Paragraph 20 reads: "'Most people don't know they can kill themselves with antidepressants such as Lexapro,' he said. "'Most of them are respiratory depressants in high enough quantities. We've got an overdose death right now from one called Effexor.'"
Paragraph 19 reads: "A week after ads for Lunesta appeared on television, there was a lethal Lunesta overdose, Robinson said. "I think we ought to outlaw drug advertisements on television the way we outlawed cigarette advertisements."
Drug deaths surge higher
A rising number of deaths from illegal and prescription drugs is hitting Alabama, and in some areas, including Jefferson and Shelby counties, fatalities caused by drugs are now surpassing those caused by traffic accidents.
The lethal trend was revealed in death statistics and records provided by coroners and public health officials. The data, gathered by The Birmingham News in recent weeks, provide a rare look at causes of death that often escape public view - fatal heart attacks triggered by cocaine use, acute poisonings and addiction.
In Jefferson County, 119 deaths occurred last year in which legal and illegal drugs were largely responsible, an increase of 42 percent since 2002. Eighty people died in the county in traffic accidents during 2006.
In Shelby County, drug deaths have been increasing at an alarming rate as the population grows. The coroner's office responded to 18 overdose deaths in 2005 and 24 in 2006. This year, from Jan. 1 until May 14, the coroner responded to 18 drug deaths. Eleven traffic fatalities have been reported so far this year in Shelby County.
Statewide, drug deaths are steadily increasing. Death certificates show fatal poisonings from drugs jumped 67 percent from 2000 to 2005. Deaths from drug addiction jumped 94 percent from 2000 to 2006.
Jay Glass, chief deputy coroner in Jefferson County, said the public lacks awareness of drug deaths. These deaths don't attract the urgent media attention of crime or traffic accidents. Determining the cause of drug deaths often requires toxicology, and sometimes it takes weeks to get results. Reports aren't readily available.
"There's a lot of hidden stuff," Glass said.
The most likely profile of a drug fatality in Jefferson County last year was a 41-year-old white man consuming a toxic combination of pharmaceuticals such as Valium and illegal substances such as cocaine or opiates, according to statistics from the coroner's office.
But the problem isn't confined to that group. Young and old, male and female, all died from drugs in 2006, according to the statistics. The trend is surfacing nationally, too, with unintentional poisonings rising in the United States 61.4 percent from 1999 until 2004.
Glass said a trend that stands out in Jefferson County involves middle-aged black men with underlying heart disease who use cocaine. The drug kills quickly by heart attack. Last year, 15 middle-aged black men died that way with cocaine in their systems in Jefferson County, according to records.
"The word has got to get out to the black community that there's a problem for middle-aged black males who think they can do cocaine," Glass said.
Another disturbing trend is revealed by toxicology results on homicide victims, who aren't classified as drug deaths. Thirty of the county's 118 homicide victims last year had cocaine in their systems, according to coroner's records.
As problematic as cocaine is, it is not the No. 1 drug found by toxicologists investigating unusual deaths. That's alcohol, said C. Andrew Robinson, toxicologist at the University of Alabama at Birmingham division of clinical pathology.
But alcohol by itself typically doesn't kill people, said Robinson, who sees blood chemistry on most questionable deaths in Jefferson County.
All too often, he finds combinations of alcohol, cocaine, opiates such as Lortab and methadone, and benzodiazepines such as Valium and Xanax.
These drug mixtures, particularly opiates and benzodiazepines, often kill by shutting down a user's respiratory system.
"It's got an additive effect," Robinson said. "It's a deadly combination."
The parade of drug deaths he sees is constantly expanding in complexity, as pharmaceutical companies march out new sleeping pills and antidepressants.
A week after ads for Lunesta appeared on television, there was a lethal Lunesta overdose, Robinson said. "I think we ought to outlaw drug advertisements on television the way we outlawed cigarette advertisements."
Most people don't know they can kill themselves with antidepressants such as Lexapro, he said. "Most of them are respiratory depressants in high enough quantities. We've got an overdose death right now from one called Effexor."
He also has found that people who die of drug overdoses often "doctor shop," or have several doctors writing overlapping prescriptions.
About a year ago, Alabama instituted a database in an effort to prevent such abuse. Much of the information that goes into the Prescription Drug Monitoring Program is confidential, but an official at the state Department of Public Health said on average about 1 million prescriptions for controlled drugs are written every month in Alabama, a state with a population of about 4.5 million.
Alabama had the nation's sixth highest rate of prescription drug consumption in 2005, with an average of 14.4 prescriptions filled annually per capita, according to the Kaiser Family Foundation.
The head of the Shelby County Drug Enforcement Task Force, Capt. Ken Burchfield, has advice for anyone who is taking a legitimately prescribed pain medication: "Go home. Count your pills. Lock them up."
In many cases, pills vanish to teenagers, cleaning service workers or even friendly neighbors raiding the medicine cabinet, he said.
Burchfield said the upsurge in misused prescription medicine is being caused by greater availability of drugs, ignorance of the dangers and a decline in the stigma attached to drug abuse.
Drugged to death:
Brenda Prendiville lost her son on his 20th birthday to an overdose of methadone. It was the second time Michael "Turky" Turquitt Jr. had overdosed on the powerful drug. His mother saved him the first time.
"I got him back with CPR that night," said Prendiville, 48, of Alabaster. "I found him the second time, but I couldn't bring him back."
Blood toxicology reports showed that Turquitt also had Valium in his system.
Turquitt suffered slight brain damage from the initial experience, his mother said, and was unable to hold a job.
Prendiville, a radiology supervisor at Shelby-Baptist Medical Center, said that both times her son had taken methadone tablets, called wafers, that he bought from an Alabaster drug dealer.
Five of Shelby County's 18 drug deaths so far this year have been caused by methadone. For decades, methadone, which is an opiate, has been used to treat opiate addicts and is usually dispensed at special clinics. But in recent years, it has been prescribed more often for general pain control.
"I know these wafers are coming from pain doctors," Prendiville said. "They write it to people who turn around and sell it."
Jack Kalin, head toxicologist at the Alabama Department of Forensic Sciences, said methadone is a killer when taken without close medical supervision. The drug builds up in a person's body, and an overdose can sneak up.
"It accumulates, and it's so dangerous, dangerous, dangerous," he said.
Shelby County Coroner Diana Steele Hawkins calls the drug death increase in her county an epidemic.
"I will go anywhere and talk to any group of people - kids or adults - about this problem," Hawkins said. "We have got to do something about it. This is a matter of life and death."