Michele Braa-Heidner, 47, started taking prescription painkillers in 1995, when she had her wisdom teeth removed. Soon after, she developed a painful spinal condition for which she needed several surgeries—and more medications. The drugs relieved the pain and "made me feel really good," she says. Soon, she found that she couldn't get through the day without them. "You're almost chasing that first high, [but] you never get it anymore unless you take a huge amount," she says.
Michael Jackson's death has brought renewed attention to prescription drug abuse, which has long been a problem for everyday Americans as well as pill-popping celebrities. About 48 million people, or 20 percent of Americans over age 12, have taken prescription medications—often, the painkillers called opioids—for nonmedical reasons, according to the National Institute on Drug Abuse, and seniors are particularly vulnerable since they often juggle many medications. Those prescription opioids cause more drug overdose deaths than heroin and cocaine combined, according to the Drug Enforcement Administration. (Drowsiness, respiratory depression and arrest, nausea, confusion, constipation, sedation, unconsciousness, and coma are among the potential health consequences of abusing the drugs.) Meantime, painkiller-related admissions to state-licensed treatment centers are on the rise, according to a March report.
But while the stories of current and former prescription opioid addicts are frightening, chronic pain experts note that addiction is relatively rare and that these drugs do offer benefits when they are properly prescribed and used. And there is certainly a need for them. More than a quarter of Americans age 20 or older—more than 76 million people—say they've experienced pain that lasted longer than 24 hours, according to the American Pain Foundation, and 42 percent of those sufferers have endured pain lasting longer than a year. For many of these people, prescription opioids like the oxycodone (commonly sold as OxyContin) and hydrocodone (sold most popularly as Vicodin) used by Braa-Heidner, as well as meperidine (sold as Demerol) and others, are very helpful. "I think the fear can be a huge barrier to proper pain control," says Paul Christo, director of the multidisciplinary pain fellowship program at the Johns Hopkins University School of Medicine. So how should you approach using a pain medication to get the relief you need without getting hooked?
First, experts say it's best to stick with one doctor to coordinate your care; that way, she will keep tabs on all the pain medications you're taking. She may also be looking for signs of abuse. Pain specialists can monitor pill use and do urine drug testing to ward off addiction in their patients. They may also require patients to sign treatment agreements that give the doctor permission to take certain steps if he or she suspects addiction—including talking to family members about suspected abuse, says Howard Heit, a pain management and addiction medicine specialist based in Fairfax, Va.
And there are other systemic measures in place to help curb abuse. By July of this year, 40 states had passed legislation to start prescription drug monitoring programs to keep tabs on when, where, and for whom controlled substances, including opioids, are dispensed. There's even a push to fund a federal program, approved by Congress but never put into action, to monitor opioid prescriptions from state to state. Meantime, after being prompted by the Food and Drug Administration, drug companies are trying to do their part to ease the problem by reformulating drugs to make them more difficult to abuse. An FDA advisory panel recently recommended approving a new formulation of OxyContin that would reduce the amount of medication released when tablets are crushed or chewed—common methods used by abusers to boost the impact of the drug. (The FDA typically follows the advice of its expert panels.)
If your pain isn't improving, talk to your physician. It's a bad idea to take medications that haven't been prescribed for you, so don't be tempted to use pills intended for a friend or relative. Instead, see if a different medication or dosing schedule might make things better, and be sure to consider alternative ways of managing pain that might work instead of or in tandem with powerful opioids