By Carolyn Butler
Tuesday, August 24, 2010; HE02
Prescription drug abuse is a staple of daily papers and gossip rags alike -- from high-profile celebrity overdoses and massive Oxycontin busts to teen "pharm parties" -- but I never really gave the issue much thought. That is, until my doctor gave me a script for Percocet after my C-section surgery, along with a stern warning to taper off the opioid as soon as possible.
The truth is, if I hadn't broken out in a full-body allergic rash after a week's worth of euphoric pill-popping, it's not difficult to imagine myself developing a full-blown addiction.
Clearly I'm not the only one who has experienced the allure of such medications, which are crucial and effective for the treatment of serious pain but can also be quite harmful when used inappropriately. For starters, several friends generously offered to relieve me of my leftover stash of pills, without a note of shame. And overall, 20.8 percent of Americans 12 and older -- or nearly 52 million people -- have taken prescription drugs for nonmedical reasons, according to the latest National Survey on Drug Use and Health, from 2008. When it comes to illicit drug use, only marijuana is more popular.
While the problem isn't new, the repercussions are mounting. One government study released last month found that the share of substance abuse treatment admissions involving prescription narcotics increased more than fourfold between 1998 and 2008, from 2.2 to 9.8 percent. (The proportion of admissions tied to use of alcohol and such illicit drugs as cocaine, PCP and heroin declined.) A second study found that emergency room visits involving nonmedical use of these drugs jumped 111 percent over the same period, to 305,885.
Nearly everyone, it seems, is at equal risk. "We're not really talking about drug use that hits one group or another, because . . . there were increases across the board, with growth cutting across age, gender, region, race, education and employment status," said Peter Delany, director of the Office of Applied Studies for Substance Abuse and Mental Health Services Administration, which published this latest research. Nonetheless, he said, young people are a particular concern, with
13.7 percent of those ages 18 to 24 and 13.5 percent of those ages 25 to 34 who sought treatment reporting pain reliever abuse in 2008, up from 1.5 and 2.1 percent, respectively, a decade before.
So why are people like you and me turning to prescription medications in droves? For one thing, these narcotics are widely viewed as safer than street drugs such as cocaine or methamphetamines, said Washington-based interventional pain physician Damon Robinson. "Because you can obtain these drugs legally, from a doctor, there is this distorted perception that they are not as dangerous as other illicit substances, like IV drugs," he said. But potent medications such as Oxycontin and Vicodin "work on the same opiate receptor as heroin and are just as dangerous and just as addictive when they are abused outside of a medical context," he said.
In addition, these drugs are now more available than ever before, whether it is in doctors' offices or on the street. "Over 20 years, the number of prescriptions for opiate analgesics in the U.S. has gone from 40 million to 180 million," said Nora Volkow, director of the National Institute on Drug Abuse. She points out that research has shown that the majority of abusers obtain pain medications from friends or family members, although they also buy them from dealers and on the Internet, or get prescriptions from one or more doctors.
Experts lament the lack of a centralized system for monitoring the distribution of controlled substances such as opioids. Robinson believes this dearth of oversight allows patients to "doctor-shop" for physicians who will provide them additional or unnecessary medication.
"Right now, there's no way that physicians and pharmacies can talk to each other," said Robinson. He noted that while some states, including Virginia, have tracking databases for prescriptions, many other jurisdictions, Maryland and the District among them, do not. This makes it easy for savvy local patients to work the system and get narcotics they don't really need.
Robinson said that some doctors require patients who receive prescriptions for opioids to sign an agreement saying that they won't lose the medication, take it too frequently or give it to anyone else. Others make certain patients subject to frequent monitoring visits and the occasional urine toxicity screen.
Experts say there needs to be a happy medium that balances the needs of pain patients with concerns about the growing addiction and abuse problem. "We certainly want to cut down on prescription drug abuse, but we don't want to prevent legitimate pain patients from getting the help and medications they need, in a safe way," says the substance abuse administration's Delany.
He recommends better training for doctors on the proper treatment of pain and prescribing of narcotics, as well as more education for the public on the correct use of these medications and the dangers that come with their misuse.
Perhaps most important is reminding patients of their responsibility to properly dispose of leftover pills -- which means that my unused Percocet has now been flushed down the toilet, per FDA recommendations for certain painkillers.