Monday, March 13, 2006

Use & Abuse

The Missourian

The recreational use of prescription drugs among American teens has been on a rapid increase since 1992. The problem is making its mark in mid-Missouri, most recently in the suspected morphine pill overdose and death of 17-year-old Chris Crivello of Ashland.

Denis Crivello woke up on the morning of Feb. 7 and made a pot of coffee like he always does. He then went to wake up his daughter, Kadie Crivello, a middle schooler, and his son, Chris Crivello, a high schooler.

“Chris was the kind of kid who would wake up five minutes before he had to go somewhere, throw on his clothes, and say ‘are you ready to go?’ ” Crivello said, remembering how hard it was to get Chris out of bed in the morning.

On this particular Tuesday morning, when Denis Crivello entered his 17-year-old son’s room, he knew something wasn’t right. Chris didn’t respond to Crivello’s attempts at waking him up.

Crivello said he dragged his son from the bed and started doing CPR. He called to Chris’ grandmother, Gladys Weir, in the other room, for help.

The preliminary investigation indicates that Chris, a senior at Southern Boone County High School, died of a drug overdose after taking his father’s morphine pills, Ashland Police Chief Scott Robbins said.

While the police were still waiting for the toxicology results on Thursday, Robbins said he’s 99.9 percent certain that the death was the result of an accidental morphine pill overdose.

Police searched the Crivello home the morning Chris died and seized 42 bottles of prescription drugs, Robbins said, including a prescription for morphine that was filled on Jan. 31. Police also seized a small amount of marijuana, pipes and a scale from Denis Crivello’s bedroom, Robbins said.

Crivello was taken into custody.

While Crivello was in custody he told police he knew his son was taking his morphine pills and selling marijuana, Robbins said. Crivello was released the same day.

Robbins has asked the Boone County prosecuting attorney to charge Denis Crivello with possession and distribution of marijuana.

The police chief also said he had a meeting with Kevin Crane, Boone County prosecuting attorney, to discuss the possibility of charging Crivello with child endangerment. Since Chris Crivello was 17 and considered an adult, Robbins said, that charge wasn’t applicable.

Crivello said he can’t remember anything that happened after he tried to revive his son, including anything he said to police. He said it wasn’t until the morning his son died that he realized his morphine pills were missing.

The 60 milligram time-release morphine pills upset his stomach, Crivello said, so his doctor gave him a different medicine for the chronic pain associated with compression fractures in his back.

Crivello said he never saw his son appear intoxicated, adding that he now knows Chris and some of his friends were abusing prescription drugs.

“I really can’t tell you how long Chris was messing with pills,” he said.

Chris’ friends, he said, told me Chris could “take double what they were, and that he never got all messed up.”

PRESCRIPTION ‘EPIDEMIC’

A week before Crivello’s death, one of his friends, Joseph Gipson, 17, also from Southern Boone County High School was taken to the hospital after an overdose caused him to stop breathing, Robbins said. Gipson survived and is no longer in the hospital.

In his Feb. 7 request asking a circuit court judge for permission to search the Crivello residence, Robbins wrote that Gipson told police he had overdosed on Xanax given to him by Chris Crivello. “When Joe was asked where Chris had gotten the Xanax, Joe stated Chris gets it from his father,” the search warrant request reads.

That overdose was one of several in Ashland in the months before Chris Crivello’s death. Robbins sees the incidents as part of a “disturbing trend” of teenagers abusing prescription drugs in the town of about 2,200 people located south of Columbia.

Earlier this school year, Robbins said, he arrested a student in Ashland after a school official confronted a group of students at a football game and discovered that one of them had been selling prescriptions drugs he had taken from his parents.

In September 2004, Robbins said, three Ashland middle school students were hospitalized after taking Amitriptyline, a prescription drug used to treat depression. The students recovered, Robbins said, but all three spent time in a coma.

There can be legal consequences for those who allow their prescription drugs to get in the wrong hands. If someone is harmed or killed, Boone County Prosecutor Stephen Gunn said, criminal charges could include child endangerment or involuntary manslaughter.

An aunt of one of the three students, Ruby Gipson, plead guilty to three counts of child endangerment. She is concurrently serving a 3 to 5 year sentences in the Missouri Department of Corrections.

Ashland is not alone.

A study released in 2005 by the National Center on Addiction and Substance Abuse at Columbia University found that the number of 12- to 17-year-olds who have abused prescription drugs increased 212 percent from 1992 to 2003, from over 735,000 to 2.3 million.

“Our nation is in the throes of an epidemic of controlled prescription drug abuse and addiction,” the researchers concluded. Prescription medicines are the second most illegally abused drug, the study indicated, trailing only marijuana.

Nine students from ages 14 to 17 have been arrested in Columbia since September for possessing or distributing prescription drugs on school property.

Police and school officials are uncertain about the extent of the problem.

“We don’t have any data to show that it has increased alarmingly,” Phyllis Chase, superintendent of Columbia Public Schools, said. “The only way we are going to know is to gather the facts.”

Columbia Public Schools gave students the Safe and Drug Free Schools and Communities survey in 2002 and plan to complete it again this year by Friday; however, none of the questions were related to prescription drugs, said Leslie Trogdon, director of the Office of School Improvement. The results of both surveys will be made available by the state after Friday. Trogdon said the office is waiting for the 2006 results in order to compare the two years.

Mark Brotemarkle of the Columbia Police Department, who serves as a resource officer at Hickman High School, said the topic of prescription drug abuse has been added to a class he helps teach for students who get in trouble with drugs.

“I feel the use (of prescription drugs) is probably out there,” Brotemarkle said, “and it is probably increasing.”

Susan Gauzy, superintendent of the Southern Boone County R-1 School District, said Crivello’s death has magnified the issue of prescription drug abuse in her community.

“I don’t know if we have an accurate picture,” Gauzy said. “However, is it apparent we have an issue? Yes. We are going to investigate that further.”

Ashland schools have held training for teachers and staff of the high school and primary school to recognize the signs of prescription drug abuse, Gauzy said. A few symptoms include: slurred speech, pupils appear larger or smaller than usual, hostility or irritability, lack of energy, weight loss or weight gain.

Parent meetings are also being considered along with more frequent searches in schools by dogs trained to sniff out drugs. Even though the dogs are trained to sniff out marijuana, Robbins said that when the dogs find marijuana or other drugs they can come across prescription drugs that are being abused.

Kristina Yow of the Ashland Police Department, a resource officer at the Ashland high school, said she is surprised that the prescription drug problem wasn’t given more attention sooner. “The signs were there,” she said. “They were definitely there.”

NEW DRUG OF CHOICE

The abuse of prescription medicines has grown so rapidly in recent years that the reasons aren’t fully understood, said Tom Hedrick, director and a founding member of the Partnership for a Drug-Free America.

“What we’ve seen in the last few years is a major change in the landscape of drug abuse among adolescents,” Hedrick said.

Of youth aged 12 to 17 in 2003, the partnership found that one in ten had abused prescription stimulants and tranquilizers, and one in nine had abused prescription pain relievers.

Hedrick said some teenagers believe prescription drugs are “much safer than smoking marijuana, much safer than smoking cigarettes and much safer than getting high on so-called ‘street drugs’ because they are medicines.”

Although pain relievers such as OxyContin or Vicodin get much of the publicity among abused prescription drugs, some teenagers are using an array of drugs, Hedrick said.

“If they can’t find a painkiller, they’ll go to a sedative,” he said. “Almost any drug, if enough is taken, will have some effect.”

There are four different categories of commonly abused prescription drugs: stimulants such as Ritalin and Adderall, sedatives like Ambien, tranquilizers including Xanax, and pain relievers like morphine pills.

Morphine, the drug that police believe contributed to Chris Crivello’s death, is an opioid that is as dangerous and addictive as heroin, from which it is derived. Morphine also is one of the most effective opioid pain relievers. Exceeding the recommended dose can cause severe respiratory distress.

Among pain relievers, morphine pills are prescribed less frequently. The Columbia University report said 2.706 million prescriptions were filled for morphine pills in 2002, compared to 27.053 million for oxycodone, or OxyContin, and 75.357 million for hydrocodone, or Vicodin.

All three opioid drugs, however, were prescribed much more frequently in 2002 than in 1992. In that 10-year period, the Columbia University study found, morphine pill prescriptions increased 279 percent, oxycodone 380 percent and hydrocodone 376 percent.

A larger consideration, identified in the Columbia University report, is the general proliferation of prescription medicines across the board. While the U.S. population increased 13 percent between 1992 and 2002, the study found that the number of prescriptions written for controlled drugs increased 154 percent.

Linda Richter, a senior research manager at Columbia University, said that drugs are being prescribed too easily, and that doctor training about prescription abuse is limited.

There are several ways that teenagers are able to get their hands on prescription drugs, and all are related to an increase in availability, Richter said.

She identified some of the reasons: unregulated online pharmacies, doctor shopping — going to several doctors with the same symptom to get several prescriptions — and filling prescriptions at multiple pharmacies.

Columbia University decided to focus on the topic of prescription drugs that was based on surveys asking teenagers and college students what drugs they saw at parties. Richter said that prescription drugs kept being mentioned; marijuana was the only drug mentioned more frequently.

School programs such as Drug Abuse Resistance Education have been stressing the dangers of alcohol, tobacco and illicit drugs. But a part of the message that is often overlooked, Hedrick said, is that using drugs for nonmedicinal reasons is dangerous.

“There is a misconception among teenagers that because the medicine was prescribed by a doctor, it must be safe,” Hedrick said. “They don’t know that taking five Vicodin, for example, can be just as dangerous, addictive and even deadly as doing heroin.”

TOUGHER DRUG LAWS

In September, a state law took effect that makes it a Class A misdemeanor for anyone younger than 21 to distribute prescription medicine to a minor on school property. The penalty is up to a year in jail and/or a $5,000 fine.

The law also provides that people younger than 21 who are in possession of prescription drugs without a prescription are guilty of a Class B misdemeanor that carries six months in jail and/or a $500 fine.

Sen. Kevin Engler, R-Farmington, said he sponsored the legislation to ensure that students would be held legally responsible for having or distributing prescription drugs. Previously, students only faced suspension or other punishment for violations of school policy rather than a criminal offense.

Engler said he thinks the main source of prescription drugs for teenagers is the family medicine cabinet or friends.

Engler said he thinks prescription drug abuse among youth is widespread.

“Most school districts won’t admit it,” he said, “but it’s a problem all over the state.”

Denise Shaw, who handles records for the Columbia Police Department, said it is important to note that many cases of prescription drug abuse in Columbia went undocumented before the new law. Consequently, she said, there are no statistics for comparison.

Rick Gaines, chief juvenile officer for the 13th Judicial Circuit that includes Boone County, said he’s seen an increase in referrals for distribution or possession under the new law.

Family Court Services, which is a division of the 13th Judicial Circuit, has had consistent increases in drug-related referrals in the last three years. In 2005, the court received 155 drug-related referrals, Gaines said, up from 135 referrals in 2004 and 122 referrals in 2003. The numbers are for all illicit drugs; Gaines said the statistics are not specific to prescription drugs.

At least two of the cases that Brotemarkle handled at Hickman involved teens who took prescription drugs from their homes. In one incident, a student had taken the psychiatric medication Haldol from his parents and, thinking it was a hallucinogen, gave it to two other students, Brotemarkle said. Another case involved a parent who was taking Alprazolam, a drug used for treating psychological illnesses such as bipolar disorder and schizophrenia, who noticed that some of the medication was missing. Brotemarkle said the parent didn’t think the child was responsible and didn’t take any action. The teen was eventually caught trading the medication for street drugs, he said.

If parents believe drugs are missing, he said, they need to quickly determine why.

Confronting a child is important, Brotemarkle said. He added that sometimes efforts to keep the incident private can be more harmful. Parents should seek professional help if they feel it is needed, he advised.

While parents might look for missing alcohol or traces of marijuana, Brotemarkle said, they might not think to check their medicine cabinets for missing pills.

“This is something that parents can have much more influence over than street drugs,” Brotemarkle said.

EDUCATION IS THE KEY

When the Rev. Dan Hayes arrived in Ashland three years ago with intentions of starting a new church, he canvassed the small town with surveys to discover how to best serve the residents.

Since then, Hayes has started the Family of Christ Lutheran Church, and he has accepted a second role as the Ashland police chaplain.

Now, Hayes is taking on yet another role in the community, working with the police and the schools to develop an awareness program about prescription drugs.

As police chaplain, Hayes was at Chris Crivello’s home the morning he died to console the grieving family.

“When you see a 17 year-old boy, two weeks from his birthday, lying dead on the floor because of recklessness and carelessness, it has a profound impact on you,” he said.

Hayes said parents are the first line of defense for prescription drug abuse. “Parents need to be willing to admit there is a problem before (we) can solve it,” Hayes said, adding that many parents he has talked to are reluctant to consider the possibility that their child might be involved in drug use.

The pastor is working with an officer from the U.S. Drug Enforcement Administration in St. Louis to arrange a seminar for parents in Ashland. Hayes said he wants to have several town meetings to discuss training and education for parents.

Shirley Armstead of the DEA in St. Louis said the administration holds informational seminars for parents across Missouri. Schools usually don’t make such a request, however, unless there has been a tragedy in the community, she said.

Attendance at the seminars can also be a problem. For example, Armstead said, the DEA recently held a seminar at Alton High School. Ninety-one parents signed up for the informational class, she said, but only 15 came.

These seminars are well worth her time, Armstead said. Reaching one parent often leads to discussions with the parents who didn’t attend, she said, which increases awareness of symptoms and the prevention of prescription drug abuse.

Hedrick, of the Partnership for a Drug-Free America, said many parents don’t understand that prescription drugs can even be used to get high.

“Parents don’t have a clue what’s going on,” he said.

Too often, Hedrick said, if parents find out their child is abusing prescription drugs, they are relieved that it is not a street drug such as cocaine.

Brotemarkle said it can be difficult to get the attention of parents.

“Unfortunately, the general consensus in the community is apathy as far as drug use and abuse goes,” Brotemarkle said. He said he would like to see more educational seminars for parents in Columbia, but said they are often not regularly available, and when they are offered, they are not well attended.

Hayes said parents in the Ashland area are paying closer attention to their teenagers.

“Chris’ death is a very clear message,” he said. “It may have had to happen for people to wake up.”

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