Three weeks apart in the summer of 2012, a 32-year old Oahu woman and a 15-year-old Maui boy were found dead from unintentional overdoses of powerful prescription painkillers.
The woman had been taking drugs prescribed by her physician. The teenager popped medication that was brought to a beer party.
The two were among 150 people around the state who died of drug overdoses in 2012. Most of the overdoses were unintentional.
The cases underscored a disturbing trend in the islands, one that public health officials still are struggling to address. Drug poisonings, or overdoses, have overtaken motor vehicle accidents in recent years as the leading cause of fatal injuries in Hawaii.
From 2009 through 2013, 773 deaths from drug poisonings were recorded in Hawaii, according to data released last week by Dan Galanis, the state Department of Health’s epidemiologist for its Injury Prevention Program.
Motor vehicle accidents, which had been the top cause for many years, slipped to the No. 3 position, with 618 deaths over the five-year period, according to Galanis’ data. Falls were the second-leading cause, with 685 fatalities.
For the four prior five-year cycles, motor vehicle accidents topped the list.
Despite the headlines that have been generated locally and nationally from fatal drug overdoses, especially involving narcotic painkillers, Hawaii experts contend that many people still are unaware of how serious the problem has become.
"There’s a general lack of public awareness," said Dr. Lorne Direnfeld, a Maui neurologist who treats patients statewide and has pushed for more data and education efforts surrounding prescription overdoses. "If somebody said to you there’s something that’s preventable and yet it’s killing more people than car accidents, does that sound like there’s enough awareness?"
Galanis said he thinks most people would be surprised to learn that drug poisonings now top motor vehicle accidents as the leading cause of fatal injuries in Hawaii.
Overdoses from narcotic painkillers, or opiates, have fueled the surge in poisonings, particularly as more of the powerful drugs have been prescribed to deal with patients’ long-term, chronic pain conditions, Galanis said.
ONE ANALYSIS of Honolulu autopsy reports involving opiate-related fatalities from 2004 to 2008 found that nearly half the 270 deaths were linked to narcotics prescribed to the victims by their doctors.
Illegally purchased opiates were taken in only 4 percent of the cases, according to the analysis done by Galanis’ office. In 41 percent of the cases, the information was insufficient to determine how or where the person obtained the medications.
The case of Andrea Benedi-Wells, the Kailua woman who died in July 2012, is now in court. An autopsy report said she died from the combined toxic effects of Tramadol and Fentanyl, two synthetic narcotic painkillers, according to court documents.
Her widower, Daniel Wells, sued Dr. Jason Florimonte, who prescribed the drugs; Longs Drugs, where she obtained them; and Catherine S. Lau, the pharmacist who filled the prescription, accusing them of negligence. The defendants, in court documents, denied the charges.
Benedi-Wells was found unresponsive in her bed July 31, 2012, just days after she started using Fentanyl patches, according to the lawsuit. Fentanyl is about 100 times more powerful than morphine, the complaint said.
In the Maui case, JayVaughn Hosino-Shaw, 15, was found unresponsive at a party at a Kahului home in August 2012. His death was attributed to a fatal overdose.
"I hope his friends get the message," his mother, Christie Cummings, told the Maui News after her son’s death. "If anyone should take anything away from what happened (to) JayVaughn is that they learn from what happened, that drinking, period, you shouldn’t be doing, let alone mixing alcohol and pills."
Direnfeld, the Maui neurologist, said the teenager’s death underscored the need for youths — especially those who are using these powerful drugs — to be better educated on the dangers of overdosing.
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DRUG POISONINGS ON RISE
A spike in overdoses on prescription drugs, especially powerful narcotic painkillers, has fueled an increase in deaths attributed to drug poisonings. Over the past five years, such deaths have overtaken motor vehicle accidents as the top cause of fatal injuries in Hawaii. Experts look at five-year periods rather than annual numbers because the longer periods more accurately reflect trends. In the previous five years, drug poisonings totaled 585, third as a cause of death after motor vehicle accidents (740) and falls (614).
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"They’re playing with fire," he said.
Keith Kamita, chief special agent with the Department of Public Safety’s Narcotics Enforcement Division, understands the need for more education. When he gives presentations to school students about the risks associated with taking prescription drugs meant for others, many are clueless about the dangers.
"When you talk to a lot of these kids, they don’t think it’s dangerous because it’s medication — medication doesn’t kill you," Kamita said.
In some of the overdose cases, students obtained the drugs from their home medicine cabinets or from other homes in which extra pills were accessible.
To help address the accessibility problem, Kamita’s division has participated in one-day collection events in which people are encouraged to drop off old, unused or unwanted prescription drugs at points throughout the islands. The collected drugs eventually are taken under guard to Oahu’s HPOWER waste-to-energy facility to be disposed of.
At an April event, more than 2,700 pounds was collected statewide, up 8 percent from the prior event.
The department also is addressing the overdose problem with its online prescription drug monitoring program, which was launched two years ago. The program allows physicians and pharmacists to check the medication histories of patients online, including whether the patients have received opiates from more than one provider.
That is meant to prevent the practice of "doctor shopping," going from one provider to another to obtain narcotics.
With the state’s ability to readily monitor prescription patterns, doctors gradually have started to prescribe opiates less, Kamita said. The physicians whose patterns have not changed now stand out, enabling authorities to look more closely for any red flags, according to Kamita.
"You’re starting to see more doctors become aware of high prescribing," he added. "The pendulum is swinging a little bit."
Dr. Jon Streltzer, a University of Hawaii psychiatry professor who until last year ran a pain clinic at the Queen’s Medical Center for about two decades, said he also senses a shift among physicians who have become more leery of prescribing opiates over extended periods, sometimes stretching 10 to 15 years.
"The culture of overprescribing is starting to change," Streltzer said. "That’s making a difference."
