Addiction to pain medication, however, is a serious problem worldwide. The Drug Abuse Warning Network (a program of the U.S. Department of Health and Human Services) noted that the opiate painkiller Oxycontin (oxycodone) was involved in more than 22,000 overdose-related emergency room (ER) visits in 2002 -- an increase of 560% since 1995. Similarly, Vicodin (hydrocodone) was noted in more than 25,000 ER visits, and Duragesic (fentanyl) was involved in more than 1,500 ER visits, a staggering increase of 6,745% over 1995.
A number of factors have contributed to the growth in pain medication addiction. The availability of prescription drugs over the Internet has fueled an international trade in illicit drugs, including many counterfeit drugs. Doctors are also writing more prescriptions for painkillers: In 1991, about 40 million prescriptions for opioids were written; in 2007, that number jumped to 180 million.
The drugs most commonly abused fall into four general categories: stimulants like caffeine, nicotine and methamphetamine; sedatives like alcohol, benzodiazapenes and barbiturates; opioids (including heroin and opioid painkillers); and other drugs, like marijuana and hallucinogens.
Opioids are generally prescribed to be taken orally, but abusers often crush the pills into powder and snort or inject the powder. Because some opioids, like Oxycontin, were developed to be slow-release formulas, snorting or injecting opioids can result in a potentially deadly overdose.
Addiction to painkillers is not, however, the same as a physical dependence, which is common when such medication is prescribed on a long-term basis. Tolerance, when the body naturally adapts to the medication, can happen with some pain pills, which means higher doses will be required to experience the same level of pain relief. Addiction includes both physical dependence (tolerance and withdrawl) and out-of-control use.
The process by which a patient becomes addicted to prescription drugs is the subject of ongoing research. Use of the most commonly abused, prescribed medication, including opioids, causes a release of dopamine in the brain. Dopamine is a neurotransmitter that affects the brain's processing (among other things) of reward-seeking behaviors and pleasure sensations. The brains of some people are more prone to addiction for reasons not yet well understood.
Patients' personal histories also help reveal those who are at higher risk for abuse of prescription drugs, including painkillers. Patients with a history of alcohol or drug abuse, for example, are more likely to become addicted to prescribed pain medication. Younger patients, too, are more likely to become addicted, as are patients who work in a healthcare setting, where access to prescription drugs is easier.
There is some controversy over the long-term use of opioids for managing chronic pain, but there is also a growing consensus that for most patients, a well-managed treatment program of opioid use is appropriate.
To minimize the likelihood of painkiller addiction, doctors are advised to stay up-to-date on advances in pain management, to make thorough examinations and take in-depth patient histories -- especially regarding substance abuse -- and to develop a strategy for monitoring patients when prescribing opioid pain medication.
Patients, too, have an important role to play in preventing addiction to prescription pain medication. Complete honesty with the prescribing doctor -- including disclosing information about past alcohol or drug abuse -- is critical to successful pain management with opioids.
Patients and doctors alike, as well as friends and family members, should be aware of the signs of prescription drug abuse and addiction. These include getting multiple prescriptions from more than one doctor, "accidentally" misplacing prescriptions or losing pills, stealing or forging prescriptions, and taking higher doses of medication than prescribed.
Treatment for addiction to prescription pain medication includes managed withdrawal and detoxification, therapy such as behavioral counseling and groups like Narcotics Anonymous, and medications including methadone, buprenorphine and naloxone.
"NIDA InfoFacts: Prescription and Over-the-Counter Medications." nida.nih.gov. Aug. 2008. National Institute on Drug Abuse, National Institutes of Health. 26 Jan. 2009 <http://www.nida.nih.gov/infofacts/PainMed.html>.
"OxyContin: Questions and Answers." fda.gov. 2 Aug. 2001. Food and Drug Administration. 26 Jan. 2009 <http://www.fda.gov/cder/drug/infopage/oxycontin/oxycontin-qa.htm>.
"Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals, and Law Enforcement Personnel." aapsonline.org. 11 Aug. 2004. Drug Enforcement Administration/Pain & Policy Studies Group, University of Wisconsin. 26 Jan. 2009 <http://www.aapsonline.org/painman/deafaq.pdf>.
"Report of the International Narcotics Control Board for 2006." incb.org. 2006. United Nations International Narcotics Control Board. 26 Jan. 2009 <http://www.incb.org/incb/en/annual_report_2006.html>.
Schneider, Jennifer P. "Addiction and Chronic Pain." nationalpainfoundation.org. 12 Jan. 2009. National Pain Foundation. 26 Jan 2009 <http://www.nationalpainfoundation.org/MyTreatment/MyTreatment_Addiction_and_Chronic_Pain.asp>.
Volkow, Nora D. "Scientific Research on Prescription Drug Abuse, Before the Subcommittee on Crime and Drugs, Committee on the Judiciary and the Caucus on International Narcotics Control United States Senate." nida.nih.gov. 12 March 2008. National Institute on Drug Abuse, National Institutes of Health. 26 Jan. 2009 <http://www.nida.nih.gov:80/Testimony/3-12-08Testimony.html>.