State’s Largest Increases

In Painkiller Use In South-Central, Northwest

MIDDLETOWN (AP) — People in Connecticut are in pain.

Statewide, the use of five major painkillers — oxycodone, morphine, hydrocodone, codeine and meperidine — increased 104 percent over the eight years, compared with 88 percent nationwide. And nowhere else is that substantial increase more apparent than in the south-central part of the state.

The area saw a 657 percent increase in the use of oxycodone, the chemical used in OxyContin, between 1997 and 2005, according to an Associated Press analysis of statistics from the US Drug Enforcement Administration.

There was also a 243 percent increase in the use of morphine in south-central Connecticut during the same period, compared with a 154 percent increase nationally and 111 percent increase statewide.

No other areas of the state had higher increases in the use of oxycodone and morphine.

The figures are for the area with zip codes beginning with 064. The region runs from Middletown and Meriden to the north down to shoreline towns including Branford, Guilford, and Old Saybrook. It also includes Fairfield and suburbs west of New Haven.

The data include nationwide sales and distribution of drugs by hospitals, retail pharmacies, doctors, and teaching institutions.

Doctors and other medical experts say it is difficult to pinpoint the exact reasons why more painkillers are being used in the south-central part of the state, but they have some ideas that echo what their colleagues are saying about increases nationwide.

*There has been a major shift in philosophy as doctors now consider pain management an integral part of the healing process.

*Older people are making up an increasing percentage of the population, and their need for painkillers increases with age. There were 4.2 million Americans older than 85 in 2005, compared with 3.1 million in 1990.

*Doctors are getting inundated with marketing materials from pharmaceutical companies.

“This whole idea of palliative medicine and pain and symptom management control has become a bigger way of treating certain types of diseases and pain suffering,” said Marcel Blanchet, spokesman for The Connecticut Hospice in Branford.

The hospice serves just over 4,000 patients with terminal illnesses a year across the state, including 56 at its in-patient facility in Branford.

South-central Connecticut also has seen an increase in outpatient surgery centers and rehabilitation clinics in recent years, Mr Blanchet said.

Yale-New Haven Hospital’s new Shoreline Medical Center in Guilford offers one-day surgeries, cancer services, and emergency care. Many Yale-New Haven doctors have offices in Guilford and Branford. And MidState Medical Center in Meriden has been advertising its Spine and Pain Institute.

Dr Malcolm Gourlie, an East Haddam family practice doctor and president of the Middlesex County Medical Association, said there were few, if any, doctors in the county in 1997 who specialized in treating chronic pain. Now, he says, there are three or four spine specialists in the area, which makes up a good part of the 064 zip code region.

“We are now managing the problems that used to go outside the county,” Dr Gourlie said. “When I trained 25 years ago, there was no formal training in pain management. It was on the job. I think there’s been more enlightenment. We’re trying to recognize and manage chronic pain better.”

Northeastern Connecticut was second in the state when it came to the increased use of oxycodone and morphine, but it was the leader in the spike in usage of hydrocodone, a generic form of Vicodin.

Hydrocodone use increased 183 percent from 1997 to 2005 in the region where zip codes begin with 062. The national average was 199 percent and the state average was 113 percent.

Dr Jeffrey Gordon, director of the blood and cancer center at Day Kimball Hospital in Putnam, said it was difficult to explain why hydrocodone use increased more in the northeastern part of the state. But he said Vicodin is a popular painkiller to give to patients after surgery, and many doctors are familiar with it.

Dr Gordon also said doctors in his area of the state have made a concerted effort to better manage patients’ pain.

“Over the past ten years, there has been much better education in the medical community to ... ask if people are having pain and to better diagnose and treat it,” he said.

“My personal volume of prescriptions has gone up because we’re seeing more patients every year,” Dr Gordon said. “I’m not concerned if over the past ten years I’ve had to prescribe more pain medicines, because overall I feel I’m doing a better job.”