How Real is Painkiller Addiction? By Kate Francis Experts agree that prescription painkiller medication addiction is real, and the risk for some can be great. According to the Office of National Drug Policy, emergency room visits resulting from the abuse of painkillers has gone up 163 percent since 1995. "Painkiller addiction is a very real addiction," says Dr. Dennis Lin, psychiatrist and attending physician on faculty in the Department of Psychiatry at Beth Israel Medical Center in Manhattan. "Prescription painkillers like Vicodin, OxyContin, and morphine work on the same neuro-receptors in the brain as heroin. They are highly addictive substances," he says. "The number of people addicted to prescription pain pills in this country exceeds the number of people addicted to all other illicit drugs combined (excluding the use of marijuana)," says Dr. Lee Tannenbaum, addiction specialist and founder of the Bel Air Center for Addictions in Maryland. According to the National Institute on Drug Abuse, estimates are that 5 million individuals in the country are misusing prescription painkillers. Laurene Spencer, MD, Medical Director at the Reliance Center, an outpatient addiction treatment facility in San Francisco, agrees: "There is now an orderof magnitude greater number of prescription pain pill addicts than heroin addicts in the US: About 5 million prescription opiate addicts vs. 500,000 heroin addicts." The demographic of greatest concern, says Dr. Spencer, are young users, teens and 20s, who may start out with the perception that since these drugs are legal and pharmaceutical quality, they are therefore less dangerous. Early misuse, she says, often comes from family medicine cabinets or from medications prescribed for a real injury (or other pain) but are then taken longer and in larger amounts than medically indicated, or saved for what turns out to be later use. "The stigma of having an addiction keeps most people from discussing their situation with their doctors. Most doctors do not have a good understanding of addiction and they would just as soon not discuss this with their patients either, and thus both sides are more comfortable in just maintaining the addiction and pretending that it is OK than dealing with the difficult topic of addiction," says Dr. Tannenbaum. Are Some Individuals More at Risk? Doctors agree that some people are more at risk for addiction than others--primarily those with any type of family history of addiction. "Addiction is caused by an interaction of chemical substances (drugs) and receptors in the brain. Receptors are genetically coded proteins, and thus their susceptibility to damage or influence by a variety of drugs is determined by their genetic code," says Dr. Tannenbaum. "Many of my patients describe a family tree riddled with alcoholics and addicts, both within their immediate families as well as afflicting cousins, aunts, uncles, and grandparents," says Dr. Spencer. Other doctors say that patients also often describe growing up in an environment so full of drug use that their use of drugs seems almost inevitable. Another risk factor includes people with anxiety and depression. According to Joseph Califano Jr., chairman and president of the National Center on Addiction and Substance Abuse at Columbia University, people who are depressed, prone to anxiety, or are alcoholics, are more likely to develop an addiction to prescription drugs. Is the Risk with Some Painkiller Medications Greater than Others? Experts agree that those painkillers that are quicker in action (meaning how fast the drug gets to the brain), the greater the addiction potential. In the realm of prescription painkillers, Percocet and OxyContin (which contain the drug oxycodone), are very quick acting and very potent, and thus they do present a very significant risk for addiction. "Among my patients, OxyContin is the most prized," says Dr Spencer. She says that while OxyContin is enjoyed when taken orally, many progress to grinding it up and smoking it because it gets to the brain faster that way (about 7 seconds vs. about 20 minutes when taken orally). Thus, it provides more of a rush. "When the brain craves an addictive substance it wants that addictive substance as quickly as possible. This is why people abusing drugs have the tendency to move from swallowing pills whole, to chewing them, to snorting them, to shooting them intravenously. Each advancement in the way people choose to use drugs increases the speed at which the drug hits the bloodstream and the brain, says Dr. Tannenbaum. Dr. Lin adds that any painkillers that contain an opioid-like substance, such as Vicodin, Percocet, OxyContin, or morphine, are all highly addictive. "Over the counter painkillers that do NOT contain opioids, like Tylenol or ibuprofen, are not addictive," says Dr. Lin. How to Identify a Painkiller Addiction When people "hit bottom" and beg for help, then it's easy to know what is going on. But what are the signs that come before that? "If someone is using painkillers on a regular basis, and has done so for any significant period of time (more than several weeks)--and they are either escalating their dose or continuing to have symptoms that are only relieved by their pain medication, you need to consider the possibility that they might be developing an addiction to painkillers," says Dr. Tannenbaum. Another way to identify a painkiller addiction is when a person's behavior significantly changes. For example, the person may become unreliable (is late or misses appointments), their personal grooming deteriorates, or their finances become troublesome. In another case, a person's mood may become very changeable. For example, they are happy one minute and irritable the next. Anyone requiring multiple refills of painkiller medication from their doctor, or obtaining their painkiller medications from friends, family members, or multiple doctors, needs to be evaluated for a possible addiction. If you notice that someone you care for is running out of their prescription opiod medications before the refills are due, suspect addiction and abuse. Physiological signs of opioid withdrawal (as the result of addiction) include nausea and vomiting, chills, fever, sweating, muscle pains and aches, and general great physical discomfort. What to Do If You Suspect an Addiction Once that you suspect an addiction, what to do about it depends on who the person is, what the behavior is, and your relationship with the person, says Dr. Laurene Spencer. "Formal interventions or working with a counselor can be very helpful," she says. Dr. Tannenbaum suggests that if an addiction is suspected, the patient should be evaluated by an addiction specialist. He says that most primary care doctors, and even pain management specialists, are not necessarily trained in recognizing addictive symptoms and differentiating them from appropriate use of painkillers for ongoing true pain issues. The general rule is that if you suspect your loved one is addicted to painkiller medications, take them to see an addiction specialist. Sources California Society of Addiction Medicine. http://www.csam-asam.org/ConfPresentations.vp.html Goldman, R. A Familiar Fiend: Painkiller Addiction. ABCnews.com. January 4, 2008. Griffin, R.M. Reviewed by Brunilda Nazario. Back Pain: Medication and Addiction. MedicineNet.com. August 2004. National Institute on Drug Abuse. http://www.nida.nih.gov/DrugPages/prescription.html Interviews with: Dr. Dennis Lin, MD. Psychiatrist and attending physician on faculty in the Department of Psychiatry at Beth Israel Medical Center in Manhattan. Dr. Laurene Spencer, MD, Medical Director at the Reliance Center, an outpatient addiction treatment facility located in San Francisco. Dr. Lee Tannenbaum, MD. Founder of the Bel Air Center for Addictions in Maryland and addiction specialist board-certified by the American Board of Addiction Medicine.