pop the pill. They will remember that.

S. GUPTA: How are you?

I first learned about Ben Gupta's story when I got a phone call just after his death from former President Bill Clinton. Ben's father, Vinod, is an old friend of the Clintons. Over the years, he's donated thousands of dollars to theirs and other Democratic political campaigns and over time, the families became close friends.

CLINTON: Ben, a beautiful man, with a beautiful life. Some people live four times as long and don't do as much good or bring as much joy.

S. GUPTA: Why did you decide to call me?

CLINTON: I called you in desperation. I wanted to know what to do. I just knew that somebody needed to do something but that's why I called you. I thought you, A, I knew you'd care about it. And B, I thought you'd know something about it.

S. GUPTA: I could tell in your voice that -- I mean, you're pretty broken up. What kind of kid was he?

CLINTON: A light shined out of him. That's all I can tell you. He grew up, he was big, strong, handsome, smart. And wanted to make something of his life. He was industrious, but he was normal. He liked to have a good time. He had -- I promise that night he had no idea that he was turning out the lights. None. And if it's true of him, it's got to be true of a lot of other people.

S. GUPTA: As soon as people hear that someone died of a drug overdose, they immediately have a perception of who that person was, what kind of life they led, their behaviors. It's not true in a lot of these people.

CLINTON: No.

S. GUPTA: Including Ben.

CLINTON: We -- all of us, the whole culture, we need to start thinking about this. This is crazy. Not a single solitary one of these people has to die.

S. GUPTA: President Clinton said to me, nobody thinks that taking an oxycontin and a few beer is good idea but you also don't think you're going to die.

V. GUPTA: Yes.

S. GUPTA: Do you think that was Ben's sort of state of mind? I know that this is playing with fire a little bit but I'm not going to die.

V. GUPTA: I don't think that he knew that this could kill him, you know?

S. GUPTA: Vinod finds some solace from his son's death by funding programs that educate people about the dangers of misusing prescription drugs and recently he made as one million pledge to the Clinton Global Initiative to support the former president's newfound passion about this issue.

CLINTON: He said, I have been very fortunate. And my son was worth $1 million.

S. GUPTA: It's still hard to talk about.

V. GUPTA: It is. It is.

S. GUPTA: Do you think it ever won't be?

V. GUPTA: No. I think about him all the time. Like I'm in D.C. today so I've been walking on the GW campus looking for him.

S. GUPTA: You're looking for him?

V. GUPTA: Yes. And I could feel him. I could feel him. Every day, I just miss him. Every day.

BEN: My girlfriend found me dead already. I had been not breathing, no pulse. And I was turning blue.

(COMMERCIAL BREAK)

HURLEY: We'll tie it so it looked like he downed the 200s.

S. GUPTA: In cities across the country this scene plays out every day. I saw it myself on a ride-along with Lieutenant John Fisk of the Seattle Fire Department. The person had three Dilaudid, two methadone.

This patient's deadly dose, an anti-seizure medication and a couple of powerful pain killers.

FISK: He may have stockpiled some of his own and taken it afterwards.

S. GUPTA: It's called stacking, prescription pills stacked on top of other pills, each one amplifying the previous one's effect.

DR. STEPHEN ANDERSON, AMERICAN COLLEGE OF EMERGENCY PHYSICIAN: I'd say it probably began about 10 years ago.

S. GUPTA: Dr. Stephen Anderson, an ER doctor in Washington state, sees the end result of stacking virtually every time he goes to work.

ANDERSON: I've taken two Vicodin before, no problem. I've taken a valium to sleep before. No problem. I've had a couple of drinks before. No problem. But all of a sudden, you add all of those into the same scenario and it adds up and causes the complications.

S. GUPTA: You're talking about, when you say stacking, sounds like it making it exponentially worse.

ANDERSON: Exactly.

S. GUPTA: Here's why/ Pop a pain pill and you get relief. And at the same time, your breathing slows down. Now even after the pain relief wears off that slowed breathing persists, sometimes for hours. Now if you pop another pain pill before it's time, you depress the breathing even more.

Some of the deadliest combinations, high-dose painkillers stacked on other painkillers. Painkillers stacked with anti-anxiety medications or painkillers mixed with alcohol.

ANDERSON: We have seen absolute skyrocketing of overdose deaths and correlates directly with the number of prescriptions that are written.

S. GUPTA: The problem, in part, is that here in the United States, we are being flooded with painkillers. Consider this, Americans take 80 percent of the world's painkillers. Eighty percent. Distribution of morphine, which is the main ingredient in most popular painkillers, increased by 600 percent between 1997 and 2007.

Pain couldn't have increased that much in 10 years but painkillers did. It's become a lucrative business and with so many pills out there, there's no broad system in place for doctors and pharmacies to keep track of it all. And again, every 19 minutes, we see the consequence. And that doesn't even account for people like this man who came close, too close to dying.

Thankfully, he survived. And so did this man from Virginia.

BEN: My girlfriend found me, dead and not breathing, no pulse.

S. GUPTA: His name is Ben. He didn't want to give his last name.

BEN: I took some.

S. GUPTA: Now listen closely. What he is describing is nearly dying after an overdose.

BEN: I remember standing around feeling good, talking with someone, and then thinking, I just need to sit down for a second. I was turning blue. I was gone in a minute. I had only had a few beers and I had also taken plenty of methadone at the same time.

S. GUPTA: Methadone, which you may recognize as a treatment for heroin addicts, is also a popular painkiller prescribed by doctors. When he overdosed about four years ago, it was the first time Ben had tried it.

Do you remember the point when you started using prescription drugs?

BEN: Well, originally, I had been prescribed them for an injury. I was on painkillers and muscle relaxers and definitely even within that time probably there were a couple of days when I took more than I was prescribed.

S. GUPTA: Did you think about the safety at all?

BEN: It's classic statement, this isn't going to happen to me. Well, of course, everyone who it happens to said that at one point.

S. GUPTA: And that's where the story of Ben from Virginia intercepts with Ben Gupta, the law student, and thousands of other unwitting overdose victims. It won't happen to me.

BEN: It's more realistic for someone like me who has a job to overdose because it's amazing how little you need of a mix of alcohol and narcotics to overdose when your body is not used to it.

S. GUPTA: How little are we talking about?

BEN: I think it was maybe four or five beers and two or three shots, and that was it.

S. GUPTA: A few beers, a couple of shots and some methadone?

BEN: Exactly.

S. GUPTA: He was at a party. He felt sleepy. And then he stopped breathing.

Your girlfriend just happened to find you?

BEN: Thankfully. Yes.

S. GUPTA: If she hadn't found you?

BEN: I wouldn't be here.

S. GUPTA: You'd be dead? For sure?

BEN: Definitely. I was dead when she found me.

S. GUPTA: For Ben the story is going to sound familiar. It started with a prescription for shoulder pain. In fact, he, in part, fits the profile of an overdose victim. Typically, they are male. They are in their 40s and 50s. They started with a prescription. And three years later, they were dead.

Between the time he got his pain prescription and then had his overdose, Ben started to become dependent.

BEN: Started out with small, like, you know, Vicodin and Percoset, but then, of course, those don't work as well, you eventually someday try oxycontin.

S. GUPTA: At your peak, how much were you taking?

BEN: Eight to 10 80s in a day. And still function.

S. GUPTA: Eight to 10 80s?

BEN: Yes.

ANDERSON: They are 10 to 15 times stronger than anything we used to have and I don't think that people fully appreciate how strong those medicines are. And they are longer and longer acting and that's part of the problem, too.

S. GUPTA: Another problem, these powerful painkillers were originally intended to treat end of life and cancer pain, but see, those patients didn't live very long so there wasn't long-term data on what they would do to Ben or to me or, frankly, to most people who now take them.

They are being prescribed for all sorts of chronic pain problems with no data to suggest that high doses of powerful painkillers are either safe or effective over the long term.

DR. JANE BALLANTINE, PAIN MEDICATION EXPERT: When did you start taking opiates?

S. GUPTA: Dr. Jane Ballantine is an anesthesiologist at the University of Washington.

BALLANTINE: You had very good physical therapists.

S. GUPTA: Ten years ago, while treating patients on high doses of painkillers, she found something surprising. Not only with those patients not getting pain relief but the painkillers were, in fact, doing something that could best be described as the opposite, making patients more sensitive to pain.

It's called hyperalgesia. So more pain medications ultimately meant more pain. And that, of course, means, well, even more pain medications. It's easy to see the problem. BALLANTINE: The high hyperalgesia was so obvious in those patients that you could, for example, see that they couldn't bear the sheet on them or any intravenous stick was abnormally painful to them.

S. GUPTA: You said that this has essentially been 20 years of failed experiment and that not many people are sort of supporting this anymore except forth diehards and the pharmaceutical industry.

BALLANTINE: I would never suggest that we shouldn't continue to prescribe for those that are really helped by opiates, people who have a real need, but the way we do it at the moment is actually harming more patients than it helps.

HURLEY: It's the McDonald's phenomenon. You can go to the emergency department and get your pain relived immediately.

(COMMERCIAL BREAK)

S. GUPTA: Former President Bill Clinton's familiarity with pain killers goes back to when he lived in the White House.

Have you ever been prescribed a medication like this?

CLINTON: Well, I did take some painkillers when I tore my -- 90 percent of my quadriceps, but I tried to be very careful and I was in a lot of pain.

S. GUPTA: And years after leaving the Oval Office, he would once again need pain pills. He said he and his doctors were cautious.

CLINTON: After my heart surgery, you know, when I was -- I hurt pretty bad for three weeks so I got some medicine, but I really tried to get off of it as quick as I could and my doctors were really good about it, you know, telling me, you know, take this if it's killing you, but be careful.

UNIDENTIFIED FEMALE: Poison Center. This is Rosie.

S. GUPTA: Be careful. It's a warning that might prevent call after call pouring in here at the Washington Poison Center.

UNIDENTIFIED FEMALE: Poison Center, this is Deborah.

UNIDENTIFIED MALE: I wasn't getting pain relief so I took too many oxycodone. I, took, um, five 10-milligram oxycodone. And I'm feeling really shaky, light headed. I'm just nervous.

HURLEY: For the most part this hasn't been recognized as a national phenomenon or a national problem at all.

S. GUPTA: Not recognized among the general population and also not recognize among the medical community?

HURLEY. Exactly. They had no idea that this combination of medications could lead to their death, and in many cases, their doctors don't recognize the risk to those patients. S. GUPTA: So how did we quietly become a country inundated with pain pills? Some believe it all began when pain was designated the fifth vital sign.

When you talk about vital signs, typically, someone gets their body temperature measured, their heart rate, their respiratory rate and their blood pressure, but the results of this push to say the fifth vital sign is pain. Never forget about asking someone about their pain.

You think that fueled this or helped drive this?

HURLEY: I do. I think physicians around year 2000 started to get pushed to better manage pain. And the physicians in our culture, that means give out more medication.

S. GUPTA: So pain becomes a vital sign. Laws are passed liberalizing the use of opiods for more than just cancer or chronic pain patients. That creates new marketing opportunities for aggressive pharmaceutical companies. Doctors prescribe the drugs for legitimate reasons but also for conditions that could be treated with much milder medications or with therapy.

The result, we prescribe enough pain pills to give every man, woman and child a dose every four hours for three weeks. Remember, 80 percent of the world's opioids are used by Americans.

Eighty percent. Does that surprise you?

CLINTON: I didn't know that. No, because --

S. GUPTA: Is that a cultural U.S. problem?

CLINTON: Yes. It is cultural and you know, people think I've got a headache, or about this, or my elbow is sore whatever. And look, I don't want to minimize, there are a lot of people who live courageous lives in constant pain but there's no question. This since we represent 5 percent of the world's people we got no business popping as many pills as we do.

S. GUPTA: Why is this, do you think, such a distinct American phenomenon?

HURLEY: We like things to happen quickly and instantaneously. It's the McDonald's phenomenon. You can drive through and get your food immediately. The same things, you can go to the emergency department and get your pain relived immediately.

S. GUPTA: Immediate relief but very little education to the dangers. And lots of questions about the long-term use of opioids. A concern I put to John Castellani know. He is president and CEO of the Pharmaceutical Research and Manufacturers of America, which represents and lobbies on behalf of drug manufacturers.

Do you know of any studies that actually show people taking narcotics for longer periods of time, other than that would be associated with end of life care or terminal cancer and having positive, consistent results?

JOHN CASTELLANI, PRESIDENT AND CEP, PHRMA: Well, we do know is the feedback we get from patients and from physicians and that is where patients are able to manage pain, with their physician, they are able to manage their chronic and acute pain, they have better lifestyles. They have a more robust life.

S. GUPTA: But remember, there is no good scientific data on the effects of long-term use of high-dose opioids.

Do you think we prescribe too many pain medications in this country?

CASTELLANI: I can't -- I can't answer that. That has to be a decision between patients and their doctors.

S. GUPTA: Are these medications addictive or not?

CASTELLANI: Narcotics? Everything I know is that they are if they are misused. If they are used properly, they are not.

S. GUPTA: Problem is misuse is rampant. In 2010, about 12 million Americans reported using painkillers without a prescription or medical need, and that number, every 19 minutes, someone died.

The challenge of course is finding way to stop misuse, addiction and death. Without cutting off a lifeline.

UNIDENTIFIED FEMALE: Life starts to lose some of its meaning when you're in chronic pain.

UNIDENTIFIED MALE: I had seen her crawled up in the fetal position for hours.

(COMMERCIAL BREAK)

S. GUPTA: Which was the most effective tool that we've offered you?

UNIDENTIFIED FEMALE: Methadone.

UNIDENTIFIED FEMALE: Hi, welcome back.

UNIDENTIFIED FEMALE: Could you just tell me about when your pain started?

UNIDENTIFIED MALE: Well, actually started after I had my stroke.

UNIDENTIFIED MALE: Hi, my name is Eric Hall.

S. GUPTA: The University of Washington Center for pain relief is busier than ever.

HURLEY: Most of my pain comes from laying down at night.

KAHANA: Every single day, we see anywhere between 250 to 300 patients that suffer from acute, post-op operative, cancer around chronic pain. And this spot by the way is my favorite. S. GUPTA: Dr. Alex Kahana is the chief of pain medicine at the University of Washington.

KAHANA: Now it's all for the patient. This is not a clinic with doctors' offices. This is for patients.

S. GUPTA: And he designed its Center for Pain to be a welcoming, supportive environment for parents who struggle to live normal lives.

KAHANA: To make it, you know, human, to make it tender, to make it hospitable. When people ask me is it hard? No, it's not. It's a privilege to do that.

S. GUPTA: And it gets to you, doesn't it?

KAHANA: Yes.

BALLANTINE: You are taking more than we now consider a safe dose.

S. GUPTA: Many of these patients are here because some physicians and legislators are trying to curb Washington state's prescription drug overdose problem.

Dr. Gary Franklin, medical director, Washington Department of Labor and Industries."

(COMMERCIAL BREAK)

S. GUPTA: Dr. Gary Franklin is medical director for the state of Washington's Department of Labor and Industries.

When is the first time this even became an issue that you had noticed?

FRANKLIN: By 2001, were sending me cases of injured workers who had had a low back sprain. And were dead three years later from an unintentional overdose of prescribed opioids. It wasn't the saddest I'd ever seen.

S. GUPTA: So he took action helping write guidelines of this year, became state law. It applies to non-cancer chronic pain patients. It mandates prescriber education. Treatment plans called pain contracts between physicians and patients and tracking of Opiod use.

FRANKLIN: UNIDENTIFIED MALE: Opioids don't do new laws reflecting best practices on universal precautions so opioids can be used much more safely and effectively this will never turn around.

S. GUPTA: The Washington state law does have its share of critics, many of whom are patients dealing with pain right now. They are particularly concerned about one provision. It requires that if a physician wants to prescribe a daily dosage of an opiate above a certain amount, he or she must first consult with a pain specialist.

The problem is there aren't enough specialists.

KAHANA: There are not enough pain docs in the world to take care of all the pain in King County, let alone in Seattle. Simply not enough.

UNIDENTIFIED MALE: Today on a scale of zero to ten what would you rate your pain as?

S. GUPTA: And that's why the University of Washington Center for Pain Relief is inundated with referrals.

UNIDENTIFIED FEMALE: Valerie Edwards from Sitka, Alaska.

S. GUPTA: It's also why it organizes so-called telepain conferences in which the center's experts provide advice to physicians.

UNIDENTIFIED MALE: It's a 33-year-old woman with joint pains and you've got questions above, I think, diagnosis and some frequent strategies.

S. GUPTA: Many of whom are practicing in remote locations.

UNIDENTIFIED FEMALE: Her primary concern is just severe joint pain.

KAHANA: Yesterday we had 50 dials-in all over the country from Sitka, Alaska, all the way to Rochester, New York.

UNIDENTIFIED MALE: Does she actually swallowed issue, that you could see in her hands.

S. GUPTA: One of the biggest fears about the new law is that doctors, unhappy with its requirements, we'll stop accepting or treating legitimate pain patients. That those with chronic conditions would be left with the care and the medications they need.

UNIDENTIFIED FEMALE: Life starts to lose some of its meaning when you are in chronic pain.

UNIDENTIFIED MALE: I have seen her curled up in the fetal position for hours, even crying at times.

S. GUPTA: In Tacoma, Washington, Christie and Burt (INAUDIBLE), husband and wife are both in pain, his is caused by multiple sclerosis.

UNIDENTIFIED MALE: My leg is constantly being electrocuted from the inside out.

S. GUPTA: Hers caused by a car accident, 16 years ago.

UNIDENTIFIED FEMALE: I was in a big old '77 Chevrolet station wagon, bent it in half, I looked in my rearview mirror and I could actually see the woman putting mascara on and I know I was in trouble.

S. GUPTA: You're slowing down or stopped the light.

UNIDENTIFIED FEMALE: I was at a complete stop. I just saw her barreling toward me, I could see that she wasn't even looking at the light.

S. GUPTA: Putting on mascara?

UNIDENTIFIED FEMALE: Yes. Yes, that I could see and she just plowed right into me. Unfortunately to this day I still have back issues because of it.

S. GUPTA: Are you in pain right now?

UNIDENTIFIED MALE: I am. Yes. The pain medications make a huge difference, thank goodness. Without them, I don't think I would be able to work a full-time job.

S. GUPTA: But she says after the new state law passed, no doctor would treat her.

How hard has it been to find doctors who give put medications you want?

UNIDENTIFIED FEMALE: Since this law passed, it's been incredibly difficult. I ended up calling multiple clinics. I would call and say, first words out of your mouth, if you want pain medication, forget about it, we're done.

S. GUPTA: Christie believes doctors are turning away patients because they see prescribing any pain medication as a risk. They fear the possibility of unintentionally violating the law. Eventually she did get appointments. And took along her medical records to prove her need for pain killers.

UNIDENTIFIED FEMALE: A lot of them didn't even look at them and were not inclined to prescribe me the medications I was on I just didn't think I could handle one more doctor's visit and feeling like I'm being attacked and being treated as a liar.

S. GUPTA: Do these doctors essentially treat you like a drug addict?

UNIDENTIFIED FEMALE: It felt that way . It was difficult and at a certain point, I almost gave up.

S. GUPTA: Christie says her experience is not unique because she is a lawyer whose work includes cases of accidents and injuries.

UNIDENTIFIED FEMALE: I've had numerous clients contact me saying, I can't find a doctor, I'm in so much pain.

S. GUPTA: Has this left some patients in the lurch? Has it made it harder for some patients to find doctors to will treat them?

KAHANA: I think yes, in all honesty, the University of Washington always saw patients that the community felt uncomfortable seeing. Yes, part of our mission.

S. GUPTA: But Dr. Kahana and Dr. Franklin, believe the guidelines, which were first published in 2007 as voluntary, are reversing the overdose epidemic in their state.

FRANKLIN: Between 2008 and 2010, we saw about a 20 percent decline in the state in the number of deaths.

UNIDENTIFIED MALE: She says that her low back pain is at a zero intensity.

S. GUPTA: It's working. It's -- that's -- there's no question?

KAHANA: No, not in my mind, at least.

HURLEY: So this helps me understand that we are on the right track you.

S. GUPTA: Possible solutions for Washington state. But what about the rest of the country?

You're the chief of explaining things. What do you tell the American people about this?

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KAHANA: As we speak, someone died now, right now, from an overdose and that something has to change.

S. GUPTA: Dr. Alex Kahana, at the University of Washington Center for Pain Relief, says that change starts with a simple first step. Spend time and listen to patients.

How would you best describe this place?

KAHANA: A place where we can actually sit and listen and understand what patients have.

UNIDENTIFIED FEMALE: I thought I'll never get out of this. It was 20 years that I had pain.

S. GUPTA: Dr. Kahana believes better treatment and fewer unnecessary prescriptions will come from understanding a patient's entire life experience.

KAHANA: You have to start capturing the story of patients in a way that you can extract it and analyze it.

UNIDENTIFIED FEMALE: This is your home screen.

S. GUPTA: At the Center for Pain Relief they do this through a system they call pain tracker. It starts with patients filling out a questionnaire before the appointment.

KAHANA: I see a two-page report. I say, oh, Mr. Smith, I see you have back pain since 12 years since you fell from a horse. I see you're sad, you're worried and drinking maybe is a problem. And you say, oh, my god, someone who finally understands what's going on.

S. GUPTA: And patients can even see the results tracked over time. But the question is, is there really time for these types of in-depth conversations in emergency rooms? You guys are busy. Do you have time to be drilling down on someone's pain issues when you're dealing with all the things that ERs deal with?

ANDERSON: It may not be any longer than a five-minute, honest sit- down conversation, but if we're really out there to save lives this is something we have to take the extra five minutes for.

S. GUPTA: Dr. Anderson walked me around a hospital in Tacoma, Washington. One of the first things you'll notice here and every ER in the state is a reminder for patients of restrictions on how much pain medication they can be prescribed.

ANDERSON: Not only are we all playing by the same rules, we are also now all communicating with one another.

S. GUPTA: This is being done through a statewide database. It provides a patient's history of visits to emergency departments in the last five years as well as other vital information.

ANDERSON: In some cases, it might even show care guidelines, like this particular physician has said no narcotics should be issued through the emergency department because they are on a pain management contract.

S. GUPTA: If something like this didn't exist, I mean the scenario is somebody could come to one emergency room, possibly get a prescription for pain medications and maybe even the same day, go to another emergency room and get a prescription for pain medications. That could happen?

ANDERSON: That's happened for years.

S. GUPTA: So pharmacies here also share data.

ANDERSON: We now have a prescription monitoring program through every pharmacy in the state of Washington that allows me to see every restricted medication that's been written in the last year for this patient.

There are other states with similar databases but they're not all connected. And an effort is well under way to try and create a national information exchange with the support of the pharmaceutical industry.

CASTELLANI: We're partnering with the National Association of Pharmaceutical Boards on the creation of the interconnect program, which will be a national database, so a scribing physician can know what an individual patient's history is.

S. GUPTA: Congress has considered creating a similar federal system to track prescriptions but that effort has been stuck in legislative limbo.

CLINTON: We are going to have to make a decision to save ourselves, to save our families. S. GUPTA: Battling this overdose epidemic is a daunting challenge.

Do you think that it's fixable?

CLINTON: Sure.

S. GUPTA: We like our pain pills in this country.

CLINTON: It is fixable. And I think now just bringing this out will have a lot of corrective impact.

S. GUPTA: Nobody is suggesting we stop prescribing narcotics. They allowed so many people to function. Who would otherwise be crippled by pain. For them this medicine is an absolute life line. But all of us need to take note. Don't take pills that aren't prescribed for you. Don't mix prescription drugs with alcohol, and never take more than the prescribed dose.

You're the chief of explaining things. What do you tell the American people about this?

CLINTON: I would say we're going to start a national conversation about this but you need to have one in your family. You need to have one in your place of worship. You need to have o one in your place of work. You need to make sure your kids talk about it in school. We need to understand that it is a good thing to alleviate pain. It is a bad thing to kill people for abuse of those alleviation.

S. GUPTA: In a nation overflowing with so many pills, with so many patients wanting and expecting a quick fix, so many truly naive prescribers, users and misusers of medications, we have to find a way to prevent people from taking a DEADLY DOSE.