published Monday, April 25th, 2011

U.S.: Prescription addiction

The United States has a drug problem, but it is not what most people think. Yes, heroin and cocaine are addictive and can be deadly. The distribution and sale of both undeniably increase the nation’s crime rate. America’s most pressing — and deadliest — drug problem, however, is the use of highly addictive prescription painkillers. They now kill more people each year than heroin and cocaine combined.

The Centers for Disease Control and Prevention reports that overdose fatalities from the painkillers have increased from fewer than 4,000 in 2000 to more than 11,000 in 2007, the last year for which statistics are available. By comparison, cocaine deaths rose from about 3,000 in 2000 to about 5,000 in 2007. The number of heroin deaths remains unchanged, the report indicates, at about 2,000 annually. The statistics are old, but officials believe that the number of deaths related to prescription painkillers continues to rise at a faster rate than those attributed to cocaine and heroin.

There are other measurements that attest to the increasing availability and use of prescription painkillers. Emergency room visits from overdoses involving them doubled to more than 1.2 million from 2004 to 2009, federal health officials say. Accidental overdoses from Vicodin and similar painkillers now kill more individuals in 17 states than vehicular accidents. Officials also say that prescription painkillers are now responsible for more deaths than black tar heroin in the 1970s and crack in the 1980s combined.

Though those facts are mind-boggling, they can hardly be a total surprise given another set of numbers. Prescriptions for painkillers continue to rise dramatically. The number written for Vicodin — which contains the opiate hydrocodone — increased from 112 million doses in 2006 to a current annual rate of about 131 million doses annually. Clearly, there is a connection between the rising number of prescriptions, the increasing rates of addiction and the number of deaths and other problems.

Public officials now acknowledge that connection. White House officials recently announced a campaign to reduce America’s prescription addiction to painkillers. They’ve enlisted the help of federal, state and local public health and law enforcement officials to battle the use and spread of Vicodin/oxycodone and other opoids. Their target is to reduce misuse of the prescription drugs by 15 percent in five years. That’s an admirable target.

If the problem is to be resolved, even in part, campaign officials will have to convince the more than 600,000 health care professionals who are licensed to prescribe the drugs to write fewer prescriptions for them. That will require a change in thinking on the part of prescribers. Many, officials report, now write prescriptions for the painkillers in question because they are not as tightly regulated as some other narcotic pain relievers and because it is easier to write the prescription than to deal with sometimes difficult patients. Tighter regulations on Vicodin and related drugs, in fact, might be necessary. They would be a useful adjunct in the fight against prescription abuse.

So would treatment programs to assist the addicted and improved law enforcement. No major progress is likely, however, until a national mindset that prefers powerful narcotics for what, in truth, is often moderate pain is changed. Powerful opiates, experts say, should be used only for those with terminal illnesses when addiction is not a worry. Everyone else should rely on over-the-counter or milder prescription drugs.

Bringing about that change in a nation that contains less than 5 percent of the world’s population but that currently consumes about 80 percent of its opoids and 99 percent of the its hydrocodone promises to be a difficult task, indeed.

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ceeweed said...

Pain is subjective and very difficult to measure. Some types of pain are excruciating like when a kidney stone starts to travel. Doctors are obligated to treat a persons' pain based on the statement , "I'm hurting".

Go to any E.R. and you will see a sign posted that you have the right to have your pain addressed and treated appropriately. If you are not satisfied with your treatment there is an address and phone number for the Joint Commission for Hospital Accreditation.

If a patient is asked to rate the intensity of their pain on a scale of 1 to 10 and they say 10, it does not matter if they are casual and calm when they say it. All hospitals in the U.S. are mandated to use a pain scale to quantify pain. Sure, doctors over prescribe control substances but they are damned if they do or damned if they don't. This is why so many people become addicts, they say "I'm hurting" they get opiates. They say "I'm anxious", they get benzodiazipines (Xanax, Ativan). They say "I'm tense", they get Muscle relaxers (Soma, Flexeril). Millions of Americans are getting the Trinity of Addiction, Lortab, Soma, and Xanax. I try not to think about it but I still wonder, How many of these addicts share the road with me every time I take a drive?

April 25, 2011 at 11:01 p.m.
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