SALT LAKE CITY — It was around 2001, down in the belly of the Utah Medical Examiner's Office, when Dr. Todd Grey and his colleagues started to notice a disturbing trend: Unexpected deaths were coming through the office without signs of trauma or explanation.
"It comes in as 'Mrs. Jones found dead in bed,'" Grey, Utah's chief medical examiner, said. "No medical history would explain why she's dead and her doctor doesn't feel comfortable signing a death certificate. We do the exam and there's no physical abnormalities. Then we get the toxicology back and, boom, she's got a load of different meds in her system that clearly explain her death."
But solving the problem of abuse of prescription drugs was difficult. Year after year, the numbers rose, and Grey and his office started clamoring for some statewide attention about the issue.
"The problem is it's very complicated and there's lots of layers to how these people wind up dead," Grey said. "Some of it is clearly abuse, some of it is misuse, some of it is doctor ignorance. There's a whole bunch of factors that play into these deaths, so there's not some sort of magic bullet that we can shoot into this problem and solve it."
He said it was frustrating to see money spent on bioterrorism and smallpox while he and his fellow forensic pathologists were repeatedly seeing prescription drug overdose deaths. But the voices of the pathologists grew louder and lawmakers started to listen.
"There was a period a couple of years ago where they had done a lot of outreach with public service announcements … and we saw a dip in the number of drug deaths," he said. "Then the funding ran out and now we're seeing the numbers go back up."
He estimates that he continues to see around 400 prescription drug-related deaths each year, and "it's going to take a sustained effort to solve this problem," Grey said.
Liz Sollis, spokesman for the Utah Department of Human Services, said an initial campaign to tackle the issue in 2006 addressed unintentional overdose deaths. Her office took over efforts to raise awareness and has tried to increase education and encourage discussions about safe use, safe storage and safe disposal of prescription drugs.
The department's website, useonlyasdirected.org, generates some traffic, but Sollis said it is an issue with more of a "social responsibility." Most people who have prescription medications obtain them legally, making it harder for others to feel comfortable questioning their use.
"Because they are legal, people don't question it when other people pop a pill," Sollis said.
"If we reach into our bag and proceed to take a pill, no one is going to ask, 'Why did you take that?' Socially, it's more acceptable to use prescription medication and less acceptable to ask someone why they're taking the medication."
She said communities and families need to become more comfortable and understanding of the fact that while prescription medication can be beneficial when used appropriately, it is also a substance that can be abused with fatal consequences.
"I would venture to bet that almost every person knows somebody: a family member, friend or co-worker who they suspect has a prescription drug problem," Sollis said. "It goes back to education and communication. In Utah, we talk around things and we don't necessarily talk to them. It's that elephant in the room and that elephant is a huge prescription bottle."
It's important for people to be honest with their doctors about their habits, she said. Alcohol, for example, can become potentially lethal when mixed with some medications. Safe disposal is also essential.
Sollis said agencies at the local, state and federal levels have worked together on the issue, as have private organizations. The way she sees it, the more conversation, the better.
"It's not your typical stereotype that we all kind of have," Sollis said. "It's your mom, it's your neighbor, it's your cousin and, as we've seen in the news, it's a nurse, it's a judge. It can be anybody.
"We've made progress and the progress is the result of people coming together."
Melodie Rydalch, a spokeswoman for the U.S. Attorney's Office, was very familiar with the criminal side of the prescription drug issue through her work. But in 2009, it became an issue that hit home.
One September night, her 19-year-old nephew went to sleep and never woke up — his death caused by prescription drugs.
"He was a terrific young man, very heavily involved in sports and athletics," Rydalch said. "It was devastating to his immediate family and our entire family."
She thinks he turned to drugs, both street and prescription, in an effort to manage some undiagnosed mental health issues. The prescription drugs were the easiest for him to get, she said, and he returned to them after treatment, as is common with addiction.
"I think everybody recognizes this is an issue and concern," she said. "But when it impacts your family personally, it makes you all the more committed to do something so other families don't have to go through what you went through."
Even more, she has learned she is not alone. Her neighbors, colleagues and fellow church members have all been affected by it.
"It's an epidemic," Rydalch said. "It's a conversation we have to keep having because the impact on families is so significant and so tragic that I think people need to be aware of it and realize that it could touch them."
She and Sollis both urged the public to take part in the U.S. Drug Enforcement Agency-sponsored "Take Back Day" on April 27, in which the public can dispose of unused medications at a number of law enforcement offices around the state. Rydalch said there are a number of initiatives that she tries to support.
"Regardless of what it's called, it's all going toward this great goal of eliminating deaths from drug addictions," she said. "When these things happen, that's the best you can do."
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