Missy is a 30-year-old woman who admits to having abused prescription painkillers for several years. “I was first introduced to narcotic painkillers when I had my wisdom teeth pulled,” she writes on a forum for prescription drug addicts. “I was prescribed Percodan and I’ll never forget how that drug made me feel. I was only given 20 pills at the time, but when I took my last one, I longed for another.”
Still Missy did not become hooked on painkillers until she was given a prescription for Vicodin many years later, following a trip to the dentist for root canal treatment. (Vicodin is a trade name for a narcotic painkiller containing hydrocodone.)
“From that point on, I found a great way to get the drugs,” she writes. “I’d call dentist’s offices after regular office hours and pretend to be one of their patients. In most cases, another dentist would be on call for the one I was asking for. I would then tell them I was having a toothache and, in most cases, they would phone in a prescription.”
Missy is just one of the many thousands of people in the United States who are addicted to prescription medications and using illegitimate means to obtain them. The typical abuser is a middle-class woman, and the addiction usually starts following a visit to her physician’s office, where she gets her first prescription for pain relief medication, according to police sources.
“This is Middle America’s dirty little secret,” says Detective Sergeant Jeff Dean of the San Diego Police Department. “They may be middle class, but these abusers have lifestyles akin to heroin addicts. Their credit cards are maxed out, they have no money in the bank, and they go from doctor’s office to doctor’s office and pharmacy to pharmacy all day long feeding the Vicodin habit.”
Who’s at Risk?
Although more women get arrested for obtaining them illegally, there is very little scientific evidence to suggest that more women are addicted to painkillers or other prescription drugs than men are, according to experts. For example, Linda Simoni-Wastila, PhD, a senior scientist with the Schneider Institute for Health Policy at Brandeis University, says that women are only slightly more likely than men to “nonmedically use” prescription medication.
Seddon R. Savage, MD, an addiction specialist at Dartmouth Medical School’s Department of Anesthesiology also doubts that major sex differences exist regarding prescription drug abuse. However, if they do exist, they may be related to “the social acceptance of women using medications and the relative stigma attached to heavy drinking or street drugging by females,” he says.
Theodore Parran, MD, an assistant clinical professor of psychiatry at Case Western Reserve University School of Medicine, says that doctors may prescribe controlled drugs to women more easily “because of cultural or historic reasons,” and this may result in the “artificial statistic that women are more often addicted to prescribed drugs.”
Parran argues that–regardless of their sex–people who have a history of substance abuse or addiction, as well as those who have easy access to controlled drugs, are the ones who are most likely to become addicted to them. “Actually, the highest addiction rates for controlled drugs are found among addicted doctors, nurses, pharmacists, and dentists,” he says.
Savage and Simoni-Wastila also agree that those who currently have (or had in the past) a drug or alcohol dependency problem are the ones who are at greatest risk for abusing–and becoming dependent on–prescribed painkillers. They also point out that the vast majority of people who take narcotic medications don’t become addicted to them, even if they take them for a long time. But experts admit it is easier to become addicted to certain pain medications than it is to others.
“Drugs that are likely to become objects of addiction are drugs that stimulate the pleasure centers in the brain,” says Savage. “These include analgesic drugs [painkillers] that are in the class of drugs called opioids [derived from the opium poppy] or drugs that have a similar ability to stimulate opioid receptors in the brain.”
“Schedule II substances (this is what they are called according to US drug laws), which are the most potent narcotic analgesics available for medical use, tend to be the ones most abused,” says Simoni-Wastila. Oxycodone (Percocet) is very popular, as are Demerol (meperidine), Dilaudid (hydromorphone), and morphine. Propoxyphene (Darvon, Darvocet) is also popular among abusers, she says.
Preventing Painkiller Abuse
Savage says that in order to minimize the chances of painkiller abuse and addiction, doctors should
- Use special care and monitoring if there is a history of substance abuse/addiction by the patient.
- Use slower-onset, longer-acting medications if the patient has a high risk of abuse or addiction.
- Prescribe small quantities of painkillers at a time with frequent reviews and renewals as needed to control pain.
- Have a trusted family member dispense the medication if the patient needs pain relief but tends to overuse.
- Reduce/eliminate painkillers as the pain improves.
Savage also notes that most people who use opioids to control pain regularly for more than a few days will develop some degree of physical dependence. “But only rare individuals who use opioids for pain control will become addicted to them,” he adds.
Article By: Thomas May, Medical Writer