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, largely because of prescription drugs.

According to the federal Centers for Disease Control and Prevention, unintentional poisoning deaths -- 95% of which are 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 wrote in a study published last month.


Drug treatment experts say they doubt that most people realize the seriousness of the problem.

Because prescription drugs aren’t street drugs, people think they don’t have the same risk, said John P. Walters, director of the White House Office of National Drug Control Policy. Walters unveiled an advertising campaign Thursday to target prescription drug abuse by teenagers. The first television ad will be broadcast Feb. 3 during the Super Bowl.

The campaign was originally 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, accord- ing to a police spokesman. An autopsy was inconclusive and toxicology tests are pending.


The great majority of overdose deaths are due to opioid painkillers, including 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.

However, unintentional poisoning deaths involving other psychotherapeutic drugs, including sleeping pills, antidepressants and tranquilizers, grew 84% from 1999 to 2004, according to the CDC study.

Headline-grabbing overdose deaths like 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 non-medical reasons almost doubled, from 7.8 million to 15.1 million, and abuse among teens more than tripled, according to a survey by the National Center on Addiction and Substance Abuse at Columbia University in New York.


“When you look back at it, the train is coming down the track at you,” said Mark Kleiman, a UCLA professor of public policy. “I have to say that most of us were asleep at the switch.”

Prescription drug sales have soared nearly 500% since 1990.

Experts attribute the rise in the use of painkillers in part to recognition among medical experts that pain was under-treated in the past.

But they also cite direct marketing 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 UCLA professor of psychiatry and associate director of its Integrated Substance Abuse Programs.

Most media accounts of Ledger’s death, Rawson said, reported that no illegal drugs were found in the apartment. Such distinctions may 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 and especially painkillers have become so easy to obtain that they are the leading drugs of choice for his clients.


Keith said doctors should be more careful about the quantity and kinds of drugs they prescribe.

Elvin Berrios, manager of Liberty House, a sober-living house in Century City, said more of his clients were getting prescription drugs online, often from little-regulated sites based overseas: “They can buy what they want and as much as they want and it arrives on their doorstep.”

It is illegal to possess controlled substances without a prescription. But response from state and federal governments and pharmaceutical companies has been limited.

In 2004, the Bush administration introduced an effort to control prescription-drug abuse that focused on reducing sales of narcotic medications online or by doctors who write pain prescriptions too freely.


Makers of prescription drugs -- including Abbott Laboratories Inc., Hoffmann-La Roche Inc. and Pfizer Inc. -- say they have instituted public awareness campaigns about the dangers of prescription drug abuse, including 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 most teenagers who abuse prescription drugs get them from the medicine cabinets of their parents or friends’ parents. 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.”

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mary.engel@latimes.com

daniel.costello@latimes.com