PAINKILLER ADDICTION DIFFICULT TO BEAT

Conservative radio talk-show host Rush Limbaugh, who last week checked
into a 30-day treatment program to break his addiction to painkillers,
faces a challenge greater than trying to silence throngs of liberals.

More than 4 million Americans are addicted to painkillers. Among those
who seek treatment, only about half are successful.

Dr. Karen Drexler, assistant professor of psychiatry at Emory
University and director of the substance abuse treatment program at
the Atlanta Veterans Affairs Medical Center, answered some questions
about pain medications and addictions:

Q: Rush Limbaugh's problems have been linked to OxyContin (oxycodone)
and Lorcet (which includes hydrocodone). For what conditions are these
drugs normally prescribed, and how are they different?

A: OxyContin is for chronic pain that needs relief around the clock.
It has a controlled-release format (though oxycodone is also available
in immediate release form). Lorcet is for treatment of pain on an
as-needed basis. Both are opioids, and both peak about an hour after
you take them.

Q: What other painkillers most often lead to addiction?

A: It has more to do with how you take the drugs than the drugs
themselves. OxyContin, if taken as directed, is not likely to cause
dependence. But if you crush the tablet, you circumvent the
slow-release mechanism. Drugs you take orally have a slower onset and
are less likely to be addictive. But by smoking or injecting any
opioids, it can take only 10 seconds to get to the brain. It's more
potent and addictive that way.

Anyone who takes opioids over time will build up tolerance. They may
need higher doses to achieve the same pain relief. But people with
tolerance are not always addicted. Addiction is the loss of control
over drug use and the continued use despite negative
consequences.

Q: What percentage of people who take OxyContin, Lorcet or similar
drugs develop addiction, and why does that happen?

A: It's definitely a small minority. But among forms of drug
addiction, it is more common than crack cocaine or street heroin use.
That's because more people take pain medications. A survey last year
by the Substance Abuse and Mental Health Services Administration said
that 22 million Americans -- about 9.4 percent of the population 12
and over -- are dependent on drugs or alcohol or both. About 4.4
million of them are using narcotic pain relievers.

Q: Are some people at higher risk of becoming addicted to
painkillers?

A: Yes, if you have been addicted to another drug or alcohol and if
you have a family history of addiction to any substance. People who
take drugs to get high are also at higher risk.

Q: What are the warning signs of addiction, and when is treatment
necessary?

A: Building up tolerance to the drug is one. Another is if someone
goes to multiple physicians with multiple complaints and fills
prescriptions at multiple pharmacies. And if the person can no longer
carry out their daily functions or if they're missing work or having
trouble with relationships.

You should talk to your doctor, who might try an alternative
medication or physical therapy for pain relief, or refer to a
substance abuse treatment program.

Q: What kinds of treatments can stop addiction to painkillers?

A: Drugs such as clonidine and methadone can ease withdrawal symptoms
during detox. Methadone is a slow-acting replacement narcotic that can
be gradually tapered. But while detox is a necessary step toward
rehabilitation, it is not rehabilitation itself.

The mainstay is psychotherapy, either in residential programs or a few
evenings a week. Most programs are abstinence-based, with the goal of
getting off all substances. Many follow the traditional 12-step model.
Cognitive behavioral therapy helps people recognize their high-risk
situations and manage their urges. You learn to avoid the places where
you got drugs and to use distraction techniques like talking to a
friend, going jogging or chewing gum.

Q: What about "rapid detox," coming off drugs in a few
days?

A: It relies on giving the drug naltrexone while the patient is under
general anesthesia. The drug blocks opiate receptors, so if you abuse
drugs, you won't feel the high you're looking for. The person doesn't
feel the symptoms of withdrawal because of the anesthesia. It can be
helpful in highly motivated groups, especially professionals whose
careers are on the line and want to get back to work quickly. But I
generally don't recommend it. Anesthesia can have its own side effects.

Q: How often is treatment successful? Don't a lot of people
relapse?

A: Addiction is a chronic illness, like diabetes or high blood
pressure. It develops after many months or years of substance use.
Once a person develops a blindness to the problems a drug causes,
those changes last a long time. The rate of staying abstinent is about
40 [percent] to 60 percent. The longer you stay in a treatment
program, the better your chances of success. Methadone is a very
effective treatment for people who have tried abstinence and not been
able to make it work.