( Los Angeles Times ) - The investigation into actor Heath Ledger's death Monday as a possible drug overdose is bringing attention to a nationwide health crisis: Overdose fatalities have risen dramatically in the United States since 1999, driven largely by prescription drugs.
According to the federal Centers for Disease Control and Prevention, unintentional poisoning deaths -- 95 percent of which involve drug overdoses -- increased from 12,186 in 1999 to 20,950 in 2004.
And during that time, prescription drugs overtook cocaine and heroin combined as the leading cause of lethal overdoses, said Dr. Len Paulozzi , a CDC injury prevention expert.
Overdose deaths have been increasing since the early 1990s. But the recent rise has been so dramatic that it is driving the first sustained increase in 25 years in the nation's overall injury death rate, Paulozzi reported in a study published in December. Drug treatment experts doubt that most people realize the seriousness of the prescription-abuse problem.
"Because (they aren't) a street drug, people think (they don't) have the same risk," said John P. Walters, director of the White House Office of Federal Drug Control Policy.
Walters unveiled an advertising campaign Thursday that will target prescription-drug abuse by teenagers. The first television ad will run during the Super Bowl.
The campaign was scheduled to be announced Wednesday, but not wanting to appear opportunistic, the agency postponed the announcement by a day after Ledger was found dead in his New York apartment.
Sleeping pills and other prescription drugs, including antidepressants, were found in Ledger's apartment, according to a police spokesman on the scene. But an autopsy was inconclusive, and toxicology tests are pending.
The great majority of overdose deaths are from opioid pain killers such as oxycodone, fentanyl and methadone (in pill form rather than the liquid dispensed for recovering heroin addicts), which control pain but also reduce respiratory function. Too high a dose, when not increased gradually under careful supervision, can shut down breathing entirely.
However, unintentional poisoning deaths involving other psycho-therapeutic drugs, including sleeping pills, antidepressants and tranquilizers, grew 84 percent from 1999 to 2004, according to the CDC study.
Headline-grabbing overdose deaths such as that of Anna Nicole Smith are the tip of the iceberg, experts say.
From 1992 to 2003, the number of Americans who admitted to using prescription drugs for nonmedical reasons almost doubled, from 7.8 million to 15.1 million, and abuse among teenagers more than tripled, according to a survey by the National Center on Addiction and Substance Abuse at New York's Columbia University.
Prescription drug sales themselves have soared -- up nearly 500 percent since 1990.
Experts attribute the rise in the use of painkillers in part to a recognition among medical experts that pain was under-treated in the past and can and should be better controlled. But they also trace the rise in drug prescriptions overall to direct media marketing by pharmaceutical companies to consumers.
"The marketing of pharmaceuticals that we've seen on television in the last 10 years -- the whole `get some medicine for whatever you need attitude' -- has really increased the acceptability of prescription drugs," said Richard A. Rawson, a professor of psychiatry and associate director of the Integrated Substance Abuse Programs at the University of California, Los Angeles.
Media accounts of Ledger's death, Rawson said, emphasized that no illegal drugs were found in the apartment. Such distinctions might lead the public to assume that the medications that were found were harmless.
"There's a stigma that's associated with illicit drugs that isn't associated with legal drugs," he said.
Brad Keith, founder of Axis Residential Treatment in Los Angeles, said prescription drugs have become so acceptable and easy to obtain that they're the leading drugs of choice for his clients. The most popular drugs abused are painkillers such as Vicodin.Keith said doctors should be more careful about the quantity and kinds of drugs they prescribe: "Doctors will prescribe these medications at the drop of a hat. It's incredibly easy for people to get them."
It's illegal to possess controlled substances without a prescription. But prosecutions for possession are rare. Response from state and federal governments and pharmaceutical companies, meanwhile, has been limited.
In 2004, the Bush administration introduced an effort to control prescription-drug abuse focused on reducing sales of narcotic medications online or by doctors who write pain prescriptions too freely.
Makers of prescription drugs, including Vicodin's Abbott Laboratories Inc., Valium's Hoffmann-La Roche Inc. and Pfizer Inc., the maker of Xanax, say they have instituted public awareness campaigns about the dangers of prescription-drug abuse, such as giving doctors and parents brochures about monitoring the pills.
The new White House campaign is aimed at the parents of teenagers, Walters said. He cited surveys showing that many teenagers who abuse prescription drugs get them from their parents' or friends' medicine cabinets. Parents have no idea it's a problem, he said.
"We want people to have access to pain relief that's changed people's lives for the better," Walters said. "We don't want them to fear beneficial medications. But we want them to control them, to dispose of them when they're done with them and to talk with their kids."