Painkillers Fuel Growth in Drug Addiction

Opioid overdoses now kill more people than cocaine or heroin.

Opioid drugs such as oxycodone (OxyContin), hydrocodone (Vicodin), and meperidine (Demerol) are among the most powerful painkillers available. Opioids are used both to treat severe acute pain (limited in duration, such as following surgery) as well as various types of chronic pain (lasting longer than three months).

Consensus exists that prescribing opioids for chronic pain caused by cancer or experienced at the end of life is appropriate and humane. Much more controversial is the practice of prescribing these medications for other types of chronic conditions, such as arthritis, migraine, or back pain. Opioids target the same brain receptors as heroin, causing euphoria. As such, a risk of long-term opioid therapy is addiction, usually defined as the development of abuse or dependence (see "Addiction terminology").

The issue of painkiller addiction is receiving more attention because prescriptions for opioids have increased tenfold since 1990. Paralleling this trend, the number of people addicted to painkillers has also increased over time.

Columbia University researchers found that opioid addiction had tripled over a 10-year period, with the proportion of Americans reporting abuse or dependence increasing from 0.1% of the population in 1991–92 to 0.3% in 2001–02. The 2009 National Survey on Drug Use and Health found that nearly two million Americans were dependent on or abusing prescription pain relievers — nearly twice as great as the number of people addicted to cocaine.

According to the latest statistics compiled by the Centers for Disease Control and Prevention, in 2007 painkillers killed twice as many people as cocaine and five times as many as heroin. Opioid painkiller addiction was also more common than abuse of or dependence on any other type of prescription drug.

Who is at risk

On television shows, drug addicts are often depicted as criminal characters making deals on dark street corners. In fact, people using opioids for nonmedical purposes are most likely initially to obtain them from friends or family members (see "Sources of painkillers," below).

Furthermore, although people with chronic pain are more likely than others to receive prescriptions for opioids, the risk of developing a painkiller addiction depends on more than just prolonged exposure to these drugs. For this reason, it's important that clinicians conduct a comprehensive medical and psychiatric evaluation of patients before prescribing an opioid medication.

In its clinical guidelines for prescribing opioids, the American Pain Society notes that the most significant risk factor for developing a painkiller addiction is a personal or family history of an alcohol or other substance use disorder. One review of 24 studies found that patients with chronic pain who also had a current or past substance use disorder were about 17 times as likely to develop a painkiller addiction as other chronic pain patients.

Another risk factor is age. Teenagers and young adults are more likely than older adults to abuse or become dependent on opioid painkillers. An analysis of national studies from 2002 to 2004 found that slightly more than 1% of people ages 12 to 25 were abusing or dependent on painkillers — roughly double the percentage in people ages 26 to 49, and six times the percentage in those 50 and older.

Sources of painkillers The 2009 National Survey on Drug Use and Health revealed that when painkillers are used for nonmedical reasons, they are usually obtained from a friend or family member. Source: Substance Abuse and Mental Health Services Administration