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Prescription Opiate Abuse
A Mounting Crisis
Prescription narcotic analgesic abuse is not a new phenomenon. However, the recent surge in the incidence of opiate abuse is new. The non-medical use of opiates is a serious and growing health problem in the United States. The National Institute on Drug Abuse (NIDA) estimates that 48 million people have used prescription drugs for non-medical reasons. In addition, nearly one in ten high school seniors reported in 2005 using Vicodin without a prescription and 5 percent reported using Oxycontin. Experts agree, and by working with addicted patients I have witnessed firsthand, that opiates are increasingly replacing marijuana and alcohol as gateway drugs. In a country where nearly 75% of graduating high school students report having smoked marijuana at least once, we are faced with a new menace.
Data from the National Center for Health Statistics (NCHS) showed that opioid analgesics such as hydrocodone, oxycodone, and methadone were more likely than cocaine or heroin to be the cause of unintentional dug poisoning deaths in the United States between 1999 and 2002. Opioid analgesic deaths during that same time frame increased by 91%. Between 1999 and 2003, the number of methadone-related unintentional poisoning deaths increased an incredible 213%. This increase tracks methadone used as an analgesic rather than for a narcotic treatment program.
Historically, opiates have been used for pain relief, cough suppression, and to induce a state of euphoria. In the 19th century, millions of Chinese became addicted to opium after smoking, eating, drinking, or sniffing it. In Europe, opiates were used as “tonics,” usually in pills of two to three grains, or dissolved in alcohol and drunk as “laudanum.” Even the rugged American Frontier saw its fair share of opiate addicted individuals, whose idiopathic dependence made travel away from the town “doc” nearly impossible.
In 1803, a German pharmacist, F. W. Sefturmer, isolated the main alkaloid of opium and named it morphine after Morpheus, the Greek god of dreams. Morphine was soon used for medical purposes in Europe and the United States. But by the end of the nineteenth century addiction to the drug had become a problem. In 1898, while searching for a non-addictive substitute for morphine, Heinrick Dresser, working at the Bayer Laboratory in Germany, developed diacetylmorphine. Bayer marketed it under the brand name “Heroin.” Unintentionally, Dresser had created a new drug approximately ten times more potent than its predecessor.
Chronic use of pain killers can result in tolerance to the medications, so higher doses must be taken to obtain the same effects. Long-term use can also lead to physical dependence – the body adapts to the presence of the substance, and withdrawal symptoms occur if use is reduced abruptly. Prolonged use of opiates eventually changes the brain in fundamental and long-lasting ways, which may explain why people have a hard time quitting on their own, and why treatment is essential. Drugs of abuse take over the brain’s normal pleasure and motivational systems, moving drug use to the highest priority in the individual’s motivational hierarchy, thereby overriding the other innate motivations and drives. These brain changes are responsible for the compulsion to seek and use drugs – hence, addiction.
Many opiate addicted patients are wholeheartedly shocked and dismayed to learn that something prescribed by their physicians led them down such a painful path. While the majority of the opiate addicted patients I treat at The Right Step began using opiates with the less potent medications, many inevitably increased the strength and types of medications from hydrocodone to oxycodone, methadone, hydromorphone, and so on. The ubiquitous misconceptions about these drugs enable their abuse. Specifically, the notion that if these medications are manufactured by large reputable companies, prescribed by caring physicians, and filled by diligent pharmacists, then they must not be harmful. That reasoning is clearly flawed. The drugs are made, prescribed and dispensed by individuals who all share the same responsibility: to do no harm.
While opioid addiction appears on the rise, it should be noted that many people take prescription medications responsibly. Studies have shown that properly managed medical use of opiates is safe and rarely causes addiction. Physical dependence is an inevitable physiologic adaptation that differs from the disease state of addiction. Everyone deserves adequate, appropriate pain management and opioids can be used to manage pain effectively.
Teaching others about opiates and other drugs of abuse is one of my passions. I chose not to wage a war on anything. Instead, I believe that by increasing our awareness about the disease of addiction, prescribing and drug abuse trends, effectiveness of treatment, and so forth, we will be able to be more effective in the treatment and prevention of addiction. So, my talk at this years Spectrum Conference, held in Houston, October 3-5th, will cover these topics with the objective of communicating how science and research clearly demonstrate that addiction is a disease like any other and that treatment is effective.