BEATING PAINKILLER ABUSE

Among People Who Get Treated, Only Half Break Their Addiction

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 his verbal battles with 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?

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?

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.

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

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

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.

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

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.