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SANJAY GUPTA MD
Aired December 29, 2012 - 16:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: This a drug overdose call.
(voice-over): Every 19 minutes in the United States, someone dies of an accidental overdose.
WILLIAM J. 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.
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.
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 (on camera): 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 (voice-over): 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.
HURLEY: This could be you. It could be me.
S. GUPTA: And that's the point. It could be anyone.
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.
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 (on camera): Yes.
(voice-over): 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 (on camera): 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.
Ben told Stuart that he and his new girlfriend had tried Oxycodone and they thought it was no big deal.
BRIDGE: 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: Tine 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.
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.
CLINTON: You explained what happened to my friend to me in two sentences.
S. GUPTA (on camera): How are you?
(voice-over): 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.
(on camera): 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 (voice-over): 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 $1 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 (on camera): 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 went walking on the G.W. 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.
DR. STEPHEN ANDERSON, AMERICAN COLLEGE OF EMERGENCY PHYSICIAN: We've seen absolute skyrocketing of overdose deaths and it correlates directly with the number of prescriptions that are written.
HURLEY: We'll tie it, so it looked like he downed the 200s.
S. GUPTA (voice-over): 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.
(on camera): The person had three Dilaudid, two methadone.
(voice-over): This patient's deadly dose: an anti-seizure medication and a couple of powerful pain killers.
LT. JOHN FISK, SEATTLE FIRE DEPARTMENT: 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.
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 it 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 -- 80 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 overdose is not the only side effect associated with powerful painkillers.
DR. JANE BALLANTYNE, PAIN MEDICATION EXPERT: When did you start taking opiates?
S. GUPTA: Dr. Jane Ballantyne is an anesthesiologist at the University of Washington.
BALLANTYNE: 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.
BALLANTYNE: 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 (on camera): You said that this has essentially been 20 years of failed experiment.
BALLANTYNE: 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.
S. GUPTA (voice-over): Former President Bill Clinton's familiarity with pain killers goes back to when he lived in the White House.
(on camera): 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 (voice-over): 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, five 10-milligram Oxycodone. And I'm feeling really shaky, light headed. I'm just nervous.
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.
HURLEY: 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.
(on camera): Eighty percent. Does that surprise you?
CLINTON: No, because --
S. GUPTA: Is that a cultural problem?
CLINTON: Yes. It is cultural. You know, people think I've got a headache, or I've got 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, and since we represent 5 percent of the world's people, we got no business popping as many pills as we do.
S. GUPTA (voice-over): 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 have seen her crawled up in the fetal position for hours.
BALLANTYNE: You are taking more than we now consider a safe dose.
S. GUPTA: Washington state has been one of the places hit hardest by the prescription overdose epidemic.
DR. GARY FRANKLIN, WASHINTON DEPARTMENT OF LABOR AND INDUSTRIES: I think this is the worst manmade epidemic in history.
S. GUPTA: Dr. Gary Franklin is medical director for the state of Washington's Department of Labor and Industries.
(on camera): When is the first time this even became an issue that you had noticed?
FRANKLIN: By 2001, our claims managers were sending me cases of injured workers who had had a low back sprain. And who were dead three years later from an unintentional overdose of prescribed opioids. It was the saddest thing that I'd ever seen.
S. GUPTA (voice-over): 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 opioid use.
FRANKLIN: 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.
BERT GOELLER, PAIN PATIENT: I had seen her crawled up in the fetal position for hours, even crying at times.
S. GUPTA: In Tacoma, Washington, Christi and Bert Goeller, husband and wife are both in pain, his is caused by multiple sclerosis.
B. GOELLER: My leg is constantly being electrocuted from the inside out.
S. GUPTA: Hers caused by a car accident, 16 years ago.
CHRISTI GOELLER, PAIN PATIENT: 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 (on camera): Putting on mascara?
C. GOELLER: 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?
C. GOELLER: 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 (voice-over): But she says after the new state law passed, no doctor would treat her.
(on camera): How hard has it been to find doctors who give put medications you want?
C. GOELLER: 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 (voice-over): Christi believes doctors are turning away patients because they see prescribing any pain medication as a risk.
C. GOELLER: 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: The doctors here say guidelines, 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.
S. GUPTA: Possible solutions for Washington state. But what about the rest of the country?
(on camera): Do you think that it's fixable?
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: You are 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 (voice-over): 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.