Cody Ruiz struggles to feel sympathy for the man he found lying at the bottom of a cliff. The man, who said he lost his footing and fell down White Mountain, was disturbingly pristine.
His reported pathway down the slope seemed unscathed, as well; dirt and vegetation from top to bottom remained intact.
And despite his claim of tumbling “head over heels,” down the embankment, the man’s baseball cap managed to stay in place.
“At first, he was saying he couldn’t move his body, couldn’t move his legs,” Ruiz, the first responder as a sheriff’s deputy, recalled of the September 2010 incident. “Then he started tapping his toe, like there was a song in his head. It just didn’t seem like he was in that much pain.”
Ruiz said the man specifically asked for a shot of morphine upon being lifted and advised rescuers that he was allergic to nonopiate medications.
When he said his pain failed to subside with four milligrams, he was given six more. Fifteen minutes later, he was administered four milligrams of Zofran, then two 50-milligram doses of Fentanyl.
Reports soon came in of a similar rescue mission that was performed a year earlier with a victim that turned out to be the same man, bolstering the officer’s concerns. Now a member of the Division of Criminal Investigations, Ruiz read other agents’ reviews and the situation came full circle.
The man, or at least his name, was already notorious around the medical community, particularly to those manning the state’s prescription drug monitoring program. In one year, the “frequent flier,” as reports labeled him, had managed to obtain 2,913 opiate pain medications through prescriptions — an average of nearly 250 per month.
The story is one extreme example of an increasing trend of prescription drug fraud in Wyoming, say officials at DCI. Deputy Director Kebin Haller said an increasing number of the department’s arrests and investigations are related to opiate painkillers, in particular.
On par with national statistics, a sharp, steady increase in deaths related to prescription drug overdoses were reported in Wyoming in recent years.
Between 2004 and 2005, five people in Wyoming died because of an accidental overdose of prescription medications, according to the state’s vital statistics. That number jumped to 28 between 2006 and 2007; 45 between 2008 and 2009; and 69 between 2010 and 2011.
Meanwhile, after a slight increase in the past seven years, 2010 to 2011 held the smallest number of deaths related to overdoses of illicit drugs since 2004 to 2005, dropping from eight to three.
In the past year, physicians at Wyoming Medical Center treated 112 cases of poisoning related to opiate medications, up from 95 the previous year and 82 the year before that.
Second to meth?
A few years ago, methamphetamine prices began to sharply increase in Wyoming, said Haller. The inflation was due in part to heightened controls on pseudoephedrine, a key ingredient in the drug. Mexico, a former production hotbed, placed restrictions on imports of the cold medicine in 2005 to curb cartel activity, then in 2009 cut off imports altogether.
U.S. state controls coincided with Mexico’s sudden deficiency. A 2005 Wyoming statute restricted the sales and distribution of the medicine, effectively severing the resources needed for meth labs.
“All these different events are going on, and the availability [of meth] in the states is down,” said Haller. Rather than paying a premium or going without a fix, Haller said users would instead turn to their — or someone else’s — medicine cabinet.
“[Opiates] can be a substitute for many of the illegal drugs,” he said. Although the painkillers are often easier to find, at up to $2 per milligram, they don’t particularly run cheap. This can propel users further down the drug spectrum.
“One of the direct results of prescription abuse and addiction is that heroin usually follows,” he said.
A sampling of DCI investigations reveals inconsistent tactics and an array of demographics related to prescription drug fraud.
In several of the prescription drug fraud investigations provided by DCI, low- to mid-level drug dealers simply added opiates to their portfolio of narcotics. Many prescription drug busts were tacked onto investigations involving meth or marijuana.
In one case, a small-time dealer was reported to law enforcement after sending a misguided text message to an attorney in Evanston, asking if she wanted any more “tabs.” In another, a college woman was reported by a worried friend, who discovered the woman was about to exchange sex with a Sheridan firefighter for pills.
As for the White Mountain “faller,” upon questioning, he told authorities that he had become addicted to painkillers after he had back surgery in the 1990s. When the prescribed dosages failed to alleviate his pain, he said he resorted to less scrupulous ways to obtain the pills.
He admitted to doctor shopping, purchasing medications from others, faking injuries and self-harm. He told officers that he had previously shot himself with a nail gun on several occasions and at one point put his fingers in front of the blade of a skill saw.
Haller cited additional cases where he’s heard of friends running over each other in cars or smashing one another’s hands with hammers.
“This shows us how strong the addiction is, and what people will do to obtain these medicines,” Haller said.
Dr. Berton Toews runs Casper’s Wyoming Recovery center, a treatment facility that deals specifically with addiction. He agrees that there is a correlation between meth’s scarcity and prescription drug addictions, but he also is quick to point out that several of even his most severe patients had no prior history of illicit drugs or criminal behavior.
Painkiller addictions transcend age, race, gender and education, he said.
According to Wyoming’s vital statistics, the average age of those who died from a prescription overdose was 43, half were male, and about 44 percent had more than a GED or high school education.
Deaths were less evenly distributed among counties, however. Over the past seven years, six deaths were reported in Big Horn County for every 10,000 residents, four for every 10,000 in Unita and Weston counties. Teton County had the lowest rate at one overdose-related death for every 10,000 residents.
“The most common scenario I see is the person who gets put on a pain med for a bona fide event,” Toews said. “But because of personal history or genetics, they become technically addicted.”
Kristi, one of Wyoming Recovery’s counselors who requested her last name not be used to protect her family, knows the downfall on a personal level, as well. A former registered nurse with a collection of degrees, Kristi became addicted to opiate painkillers such as Vicodin after shattering her tailbone.
Kristi soon found her medical background aggravated the addiction. She was a natural at gaming the system.
“I had knowledge of how to be really smart around a pharmacist and how to be really savvy with doctors,” she said.
After three opportunities to get and stay clean, Kristi ended up in prison for 12 months, leaving behind her now ex-husband and three children.
Unable to practice nursing, Kristi went back to school to become a therapist after she was released. Now clean for 12 years, she meets with recovering addicts and uses her experiences to empathize with what they’re going through. Although she said she never tells them about her history up front, she is often asked about her “story,” and said she never lies.
“I do this job every day so I don’t ever forget,” she said.
Dr. Toews said about one-fourth of his patients’ addictions were abetted by “Dr. Feelgoods,” who didn’t take the time to discuss a patient’s ailments or educate themselves on an addict’s tactics or the disease of addiction. Many doctors are well-meaning, he says, but can be duped by a cunning patient.
“It takes 20 seconds to say yes and 20 minutes to say no,” he said.
A small percentage, officials say, suffer from addiction themselves. In 2009, a woman contacted the Rock Springs Police Department to report a physician who approached her at a car wash to request a favor.
According to the arresting affidavit, he wrote her a prescription for 50 Percocet pills and asked her to fill it and bring the medication back to him. When police approached him shortly after the drop off, the doctor admitted he had already consumed five.
Officials say the state’s prescription drug monitoring program has enabled them to recognize the signs of some of these physicians.
Wyoming Online Prescription Database Coordinator David Wills said he recently spotted a super-prescriber in the state.
“When we did further checking, it was outrageous,” he said.
In two years, Wills said, this physician treated 800 patients and prescribed each an average of 1,877 pills.
“I did report it to law enforcement, and it turned out 90 percent of all the [local] drug busts lead back to this one doctor,” he said. Wills said he was unable to reveal the doctor’s identity.
However, there are certain difficulties in catching others, experts say. “Most people aren’t going to turn in their drug dealers,” said Kristi.
Since 2004, Wyoming has participated in a prescription drug monitoring program, designed to flag those who exhibit behavior related to abuse or diversion.
Wills said he is notified after “doctor shoppers” visit a threshold number of physicians and pharmacists within a month. He then contacts the providers, pharmacists and, in severe cases, local law enforcement and warns them of potential fraud. Practitioners can also submit a request for a profile on a particular patient.
Doctor shopping behavior has plunged by 72 percent in recent years, he said, from 152 shoppers in the fourth quarter of 2008 to 42 in the first quarter of 2012.
Wills said he’s particularly pleased by doctors’ and pharmacists’ participation in the program. The number of requested patient profiles went from 1,500 a quarter at the beginning of the program to nearly 5,000 a quarter.
“That’s why doctor shopping is falling,” he said. “The credit has to go to the practitioners and pharmacists.” Wills said the program will soon be online, making profiles available for viewing at any hour of the day.
Sgt. Deahn Amend of the Casper Police Department said officers also work closely with pharmacists and doctors in their investigations, which has helped curb doctor shopping behavior.
More recently, she said, police have been receiving reports of prescription robbery. Cars have been broken into, and those holding open houses have fallen victim to addicts or dealers surfing medicine cabinets.
Haller said that, like any drug addict, those desperate for painkillers will evolve their methods of obtaining a substance when others become unavailable.
He said there are probably several answers as to why prescription drug deaths continue to increase, despite the successes of monitoring programs.
In February 2012, the White Mountain faller pleaded guilty to four counts of unlawful possession of a controlled substance. He received a six-month sentence, all suspended except time served, according to DCI records. He was ordered to serve four consecutive six-month supervised probationary periods, which are set to end early 2014.
“Now it’s up to us as consumers to protect ourselves against a prescription controlled substance,” Haller said.
“They are like a loaded gun. If they get into the wrong hands, they are going to cause damage to people.”