Prescription-Painkiller Abuse on the Rise

By JESSICA BRAUNSCHWEIG

Teenagers and young adults are abusing prescription drugs in staggering numbers, and the crippling effects of this addiction must be addressed head-on, experts said Monday.

(We must) maximize the treating of severe pain and minimize the risk of overdose, Nora Volkow, director of the National Institute on Drug Abuse, told a conference on pain, opioids and addiction at NIH headquarters in Bethesda, Md.

The conference focused on opioids, the most powerful kind of treatment prescribed to treat nearly every type of pain. Examples of opioids include morphine, codeine, oxycodone (OxyContin) and hydrocodone (Vicodin). Though opioids are effective when properly taken, the abuse of opioids and even extended treatment with them can result in intoxication and addictions. The dangers increase when people take opioids in combination with over-the-counter medications such as allergy and cold medication, as well as drugs and alcohol. Such hazardous combinations can cause respiratory depression and, in some cases, lead to death.

Approximately 48 million people 12 and older have used prescription drugs for non-medical reasons, according to the NIDA, and researchers are still trying to figure out why. For one thing, the increasingly easy access to prescription medications may be one of the reasons for the escalation of prescription-drug use in youth. The number of drug overdoses leading to death has doubled between 1999 and 2004 in people 15 to 24, according to the Centers for Disease Control and Prevention.

In 2006 teenagers and young adults were more likely to abuse prescription drugs than older adults. Furthermore, 12- to 17-year-olds abuse painkillers more than any other drug; high school seniors abuse OxyContin at a rate of 5 percent and Vicodin at a rate of 9.3 percent, according to the NIDA. Such statistics have motivated the NIDA to develop school programs about the dangers of such drug abuse.

Yet such programs may not be enough, said Carol Boyd, director of the Institute for Research on Women and Gender at the University of Michigan at Ann Arbor. While Boyd supports the NIDA’s school programs, she also believes the message needs to circulate through family discussions and the doctor’s office.

Boyd oversees both the Student Life Survey and Secondary Student Life Survey, which record statistics of prescription-drug use within middle-, high school- and college-aged youth. Approximately 80 percent of the kids who abuse prescription medications are doing so to relieve pain, according to her findings. The problems quickly worsen, however, when kids use the drugs to fall asleep or get high, she said. Boyd has found the more kids use opioids for reasons other than pain relief, the more likely they are to abuse other substances.

We must look carefully at what behaviors constitute the non-medical use of prescription drugs and tailor the prevention messages to the different behaviors, Boyd said.

While more effective prevention messages need to reach youth, older adults are also at risk, experts said. CDC statistics show most new users of opioids are in the middle-age bracket; those 45 to 60 are most likely to take opioids.

The elderly also tend to overdose and dangerously mix over-the-counter drugs with dietary supplements, which can be fatal. In the United States people older than 65 make up 13 percent of the population yet receive one-third of all prescription medications, according to the NIDA.

Not everyone who uses opioids will become addicted, however. Studies show that pre-existing factors cause certain people to be more susceptible to opioid addiction, such as mental-health disorders, depression, anxiety and prior substance abuse.

The abuse of opioid medications also stems from how drug companies inaccurately conduct their clinical studies, said Mark Sullivan, professor of psychiatry and behavioral sciences at the University of Washington in Seattle. Study participants in trials involving the safety of opioid treatments are often not the people who will end up using them, he said. For instance, people with mental-health problems and substance-abuse histories are common users of the drug, yet they are considered too high-risk to be part of medical research.

We have evidence these things work for a group who is not even getting them, Sullivan said.

The guidelines for long-term opioid therapy are also largely based on anecdotal consensus and not any specific data. Often, healthcare workers assume that if a patient doesn’t return, he is doing fine.

Health officials noted the relapse rate for opioid abuse is more than 80 percent, while chronic opioid users tend to continue their habits.

Yet chronic pain is often a cruel reality that, when left untreated, reduces quality of life for many Americans. When used properly, opioids are incredibly vital to healthcare and pain management, experts said.

The possibility of addiction in no way decreases the drug’s usefulness, Volkow said.