The proven effectiveness of opioid-based pain relievers such as oxycodone and oxycontin has made them a favored choice for pain management practitioners.
In Yavapai County, doctors prescribed more than 11.4 million doses of oxycodone and hydrocodone, 1.5 million carisprodol (Soma) tablets and 4.4 million benzodiazepine (Valium, Zanax) pills in 2011.
But the drugs' euphoric side effects leave them ripe for abuse, and creative users and drug dealers are going to remarkable lengths to obtain them, including prescription fraud, forgery and identity theft. And Yavapai County law enforcement officials blame the drugs for at least nine deaths of people aged 30 or younger over the past 15 months
A county undercover officer, who asked to remain anonymous because of his current assignment, said pain pills have largely replaced methamphetamine as the local drug of choice.
"We ask kids if they use meth and they turn up their noses," he said. "And it's hard to get a dealer to deal meth anymore because they know if they get caught they're going to prison" because of required sentencing laws for sale of the dangerous drug.
But when it comes to pills it's a different story.
"Whatever drug we're buying (on an undercover operation)," he said, "we ask if there's any pills. And the answer has been, 'Oh, yeah, we have plenty of pills.'"
The easy availability of the drugs stems in large part from the medical community's reluctance to sign up for and use Arizona's Prescription Monitoring Program (PMP). At last count, just 15.5 percent of practitioners statewide are registered to use the database, which keeps track of controlled substance prescriptions, who prescribes them, who uses them and in what amounts. Practitioners who register for the program can then consult the database in a five-minute online session to see the drug history of a patient.
The shortage of participation has led to the current "Sign up to Save Lives" effort on the part of Matforce, the county's anti-drug organization.
"The information is there for the gatekeepers to use," Yavapai County Attorney Sheila Polk said. "To me, the doctors and pharmacists ought to use it because, why not be part of the solution?
"Isn't that just good medicine to see if their patients are getting these drugs from somewhere else?"
Polk is also urging patients to encourage their doctors to use the program if they aren't already doing so.
In the past week, the task force has sent out about 350 letters to county medical professionals including doctors, dentists, pharmacists and even veterinarians, explaining the monitoring program and urging them to sign up and use the database. Matforce volunteers are making follow-up calls and Polk said the response has been overwhelmingly positive.
Polk's efforts have included meetings with corporate officials from several large chain pharmacies, whose local employees have said they were not allowed Internet access to consult the database. Legally, all pharmacies are required to report information about the drugs they distribute, but not to refer to the database when filling a prescription.
"Walgreens has made it mandatory (for its pharmacists) to register and plans to make it mandatory to use," Polk said. Fry's has already become a user of the system, CVS and Walmart told her they were planning to sign up and Safeway is still looking into participating.
She added that pharmacists she met with offered suggestions for improving the system, including the addition of "red flags," such as was the transaction in cash, was it a new patient, did the pickup come late in the day and was the request for an early refill.
A current court case illustrates the lengths that some will go to in order to obtain pain medications, and the effectiveness of using the PMP to fight abuse. In one case, Cottonwood resident Kelly Coplin, 27, allegedly defrauded doctors, pharmacists and used another person's identity to illegally fill numerous prescriptions, under multiple identities, for opioid-based pain pills. She faces a six-count indictment for charges including fraud, identity theft and possession of a narcotic drug for sale.
Coplin's arrest came about because a pharmacy employee made a call to the doctor who supposedly wrote a prescription and discovered he hadn't. Investigators then consulted the PMP and developed a pattern of Coplin's alleged prescription fraud.
Coplin has pleaded not guilty to the charges and is free on $25,000 bond.
Authorities tend to shy away from the question of whether use of the monitoring system should be mandatory. An aversion to an additional layer of regulation seems to be the cause.
"The problem is the climate," Polk said. "There's no support for legislation to make it mandatory."
And at least one patient is concerned that the program might have unintended consequences.
Sam Brunstein of Prescott Valley has suffered debilitating headaches for decades. His doctors have been unable to identify the cause of his pain, but he has found that judicious use of pain medications helps him get through the day.
"I fully support the concept of some method to cure the abuse," said Brunstein, who added that his own doctor employs safeguards such as occasional urine tests to make sure he isn't using legal or illegal drugs that would compromise his treatment. "The question in my mind is have they properly identified the problem they're trying to solve."
Yavapai County Sheriff Scott Mascher said the system won't take away from doctors' ability to prescribe the pain meds to those who need it, but that something needs to be done about the spread of illicit use.
"It's ridiculously easy to get these drugs when people don't use the monitoring system," Mascher said. "We're seeing these drugs involved in all kinds of crimes. It's becoming an epidemic."