The Tipping Point of Addiction vs. Pain Management

Forget heroin, forget cocaine. Prescription drugs kill more of us than those 2 combined. Prescription drugs can kill when misused by patients in error or by addiction.

Approximately 15,000 people died in 2008 (the most recent year for which data is available) from overdoses using narcotic drugs like Oxycontin, Percocet, Xanax, Valium, Ativan, Adderall, Concerta, Ritalin. Many of these people were not addicts. “I think that accidental deaths from prescription narcotics is still much more a function of unintentional misuse or chronic habituation and overuse, rather than an epidemic of addicts enabled by unscrupulous prescribers,” says Henry Carson, a pathologist in Iowa City, via email (Forbes.com).

But the fact remains that many of the drugs in common use today are extremely addictive. The warning is right on the label of many painkillers and other narcotic drugs — that *even when used correctly* many painkillers can cause dependence. Addiction to painkillers is a deadly side effect that spans all age groups and income levels. The FDA has been tracking the ever-growing abuse problem. It cannot be ignored that “enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for one month” (Source: CDC).

Until last week, action by the FDA has been stymied for fear that restricting access to painkillers (in order to lower abusive use) would result in withholding drugs from patients with legitimate pain management needs.

In an interview with the New York Times, Dr. Janet Woodcock said that FDA officials were aware that changing the prescribing rules would affect patients. She said, however, that the impact on public health caused by the abuse of the drugs as well as their medical use had reached a tipping point. Dr. Woodcock is the director of the FDA’s Center for Drug Evaluation and Research.

The FDA is now recommending that opioid painkillers be reclassified as Schedule II medication, up from Schedule III (For a  description of each of the 5 Schedules, see here.) There are a few more approval processes to go through, but this proposal is expected to pass. This change will mean that patients have to see their doctor every 3 months, rather than 6, for a refill. Also, pharmacists will have higher reporting standards and patients will have to go to the pharmacy in person, rather than having the doctor phone it in, along with other inconveniences designed to make “prescription shopping” and using multiple pharmacies more difficult.

Death isn’t the only medical cost of addiction. For every 1 death from prescription drugs, the CDC estimates there are:

  • 10 treatment center admissions for abuse
  • 32 ER visits for misuse and abuse
  • 130 people who abuse or are dependent
  • 825 non-medical users

Here’s what Dr. Sanjay Gupta had to say about the addictive nature of painkillers, via CNN:

We know, however, that after just a few months of taking the pills, something starts to change in the body. The effectiveness wears off, and patients typically report getting only about 30% pain relief, compared with when they started. Even more concerning, a subgroup of these patients develop a condition known as hyperalgesia, an increased sensitivity to pain…. As you might guess, all of this creates a situation where the person starts to take more and more pills. And even though they are no longer providing much pain relief, they can still diminish the body’s drive to breathe….If you are awake you may not notice it, but if you fall asleep with too many of these pills in your system, you never wake up. Add alcohol, and the problem is exponentially worse. People who take pain or sleeping pills and drink a couple glasses of wine are playing Russian roulette.

Nobody wants to withhold painkillers from those who need them. Yet painkillers are too easy to misuse and a side effect of painkillers is addiction. Uncontrolled addiction leads to death, with much collateral damage along the way. And, a disturbing fact, a USC/Annenberg study finds that painkillers are not an effective method for dealing with pain.

What are we doing to ourselves?

Comments? Thoughts? If you have a story about Valium, Oxycontin or Percocet, please tell us on Facebook.


Suzanne B. Robotti

Suzanne B. Robotti

Suzanne Robotti founded MedShadow Foundation in 2012. Learn more about Su and her mission.


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