Photo by Skip Lawrence Jean Duley, BSW, CSC-AD, displays a bottle of the addiction treatment drug Suboxone at Comprehensive Counseling Associates.

The number of accidental drug overdose deaths in the United States rose from 11,155 in 1999 to 22,400 in 2005, according to Leonard J. Paulozzi of the Centers for Disease Control and Prevention, who testified to Congress about the growing problem this spring.

And some of the main culprits may be in your own medicine cabinet.

Prescription drugs were the main cause of 45 percent of accidental overdoses in 2005, the most recent data available from the CDC, and painkillers accounted for nearly all of these. A study published last fall in the Archives of Internal Medicine showed oxycodone alone killed 5,548 people between 1998 and 2005, making it the deadliest drug approved by the Food and Drug Administration.

Narcotic painkillers contributed to 25 of the deaths of Frederick County residents who died in 2005 and 2006.

Since the number of people dying of prescription drug overdoses is growing, their demographics are changing as well. Men are still more likely to die from drug overdoses than women, but now people in their 40s are more likely than those in their 20s or 30s to die of an overdose, Paulozzi said. Whites are now more likely to die from overdoses than blacks, and more overdoses are occurring in rural counties than in cities.

Twenty-seven of the Frederick County residents who died of overdoses in 2005 and 2006 were men, 33 were white, and 25 were older than 35.

Paulozzi testified that the CDC's statistics "probably underestimate the present magnitude of the problem."

Eleven of the overdoses in 2005 and 2006 in Frederick County involved alcohol, either as the main cause or a contributing factor.

Alcohol has a doubling effect on some drugs, like sleep aids, anti-anxiety medications and painkillers, said Marty Brown, a social worker at the Frederick County Health Department. Taking one of these pills with one drink is the equivalent of taking two pills with two drinks, he said, a fact many people don't realize.

--While narcotic painkillers contributed to about two-thirds of Frederick County overdose deaths in 2005 and 2006, roughly 75 percent of adults admitted to the county's public substance abuse treatment programs those years were treated for additions to alcohol, cocaine or marijuana. Less than 20 percent were admitted for abuse of prescription painkillers or other narcotics.

The same holds true for the most recent two years; 84 percent of clients in 2007 and 72 percent so far this year are being treated for illegal drugs and alcohol addiction, while 18 percent and 14 percent, respectively, are in treatment for narcotics abuse.

The reasons for the chasm seem simple enough: prescription drugs aren't illegal, so they're more readily available than those that are. Arrests and treatment are far less common in cases of prescription drug abuse than in cases involving illegal drugs. In fact, Paul Wolford, Frederick County's drug court coordinator, said none of the program's participants are there for prescription-drug related offenses.

Recreational use of prescriptions has become an almost accepted part of society, Brown said.

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Legal trouble

While Cpl. Michael Lee, a member of the Frederick Police Department's drug enforcement unit, said his department hasn't seen a drastic increase in criminal activity involving prescription drugs in recent years, drugs like OxyContin, Valium, Ritalin, and muscle relaxers are attractive to both dealers and users because of their street value and availability.

For example, OxyContin sells on the street for between $20 and $80 per pill, depending on strength, Lee said, compared to about $1.25 per 10 mg tablet in a pharmacy.

"(Prescriptions are) easier to get and distribute; you can get it from a relative or friend, you can lie to get it and make money É but it's not something we regularly see," Lee said.

States have taken on prescription drug abuse in several ways. Some track Medicaid patients' prescription use to identify those who obtain prescriptions from multiple providers in what's known as doctor shopping. These states can then limit such patients to one pharmacy or physician.

California is considering creating a secure online database of prescriptions that any doctor or pharmacist can check before writing or filling a prescription.

Frederick pharmacies also work together to help minimize prescription fraud, said David Fulton, whose family has owned Whitesell's Pharmacy in downtown Frederick for 24 years. Pharmacists at drug stores across town keep each other updated on potentially fraudulent prescription writers, and Fulton said no pharmacist is required to fill a prescription he or she deems suspicious.

Pharmacists and staff at Whitesell's know many of their clients, and they don't hesitate to make a verification phone call when they receive a prescription from an out-of-town customer or physician, Fulton said.

"You always want to trust people, but you're always on the lookout for suspicious people and prescriptions," he said. "We're not trying to hurt (customers), but we don't want to generate their enterprise" of selling prescription drugs on the street.

Fulton said several people have been arrested in his store for attempted fraud, and several years ago, an employee chased a man out of the store after he grabbed pills from the counter and ran.

Pharmacists at Safeway on West Seventh Street were able to foil a false prescription scheme last fall, and 25 year-old Chad Furlough was arrested. Furlough's prescription was for 60 pills, twice what is typically prescribed, and a call to the doctor on the note confirmed the prescription was fake, according to police reports.

Other prescription-related encounters in Frederick have been more violent. A man armed with a gun stole methadone from The Frederick Institute, a drug treatment center, in November 2006. In April 2007, Lee Gustafson, a pharmacist at CVS on Rosemont Avenue, was shot during an attempted robbery at the store's drive-through window.

The rise of Internet pharmacies has contributed to the problem as well. For example, in 2006, 34 known or suspected illegal Internet pharmacies dispensed nearly 100 million doses of drugs containing hydrocodone, according to the International Narcotics Control Board's 2007 annual report. Those who order from illegal Internet pharmacies can get up to 200 pills per order, many more than they could get from a traditional pharmacy.

Pharmacists and law enforcement can do their part, but prescription drug abuse is more than a criminal issue, said Leilani Drayer, also a pharmacist at Whitesell's. Taking a system-wide approach is difficult, given the number of groups involved, she said.

"It's hard enough to get two adults to sit down in a room and agree on something, so imagine when you have a group of agencies trying to tackle a problem," she said. "If you're really going to try to take it on É as an individual, you can take a stab at changing your little part of the world."