(Editor’s note: This is the 11th of a year-long monthly series about how alcohol and drug addiction affects the community and how those affected work to achieve a better life.)

(Editor’s note: This is the 11th of a year-long monthly series about how alcohol and drug addiction affects the community and how those affected work to achieve a better life.)

Julia M. Dendinger-News-Bulletin photo: This is just one of the unmarked bottles of pills found on a regular basis when drug search warrants are served at homes around Valencia County. This particular pill is for treating attention deficit hyperactivity disorder, but for someone without the disorder, it still produces a high.

It’s become a symbol for better health — an amber plastic bottle with a white lid.

Prescription medications are so prevalent in homes around the country they have become all but invisible.

But one type of medication has become very visible and is now part of the illegal drug world — prescription opiates.

New Mexico ranks No. 2 in the nation for drug overdose deaths, behind West Virginia, down from the No. 1 spot just a few years ago.

In 2007, New Mexico led the nation in drug-induced deaths, with a rate of 24.2 deaths per 100,000 people. That number dropped slightly in 2009 to 22.4, but it still topped the nation’s list.

Belen Police Detective Sgt. Joe Portio sits in his windowless office, holding up one of those easily recognized amber bottles. The label has been peeled off, giving a clear view of the oblong white pills inside.

“Every drug raid, we find bottles with pills,” Portio says, rattling the pills softly.

For now, it’s a mystery bottle, with mystery pills that Portio must later identify. A large magnifying glass on a stand sits on his desk to his left, along with a thick book open to the New Mexico statutes on controlled substances.

In this case, the pills were prescribed to someone with attention deficit hyperactivity disorder. While it’s not your typical opiod-based painkiller, for people without an ADHD diagnosis, the three-sectioned pills will still make you dizzy, high and euphoric, Portio says.

“Valencia County has a problem,” he says bluntly.

One of Portio’s chief frustrations is that the pills are virtually untraceable.

Julia M. Dendinger-News-Bulletin photo: Caught between treating pain and not feeding addiction, Dr. Mark Evanko, medical director for First Choice Community Health Care in Los Lunas, explains how he and other doctors walk a fine line when prescribing painkillers.

“As soon as they get a bottle, they peel off the label,” he said. “And it’s not like these things come with serial numbers.”

A parent himself, Portio worries that users are getting younger and younger. When he started his career in law enforcement, the detective said the heroin users were easy to spot — men of a certain age, usually war veterans of a certain era.

Now that stereotype is being wiped away. The use of opiate pills and heroin interchangeably has obtained a certain cache among high school students across all cliques.

Parents have to be aware of this, he says, and take action.

“Parents, you do have the right to go through your kids backpacks. Find out what they have,” Portio said.

Any number of websites will give a quick pill identification. Maybe the pills really are just acetaminophen, but maybe it’s a Schedule I or II narcotic.

And whether it’s pills, cocaine or meth, Portio says trafficking is trafficking.

“State statute is very clear. People will try to say, ‘Oh, but I just gave them the pills.’ Statute defines trafficking as selling, bartering or giving away,” the detective said. “The first offense is a felony. One pill can cost you the rest of your life.”

Belen Schools Resource Officer Michael Esquibel said he has seen 15-year-olds start off using pills and be full-blown heroin addicts a year later. He remembers one young man who has gone through rehab twice.

“I saw him a few weeks ago and he seems to be doing well,” Esquibel said.

Like a lot of youth misbehavior, Esquibel said abusing pain pills is driven by peer pressure and a desire to fit in.

“And parents don’t keep good track of their pills, don’t count them, forget about them,” he said. “Parents are too trusting of their kids. Most of the issues I see at the middle school are pill-related.”

The world of drugs is a secret world, Portio said, and the only way to do away with it is to talk about the use and abuse.

“It doesn’t matter if they are your family, your friend or whatever,” Portio said. “If you really care about them, you’ll talk to somebody.”

Earlier this month U.S. Sen. Tom Udall visited First Choice Community Health Care in Los Lunas to talk about just that.

When Udall ran for New Mexico attorney general in 1990, the state was No. 1 in DWI deaths, so seeing his state near the top spot for yet another negative reason was a watershed moment for him.

While in Los Lunas, Udall announced plans to introduce a bill to help reduce prescription drug abuse and misuse. The senator’s bill seeks to address and combat the major problem of prescription drug abuse and misuse within New Mexico communities.

“It’s never good to see your state at No. 1 for something like this,” Udall said.

The senator said he was surprised by how many drugs found their way to the streets through perfectly legal routes.

“People go in for a good reason and end up going home with 30 days of medication,” he said. “Then they get home and there are leftovers that make it out there. Yes, some physicians are over-prescribing but that is a very small number.”

Udall’s bill, the Increasing the Safety of Prescription Drug Use Act, would expand medical-education training and use of timely data to ensure that patients receive prescriptions safely and legally. The bill would strengthen monitoring techniques for existing high-risk prescriptions — such as by expanding the reach of a prescription drug database across states — and implement new measures to prevent prescription drugs from falling into the wrong hands.

Increased patient assessment would help refer potentially addicted patients to treatment. The bill would also develop partnerships between the U.S. Health and Human Services and state and local governments to increase ongoing opportunities for proper medication disposal.

According to a June 2013 report from the New Mexico Department of Health’s substance abuse epidemiology section, from 2007 to 2011, 49 percent of the state’s unintentional drug-induced deaths were caused primarily by prescription drugs.

Of that 49 percent, medical examiner data indicates a full half of those overdoses were from prescription narcotics such as methadone, oxycodone and morphine.

The report indicates for that five-year period, there were 106 drug-induced deaths in Valencia County, which translated to a rate of 29.1 deaths per 100,000 people, more than both the state’s rate of 24.3 and the national rate for that time of 12.3 deaths.

Valencia County Sheriff Louis Burkhard said what his department is seeing is juveniles “getting into Mom and Dad’s stash. Somebody breaks an arm, they bring them home, take a few, toss the rest in the cabinet and forget about them. That happens a lot.”

When homes are searched on drug warrants, Burkhard said they aren’t finding stockpiles of pills like they do other drugs such as meth or the newer designer drugs.

“They sell and use the pills quickly — six here, four there. They go fast,” the sheriff said.

When he gets wind of someone selling pills, he treats it like any other drug.

“We approach it the same way we would if we got a tip that someone was selling meth. The problem is it’s so wide spread. There is no one community or group,” Burkhard said. “Throughout the county, we have people who are addicted to prescription medications in some way.”

Heading into his eleventh hour at the office, Dr. Mark Evanko, the medical director at First Choice Community Health Care in Los Lunas and a primary care physician at the facility, talks about the conflict he and other doctors often encounter when treating patients for pain.

Some pain is temporary — a broken arm or a sprained ankle. But sometimes pain is long term — a patient with post-cancer scar tissue from chemotherapy and radiation treatments or someone with a degenerative disease like rheumatoid arthritis.

“They still have pain. They aren’t going to get better. There is no cure; treatments but no cure. So what do you, as a doctor, do?” Evanko asks. “I don’t want to see anyone suffer in pain. But I also don’t want to contribute to their death.”

So he often finds himself between a moral rock and a hard place. A woman with rheumatoid arthritis comes to his office asking for help. She admits she used heroin in the past. As per state regulations, Evanko has to do a drug test.

Her urine is dirty. He makes her wait and repeats the test. Still dirty. Evanko can’t write an opioid prescription for her, which is what she ultimately needs.

“But she still has pain,” he says.

Evanko says he is probably the biggest opiate prescriber in the county. He points this out, not with pride but with a kind of resigned sadness.

“My first duty as a doctor is to prevent suffering and pain,” he said. “A person in chronic pain is not going to get better. And they are not coming off the opiates — they will not function.”

Evanko draws a clear line between addiction and physical dependency. Someone on opiates for any length of time will naturally develop a physical dependency on the drugs.

“People with true pain don’t become addicted. If they stop taking them, they will go through withdrawals and detox. No doubt about it,” he said.

While a person with a dependency will abide by all the rules to make sure they continue to receive the medication, an addict engages in addictive behavior, Evanko said, constantly seeking a high.

They will keep secrets, steal from their friends and family to buy their drugs from sources other than their doctor.

“Addiction interferes with your daily life, your job. There is a whole subculture that goes along with addiction,” Evanko said. “Some people don’t get out.”

So how do doctors tell the difference between the two? Evanko says they have to use the tools available, such as the statewide prescription database, to make that call. The database allows doctors to review all the prescriptions issued to a patient and which doctor gave it to them.

This is done in an effort to prevent “doctor shopping,” where an addict goes from doctor to doctor, accumulating narcotics prescriptions.

Doctors around the state have also implemented narcotics contracts with their patients, which require patients to get any and all opiates from their doctor only.

Treatment can be terminated if the doctor finds out the patient is seeking the drugs elsewhere or using them improperly.

Evanko said he supports Udall’s proposed law even though, in some regards, it will make his job more difficult.

“The problem is more complex than any law can handle,” he said. “These are legal medications that can be prescribed for legitimate reasons. We need new ideas. This problem is not going away.”

-- Email the author at