PAINKILLER OVERLOAD

Amid the Weed Scare There Grows a Thornier Problem: The Misuse of
Opioids. The Pills May Be Prescribed, but the Abuser's Behavior Isn't.

The local popularity of medical marijuana aside, the prescription drug
of choice these days seems to be the opioid painkiller. And small wonder.

The medications are highly effective in controlling pain -- whether
from dental procedures, surgery, traumatic injuries or chronic
conditions such as back pain and cancer. They're remarkably safe when
used properly. And they produce a sense of well-being -- yes, a "high"
- -- that makes them irresistible to millions of Americans who take them
for relaxation or recreation.

And therein lies the problem. The risks of addiction and accidental
overdose are far greater when the drugs are abused this way. That's
why the U.S. Food and Drug Administration last year ordered several
manufacturers to develop plans to help curb inappropriate use.

Maybe those efforts will ultimately work. But it seems the request is
a bit like asking automobile makers to stop people from speeding. The
speeders need to take responsibility for their own actions.

Addiction, OD Threat

Even among those at high risk, addiction to opioids doesn't occur
overnight.

The drugs work by attaching to specific receptors in the brain and
blocking the perception of pain; over time they can cause physical and
chemical changes in the brain's pathways. Those changes can lead to
compulsive drug use.

"Somewhere between 5 and 10% of people who take opioids regularly
become addicted," says Dr. Nora Volkow, director of the National
Institute on Drug Abuse at the National Institutes of Health. People
with a personal or family history of drug or alcohol abuse are the
most susceptible.

Then there's the risk of overdose. Taking too much of an opioid can
cause breathing to slow and, in some cases, stop entirely. As abuse of
these drugs has grown, so has the number of overdoses. The federal
Centers for Disease Control and Prevention report that fatal
poisonings involving these medications more than tripled from 1999
through 2006 -- from 4,000 to more than 13,500.

Even the threat of death doesn't seem to be stopping people from using
these drugs inappropriately.

More than 5 million Americans currently use pain-relieving medications
like Vicodin, OxyContin and Percocet for nonmedical reasons, according
to the 2007 National Survey on Drug Use and Health, conducted by the
Substance Abuse and Mental Health Services Administration.

The problem is particularly high widespread among adolescents. A
survey performed by the National Institute on Drug Abuse in 2007 found
that almost 1 in 10 high school students had used prescription pain
relievers in the past year without a doctor's supervision.

Experts on drug abuse and addiction worry that people have come to
overestimate the safety of prescription opioids. The drugs are
fundamentally similar to heroin, but many people don't view them as
such. "After all, they're FDA-approved, doctor prescribed and pharmacy
dispensed," says Dr. H. Westley Clark, director of the Center for
Substance Abuse Treatment, part of the Substance Abuse and Mental
Health Services Administration.

The widespread availability of these medications likely contributes to
abuse as well. Although drug dealers, shady Internet sites and
disreputable doctors are often blamed for putting these drugs into
people's hands, the source is typically much closer to home. Sharing
(not to mention selling and stealing) prescription drugs has become
commonplace.

The 2007 SAMHSA survey found that almost 56% of people who reported
taking painkillers for nonmedical purposes obtained the drugs from a
friend or family member, almost 9% bought them from a friend or
relative, and roughly 5% took them from a friend or relative without
asking.

It's difficult to decipher how these drugs are being prescribed and
for whom. One thing, however, is abundantly clear. "We're prescribing
much more than we were 15 years ago," Volkow says.

Hydrocodone -- one of the active ingredients in the drug Vicodin (the
other one is acetaminophen) -- is currently the most widely sold
medication in the country. More than 124 million prescriptions for
hydrocodone were filled in 2008, according to a national audit
conducted by IMS Health, a medical data provider.

Over-Prescribed Drug

Some prescriptions for opioids are unnecessary. Physicians often
recommend opioids when an alternative analgesic (like a nonsteroidal
anti-inflammatory medication such as ibuprofen) would suffice. Or they
rely too heavily on the drugs to the exclusion of non-opioid
medications and mind-body treatments to control pain.

Even when the use of opioids is justified, physicians frequently
dispense more medicine than necessary. Because it's hard to anticipate
exactly how many pills a patient will need, doctors often provide too
many and then allow for unnecessary refills.

Drug manufacturers undoubtedly bear some level of responsibility to
ensure their products' safety. But people who take these medications
- -- as well as the doctors who prescribe them -- also need to be held
accountable for the drugs' misuse.

"The burden of responsibility must be spread around," Clark
says.

Just weeks ago, the drug makers sat down with representatives of the
FDA to lay out possible strategies for addressing the opioid issue.
Most emphasized further education of patients and physicians about the
inherent dangers and safe use of these drugs.

Education is rarely a bad idea, but I'm not convinced in this case
that it will have the desired effect. Much time, energy and money
could be spent restating what many people already know and, for a
variety of reasons, choose to ignore.

An education campaign highlighting the risks of opioids could have
negative repercussions for the "non-speeder" -- people who need these
medications and who use them responsibly. Their pain may go
under-treated as physicians become more hesitant to prescribe opioids
and patients become more reluctant to use them.