On June 18, Nancy Kueter's 18-year-old son Dustin died from a prescription drug overdose.

Until that day, Kueter didn't know her son was abusing prescription drugs. She also didn't realize just how pervasive prescription drug abuse has become.

"I just think people need to know," Kueter said. "If I could save another kid's life …."

Dustin died in his own bedroom from an overdose of the prescription painkiller oxymorphone. Although he had had problems with marijuana use as a younger teenager, he was on probation and underwent frequent drug testing, Kueter said. He seemed to have turned the corner, with his recent graduation from Stevens High School and a new job he loved. "Actually, I thought he was doing great," Kueter said.

Kueter believes that the peer pressure to abuse prescription drugs was just too much for her son. She said three other people were in her son's bedroom the night he died. A police investigation into his death has been closed without any criminal charges filed, a fact that frustrates Kueter.

Nationwide, prescription drug abuse is on the rise. The Office of National Drug Control Policy calls the increase "a serious threat to public health and safety."

The three classes of prescription drugs most commonly abused are opioids, depressants and stimulants, according to the National Institute on Drug Abuse. To get the fastest and most potent high from the drugs, addicts crush the pills before snorting or smoking them. They also liquefy and inject the drugs.

Nationwide, unintentional deaths involving prescription opioids increased 114 percent from 2001 to 2005, and treatment admissions increased 74 percent in the same time period.

Deaths from prescription drug abuse now rank second only to car accidents as the leading cause of death.

South Dakota has not escaped the trend, said Craig Price, supervisory special agent with the South Dakota Division of Criminal Investigation.

From 2006 to 2008, statewide drug arrests have steadily increased for prescription drug violations. There were 44 arrests for the narcotic hydrocodone/Vicodin in 2006. By 2008, arrests had risen to 120.

Arrests for oxycodone/OxyContin rose from 22 in 2006 to 77 in 2008.

During the same 2006-2008 period, arrests for the street drug methamphetamine dropped from 705 to 419.

In 2005, the state of South Dakota began restricting the sale of medications containing pseudoephedrine or ephedrine, a key ingredient in meth. Price said law enforcement officers speculate that as it became more difficult to make meth, addicts turned to other drugs.

"Meth traditionally was easily made by anyone," Price said.

Laura Lewis, clinical supervisor at the City/County Alcohol & Drug Programs in Rapid City, said they, too, have seen an increase in the number of people seeking treatment for opiate abuse. From January to December 2007, 22 people were admitted with an opiate addiction. During the same time period in 2008, the number rose to 48 people.

And in the past six weeks, the detox center has admitted one or two people every week who are addicted to prescription drugs.

Rapid City Regional Hospital's emergency department doesn't track specific drugs in overdose cases, but the hospital experienced an increase in all drug overdoses - four during fiscal year 2007 to 15 in the same corresponding period in 2009.

With an eye toward the rising numbers, South Dakota Attorney General Larry Long took steps last year to address prescription drug abuse in the state.

He created two Division of Criminal Investigation positions to focus solely on investigating prescription drug abuse.

John Wenande, who worked previously with the Rapid City Police Department, took that DCI position at the first of the year. He investigates all prescription drug crime in western South Dakota.

Wenande said based on what he sees now, he expects arrests for prescription drug violations to double from 2008 to 2009. "We can see the up-tick," he said.

Wenande said one of the most common ways addicts get prescription drugs is by "doctor shopping." Addicts visit different physicians, who unknowingly prescribe the same medications. The abuser than sells or abuses the drug.

Wenande said prescription narcotics generally sell for about $1 per milligram on the street, making them a lucrative venture. He recently investigated a woman who obtained a prescription from her doctor because she was experiencing pain. She then obtained another prescription from a second doctor. She used the initial prescription to treat her pain and sold the second bottle of pills, earning $1,200 a month for a year before she was caught.

Addicts also forge prescriptions, alter prescriptions, rob pharmacies and steal from relatives and strangers. Wenande said in one local case, visitors to an open house were stealing medication from the homeowner's medicine chest.

"It's all walks of life," Wenande said.

In addition to hiring two DCI agents, the attorney general's office is also planning to implement a prescription drug database to combat the problem.

DCI agent Craig Price said the database would mirror the one used in North Dakota, which requires pharmacists to log whenever a prescription for a controlled substance is filled.

Howard Anderson, executive director of the North Dakota Board of Pharmacy, said doctors can then electronically check patients' prescription drug histories.

"The purpose of the program is to provide better care to those patients taking controlled substances," Anderson said. "Practitioners are universally supportive of it. They feel it's been a real benefit in taking care of their patients."

The secondary beneficiaries of the database would be law enforcement, Price said. Officers could access the database for ongoing investigations.

Although Kueter is glad to see the problem being addressed in South Dakota, the interventions are obviously too late for her son. And Kueter is convinced parents don't realize just how many kids are dabbling in prescription drug abuse.

"A lot of people don't know about it," she said. "There were just no signs that Dustin was using these drugs."

She hesitates to offer advice, saying only that she wants the message out there so other parents don't face the same grim reality she did.

"Watch your kids, and make sure you know who they're really hanging around with," she said. "I want it to stop."

Commonly abused prescription drugs

y Opioids: Used for their pain-relieving properties, medications that fall under this class include morphine, codeine, oxycodone (OxyContin, Percodan, Percocet).

y Depressants: Used as sedatives and tranquilizers, depressants slow normal brain function. Some that fall under this class include barbiturates and benzodiazepines, such as Valium, Zanax and Halcion.

y Stimulants: These drugs increase alertness, attention and energy while elevating blood pressure and increasing heart rate and respiration. They are prescribed for treatment of such conditions as attention deficit hyperactivity disorder, narcolepsy and depression.

Addicts take the prescription drugs in various ways: ingesting, snorting, smoking and liquefying them and shooting them intravenously.

Source: The National Institute on Drug Abuse

Treating prescription drug abuse

Kicking an addiction to prescription opiates doesn't come easy or cheap.

Laura Lewis, clinical supervisor at the City/County Alcohol & Drug Programs, said the initial stage of opiate drug detoxification can be excruciating for an addict.

"When someone comes down from opiates, it's like getting the flu times 10," Lewis said.

Treatment programs sometime use the drug Buprenorphine, which can help prevent withdrawal symptoms. The drug has a low rate of abuse and addiction, Lewis said.

But even with the withdrawal symptoms relieved, addicts still face other challenges.

Lewis said often, an addict began taking the abused medication for legitimate pain reasons. That makes it even more difficult to end an addiction because they still have the pain.

Another challenge: the length of rehabilitation needed.

Unlike many rehabilitation programs that last about 30 days, prescription drug addiction requires six months. It is often too much for a person to commit to, financially or time-wise. "They need long term treatment, … and long-term treatment isn't cheap," Lewis said.

Because of those challenges, people with addictions to prescription narcotic have a high rate of relapse, Lewis said.

Contact Lynn Taylor Rick at lynn.taylorrick@rapidcityjournal.com or 394-8414.