RDD is grateful for our patient’s trust in us. Our patients can be assured that a portion of their cost of treatment goes to SMILE TRAIN to help poor children around the world with a much needed surgery. These dear little children no longer have to live with a disfigurement.

After a 20-hour journey, very little sleep the past four nights and four days of non-stop meetings, I’m actually feeling more energized and motivated than ever before!

I traveled to Hyderabad, India to meet with Smile Train international managers and some of our partner surgeons and anesthesiologists who attended a Smile Train-sponsored conference. Over 250 partner-doctors will meet to discuss, evaluate and enhance ways to strengthen our cleft programs to impact more lives than ever before.

This week, our mission came to life in the presence of this esteemed group. Our mission is and continues to be: To empower local medical professionals to provide safe, high-quality and cost-effective cleft treatment for the millions of poor children around the world who suffer from cleft lip and palate.

We’ve just finished a record-breaking third quarter for our fiscal year. Among the highlights, our South Asia region (made up of India, Nepal, Sri Lanka and Bangladesh) had its best quarter ever in the 12-year history of Smile Train, with 13,734 surgeries. This is a 14% increase over last year. And worldwide, we had our 3rd highest quarter ever!

This is a great milestone for everyone here at Smile Train, our partners around the world and really, you, our donors who make this happen.

But our work is not done. Every year more than 170,000 children are born with cleft lips and palates. There’s a huge backlog of children left to help and all of us here at Smile Train are committed to helping every child born with a cleft live a full and productive life.

These surgeries – that take as little 45 minutes – are so important to the children still suffering from cleft lips and palates.

Thank you so much for helping children around the world and giving them a new smile and new life.

All the best,

Priscilla Ma
Executive Director

When White House drug czar Gil Kerlikowske recently toured Appalachia, he met with 14 imprisoned women who were in drug treatment, 13 of whom were being treated for prescription-drug use.

Kerlikowske asked the women how many had been to Florida to get their drugs. “Thirteen of the 14 raised their hand,” Kerlikowske said.

So it may be no surprise that Kerlikowske has an interest in what Florida — considered a key supply source for prescription drugs — does to help solve the problem.

The debate over how to tackle the prescription-drug problem in Florida was renewed last month when Gov. Rick Scott proposed eliminating the Prescription Drug Monitoring Program, a database touted as one of the best tools for fighting prescription drug abuse.

Kerlikowske was in Florida last week and spoke with the Orlando Sentinel

Q: Florida officials say the state is a key supplier of prescription drugs. Is this accurate?

A: Oh, yeah. Not only the data — about where people are dying and where they’re overdosing — but where the pills come from. They’re being issued in Florida, they’re being filled in Florida. I think it’s absolutely accurate. Unfortunately, Florida is a key supplier.

Q: Do you think Florida should implement its Prescription Drug Monitoring Program?

A: Yes. Absolutely. We don’t claim — and I don’t think anybody claims — it’s an end-all and be-all to the prescription-drug problem. But when you look at approaching this problem, you’ve got to approach it holistically. This is just one of those tools. The PDMPs are a good start.
Q: Your office has said prescription-drug abuse is the fastest-growing drug problem in the U.S. How does this compare with other drug problems?

A: In the big picture, it really does stand out greater in many ways. Look at the number of deaths. It’s greater than heroin and cocaine overdose deaths combined. In 17 states, it’s greater than car crashes. In those 17 states it would be the No. 1cause of accidental death.

If there was a headline that said Toyota Priuses were responsible for 36,000 deaths a year, there would be a huge outcry. And yet, this one is very difficult.

Q: What makes prescription abuse different from abuse of other drugs?

A: People don’t recognize the danger of prescription drugs. When I was in Appalachia, they often talked about sharing drugs. There are a lot of people from the agriculture industry and mining industry who have injuries, and they would be prescribed prescription drugs. Someone else would have an injury, and that drug would be shared. It was a pretty common thing.

These are pharmaceuticals. I think it really does make it a much harder epidemic … to combat. That’s why prevention is going to be the key, not just trying to shut down pain clinics.

Since 1990, there has been a tenfold increase in prescriptions for opioids in the U.S., according to the Centers for Disease Control and Prevention (CDC). In 2007, 3.7 million people filled 21 million legal prescriptions for opioid painkillers, and 5.2 million people over the age of 12 reported using prescription painkillers nonmedically in the previous month, according to a survey by the Substance Abuse and Mental Health Services Administration (SAMHSA). From 2004 to ’08, emergency-room visits for opioid misuse doubled. At the same time, the drugs have become the stuff of pop culture, gaining cachet in the process. The fictitious Dr. House and Nurse Jackie gobble them like gumdrops, as did the decidedly nonfictional Rush Limbaugh and Heath Ledger. And, like Ledger, some users don’t make it out alive.

In 1990 there were barely 6,000 deaths from accidental drug poisoning in the U.S. By 2007 that number had nearly quintupled, to 27,658. In 15 states and the District of Columbia, unintentional overdoses have, for the first time in modern memory, replaced motor-vehicle incidents as the leading cause of accidental death; and in three more states it’s close to a tie.

Florida’s prescription drug epidemic, already responsible for nearly seven deaths a day, is taking its toll on the youngest, most vulnerable in our communities: newborns.

In 2009, nearly 1,000 babies born in Florida hospitals were treated for drug withdrawal syndrome. They’re irritable. They don’t eat well. They can spend days, even weeks, detoxing.

And the number is skyrocketing.

Janet Colbert, a registered nurse in a neonatal intensive care unit at a Broward County hospital, witnesses with alarming frequency the heartbreaking physical trauma these newborns endure.

“I kept seeing the torture these babies are going through,” said Colbert, 59, of Dania Beach. “This one baby, he couldn’t even feed. He was screaming, his face was just quivering so badly he couldn’t even get his face around the nipple to feed — and I just said I have to do something.”

Last spring, Colbert and two other women, also healthcare professionals, founded the STOPP Now organization (Stop the Organized Pull Pushers). They stage monthly protests at certain Broward County pain clinics they consider to be pill mills doling out excessive quantities of narcotic painkillers.

From 2006 to 2009, there was a 173 percent increase in newborns treated at Florida hospitals for drug withdrawal syndrome, according to Agency of Health Care Administration records obtained by the Orlando Sentinel.

The most recent data show no signs of a slowdown. During the first half of 2010, 635 cases were reported.

While the state records don’t specify which narcotics those babies tested positive for, South and Central Florida doctors say a majority of the withdrawal cases involve prescription drugs.

“We see them here almost daily,” said Dr. Matthew Seibel, a pediatric hospitalist at Arnold Palmer Hospital for Children and Winnie Palmer Hospital for Women & Babies. “It is standard operating procedure around here, unfortunately.”

Infants suffer

It used to be that infants born with drug withdrawal symptoms were more likely to be suffering from a crack cocaine addiction.

But doctors, nurses and social workers say cases of “crack babies” are dwindling, while cases of prescription drug dependence are becoming more prevalent.

Colbert, the nurse, said more often than not the babies at her hospital are testing positive for oxycodone and other prescription drugs.

Former state Sen. Dave Aronberg, a Palm Beach County attorney now leading Attorney General Pam Bondi‘s new anti-pill mill initiative, called the newborn drug withdrawal statistics “horrifying.”

“Prescription drug abuse has become the number one public safety threat to Florida,” he said.

State child-welfare officials in Central Florida have taken notice of the surge. The problem was escalating so much in Orange County that in 2008, the local Department of Children and Families office reinstituted its Drug Dependent Newborn unit. It’s the only DCF unit in the state dedicated to serving newborns dependent on drugs.

Last year, the unit received 206 cases.

In South Florida, all the hospitals with delivery rooms see babies born addicted to painkillers, nurses said. Fifty-five were born addicted to some substance — the state doesn’t break out painkillers — in the first half of last year in Broward and Palm Beach counties, up sharply from 29 in all of 2006, state figures show.

From her experience, Colbert said, those numbers sound low. That may be because some doctors classify cases as maternal drug abuse rather than neonatal drug abuse, she said.

Hospitals prefer to keep addicted babies for at least four weeks to gradually wean them off drugs, rather than send them home to detox, said registered nurse Mary Osuch, manager of the neonatal intensive care unit at Broward General Medical Center in Fort Lauderdale.

“If we don’t intervene, they are more vulnerable to child abuse because they are inconsolable and the parents can’t take it after a while,” Osuch said.

The drugs steal their appetites and cause stomach cramps. When the babies do eat, they get diarrhea. They don’t rest well. And they are irritable all the time, Osuch said.

“It’s so hard to watch them,” Osuch said. “You can’t console them.”

Typically, NICU doctors give addicted babies the sedative phenobarbital to ease the withdrawal, Osuch said. If that doesn’t work, they use methadone or even morphine. Over days or weeks, they reduce the dosage until the baby is drug free and eating and sleeping normally.

Mothers are steered toward parenting classes, counseling and assistance with scheduling doctors appointments and follow-up care for the newborn.

Mores seek treatment

At the Center for Drug Free Living’s Addictions Receiving Facility near downtown Orlando, the number of people being treated for prescription drug abuse — including pregnant women — is on the rise.

Doctors have treated pregnant women with methadone, often prescribed in place of oxycodone for pain management, since the 1960s.

That method still stands today, because women who abuse drugs like oxycodone cannot go cold-turkey while they are pregnant. Doctors say it’s too stressful on the mother’s body, which imposes stress on the developing baby.

Doctors would rather have a steady level of methadone in the developing baby than a mother who takes other drugs, explained Dr. Stacy E. Seikel, medical director at the center.

“When the mother is in withdrawal, the baby is in withdrawal,” she said. “If the baby is in and out of withdrawal the entire pregnancy … the baby can’t grow and mature well.”

‘Prescription nation’

Officials say the increase in drug-dependent newborns is further evidence of Florida’s — and the nation’s — growing use of prescription drugs.

Drug addicts and dealers from northern states, dubbed “pillbillies,” travel to Florida, where a plethora of pain clinic doctors are willing to dole out addictive, powerful painkillers and sedatives like oxycodone and alprazolam.

From October 2008 to March 2009, 49 of the nation’s top 50 dispensing doctors of oxycodone were in Florida, with the majority concentrated in Broward and Palm Beach counties, a grand jury reported. And according to one national study, the use of prescription pain medication increased 400 percent from 1998 to 2008.

Colbert, the neonatal nurse, says every time she tries to comfort yet another inconsolable newborn through withdrawals, she wonders why politicians allow the abuse to continue.

“It’s like a side effect no one’s seeing,” she said. “Every time we admit another baby like this, I wonder, why isn’t somebody doing something about this.”

Sen. Mike Fasano, R-New Port Richey, who has been a state leader in the pill mill fight, said he was unaware of this aspect of the prescription drug scourge.

“You don’t realize how there’s that trickle-down effect,” Fasano said. “This is another perfect example of why we have to address this crisis in Florida, this epidemic.”

When Gov. Rick Scott says he wants Florida open for business, who knew that he also meant the deadly pill mills that have ruined so many lives?

Scott’s move to scrap a prescription narcotic database intended to temper the excesses of South Florida’s rogue pain clinics makes no sense.

Unless the governor somehow likes the drug tourism, overdoses and other human wreckage spawned by our pill-friendly culture. Prescription drug abuse is blamed for an estimated seven deaths a day in Florida.

The database can help law enforcement, pharmacists and health officials pinpoint patients who abuse or traffic in powerful pills like oxycodone by getting multiple prescriptions in a short timeframe, a practice known as doctor-shopping.

The Legislature approved the database in 2009, with private grants paying for it.

It was supposed to launch last December, but has been delayed by a dispute involving a contractor who didn’t win the bid.

Forty-two other states have databases.

Now along comes Scott, who took office last month, trying to scuttle Florida’s database before it begins.

And in the cryptic style that’s becoming his trademark, the public can’t get a detailed answer about his rationale.

Last Tuesday, Scott told reporters, “That program has not been working.”

Huh? The program hasn’t even started. He went on to say he was working with Florida Attorney General Pam Bondi to deal with the pill-mill issue. He didn’t get into specifics.

That was after his spokeswoman said Scott didn’t think the database was a function best performed by government.

Say what? If it’s not government’s role to monitor controlled substances, then why bother monitoring anything? Let’s just do away with driver’s licenses, vehicle registrations and concealed weapons permits too, since cars and guns are legal.

The database had support from just about everyone — legislators, law enforcement, responsible doctors and pharmacists and legitimate pain clinics.

And it’s not like it would cost taxpayers anything, since the money is supposed to come from private sources.

Scott baffled everyone with his request to repeal the database, filed in documents with his proposed budget. It follows his decision last month to abolish the office of drug control, whose chief was spearheading the database efforts.

Broward Sheriff Al Lamberti, who saw Scott a few days earlier and emphasized the importance of the database, said he was “very surprised.”

Pain clinics have mushroomed across South Florida in the last decade, with many dispensing prescriptions and drugs to cash-paying customers after cursory exams.

Some customers — known as pillbillies — travel from Kentucky, Tennessee and West Virginia.

Some Broward and Palm Beach County cities, tired of complaints about the clientele, have put moratoriums on new pain clinics. I know a beauty salon owner who recently moved because she no longer felt safe in a Hollywood strip mall she shared with a pain clinic. Tamarac is trying to shut a pharmacy that has dispensed more than 2.8 million oxycodone pills in two years.

Broward Sheriff’s Office Tamarac district chief Marc Duguay said it’s a public safety issue, even though the pharmacy is not doing anything illegal.

“Tallahassee needs to do something,” Duguay said.

But the governor fiddles while the pill epidemic rages on.

It wasn’t a banner week for Rookie Rick. He played accounting games with his budget numbers, trumpeting a $5 billion reduction while conveniently lopping off hefty items that still exist, like university tuition and court administration fees.

He backed off his ambitious plan to expand private-school vouchers, finally acknowledging it wouldn’t be legal without changing the state constitution.

And he ticked off state workers with proposed job cuts and a pension revamp that would cut into their paychecks, while giving big tax cuts to … wait for it … corporations.

Of all the inscrutable things Scott has done, the database stance is hardest to swallow.

The governor needs to explain himself better.

And if Scott’s notion of hands-off government precludes common-sense measures like a narcotics database, it might be time for all of us Floridians to reach for a prescription pad and some pills. This could be a long four years.

Hi,

We wanted to tell you about one of the hundreds of thousands of children who has been helped by your donations.

Kiiza was brought to us at the age of 13.

He was born to a cattle keeping community in a very poor region of Uganda. His clan believes that a child born with a craniofacial deformity brings a curse to the herd which results in loss of cattle.

Others like him are traditionally buried alive in a heap of cow dung at birth, and never see the light of day.

Luckily he was delivered in hospital, and by the time his clan took a decision about his fate, the health care providers had already assured his mother that Kiiza would grow up like any other boy, if he receives care.

Care, however, didn’t come early since this community lives in the country side. An attempt to send him to school failed because he easily became a laughing stock in class being mocked and ridiculed.

His mother didn’t lose hope for her son. She heard an announcement, inviting all children with this deformity to come in for free surgery sponsored by Smile Train, including a promise to assist with transport. She borrowed money from her neighbors and brought Kiiza in for surgery.

After his free cleft surgery, Kiiza was so full of joy and promised that although he was starting school late in life, he would work hard and become a doctor to help other children with similar problems!

These simple surgeries – that take as little as 45 minutes – are SO important to the millions of children with cleft lips and palates.

From all of us here at Smile Train.