Why are so many people addicted to prescription pain pills?

I was reading a great blog I’ve started visiting, http:addictionblog.org and came across an entry about why the U.S. has more pain pill addicts now than 10 years ago.

I couldn’t resist blathering on,  commenting on the blog. I wrote so much the software thought I was spamming. So I thought I’d repeat my comments here, on my blog.

This is an important issue. We now have an estimated 1.7 to 2 million people addicted to prescription pain pills. Many of the conditions that contributed to this wave of addiction have been changed – but not all.

Prescription opioid addiction has increased dramatically over the last decade, due to a combination of factors. First, there was the pain management movement, which emphasized the importance of adequate pain control. Of course that’s an admirable goal, but the risks of addiction were understated due to bad science and misinterpretation of limited data. Instead of a risk of addiction of about 1%, quoted by many pain management gurus, the true incidence is more like 10 – 45%, depending on which study you read.

Then against that backdrop, OxyContin was released and marketed to general practitioners and family docs with limited knowledge about how to identify and treat addiction. In general, medical schools and residencies have done a lousy job of educating doctors about proper prescribing of opioid medications, how to identify addiction, and where to refer people for treatment of their addiction.

 Then there was access to opioids via the internet, which actually seemed to be a bigger problem than it was. A small percentage of abused opioids came from the internet, but some people became addicted in that way. With the changing laws, these rogue internet pharmacies are less numerous.

States most heavily afflicted by pain pill addiction didn’t have prescription monitoring programs in place. These programs are essential tools to identify people who are getting pills from more than one doctor at a time, called “doctor shopping,” which is often an indication the person has an addiction that needs treatment. Fortunately, most states either have these programs now or are in the process of putting them into place.

But a big part of the problem is cultural. We share prescription medications, even controlled substances, with alarming frequency. Most people aged 18 – 24 who use pain pills nonmedically get them from friends or family, not from some nefarious dealer on the corner. Adolescents don’t realize how dangerous prescription pain pills are.

Anyone with pain pills in their medicine cabinet needs to lock them up to keep them safe, or dispose of medication when they are no longer needed. And we need to stop sharing our medications. It’s illegal, dangerous, and contributes to addiction.

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12 responses to this post.

  1. I liked your article very much. The problem I see with prescription drugs is there are many Illegitimate Pain Management Doctors. They supply prescription drugs to people with no pain problem at all. There are so many cases where these doctors have prescribed drugs like Vicodin, or even Oxycontin without ever having taken a urine test, x-ray or even an MRI.
    I think the FDA and the DEA need to lean much harder on doctors and I think the records should be checked from years ago. I am sure there are no x-rays or MRI’s to support the Prescription Drugs they are writing prescriptions for.
    What I find is so amazing, and have seen many times, there are doctors that have patients come in each month, don’t ever see the patient, they pay the front desk and pic up their prescription and leave. The DEA and the FDA should really go undercover and I am sure they will be amazed at what will be found. More importantly, many lives will be saved.

    Cary Silver

    Reply

    • I think you’re right, in some cases. But part of the problem is that we doctors can’t see someone else’s pain. There’s no lab we can order to make sure a patient is feeling the amount of pain they’re reporting. With many chronic pain conditions, X-rays and labs may be perfectly normal. Can a doctor then say the patient is lying about pain? No, we know some pain can’t be demonstrated by any tests.

      The pain management movement taught physicians nationwide that overall, doctors in the U.S. were undertreating pain. Doctors were even sued for not providing pain relief. Many doctors were taught to believe the incidence of addiction to pain pills was low, and they never learned any different. I remember being scolded in medical school for make a comment about a patient, implying the patient was exaggerating his symptoms to get pain pills. My attending physician said, “You must always believe the patient. If they say they’re in pain, they are!” But with opioids, we have seen good people lie about the amount of pain they feel in order to get medications that give them that good feeling of well-being, or a high. That “high,” or euphoria, gives the incentive to exaggerate or lie. Should we demand patients somehow “prove” how much pain they’re in? I don’t think that would be good practice of medicine, either.

      Doctors DO need to take precautions commonly recommended when prescribing opioids to a patient for more than three months. These include doing a better job of screening patients for past history of addiction, family history of addiction, psychiatric illnesses (they increase the risk of addiction), and other risk factors. Drug testing is essential, to make sure the prescribed medication is in the patient’s system, and other drugs aren’t. Doctors need to use prescription monitoring programs in their states. These plans are one of the most effective tools we have to detect medication misuse. Pill counts may be a good idea. That’s when the doctor calls the patient to take their pills back to their pharmacy so that they can be counted, and the pharmacist then tells the doctor if the correct number of pills remained in the bottle. People who sell or who take medication too early won’t have enough pills when they come for a pill count.

      There are systems that help make prescribing safer, but not enough physicians are using them. They are time consuming, and patients get angry with these measures, and it’s an effort to try to explain to patients why you have to screen everyone. but i say it’s way worth it, if it reduces the number of people who become addicted to pain pills.

      Reply

      • Hi. You wrote some really wonderful points here. I understand what you mean that a Doctor cannot know someone else’s pain. That is so true. I guess the key point is to have tighter and realistic measures in starting the narcotic prescription. We all know, or a lot of us anyway, how addicting opiates are.

        I think even periodic testing, randomly, and fairly often will put any addict on notice. I am sure there is a way for Example if a patient is supposed to take two 40mg of Oxycontin a day, one in the am and one in the pm, I am sure there is a way a random test can show if the person has more than the allotted 80mg for the day in their system. An addict that has taken 10 that day, I would think their would be a way to test it. There is really a great Recovery movie out that has literally saved lives around the world. It is worth checking out. The site is:

        http://www.moderndayrecovery.com

        Thank you for the great comments.

  2. I totally agree that the government needs to put a stop to these doctors who are overprescribing for the sake of a dollar. I know of two different doctors in my area who herd their patients in and out like cattle and overprescribe. They are making a fortune and even have a two year waiting list. The first visit, the patient actually sees the doctor but from that point on each visit is only overseen by the doctor’s assistant. These facilities will be hard to put under because, they do go by the book. The patient must submit for drug screens, provide and MRI and submit to random pill counts. The patients, who are indeed addicts, are willing to abide by such rules in order to continue receiving an abundant supply of pain medication. I was a patient at one such facility. I know how they operate and I know what to say as a patient in order to get my scripts. But I also know the doctors who are more than willing to play the game for the almighty dollar. This must stop.

    Reply

  3. How do addicts get by the pill counts? And by pill counts, I mean the doctor calls a patient randomly, and asks him/her to go to his/her pharmacy to have the remainder of the bottle counted, and report this number to the doctor. If someone is an addict, they usually aren’t able to take the meds like prescribed, take them too early, and have fewer left than they should.

    Reply

  4. How do addicts get by the pill count? What I have seen many people do, is they pay cash and go to several doctors. That is why some kind of really good interim testing is needed. There is a doctor in my town that is not what I call a “Pain Management” Doctor but a Professional Drug Dealer. In fact I have seen cases where the doctor does not even write the prescription, they are written in masses by assistants.

    Reply

    • Hi Cary,
      I see. They have the right pill counts because they have several sources. But that can only work if their doctors aren’t checking the state’s prescription monitoring program. That’s an electornic database that physicians can get access to, that contains all the controlled substances filled under the patient’s name, the amounts, date prescribed, date picked up, address of pharmacy, etc. I check the database on all of my patients before admission and periodically. It works really well.

      Reply

      • Oh, and in response to your other post: thanks for the movie recommendation! I will check it out.

        ON the other issue, because of the differences in the way different people metabolize drugs, there’s no way to correlate urine drug levels with the amount consumed. You may be able to get a very general idea, but the science isn’t good enough to know how much and when it was taken. Plus, dilute urine will have lower drug concentrations than concentrated urine, so it also depends on how much fluids the patient has consumed. Blood levels may be better, but that would depend on length of time since last dose, and be expensive & cumbersome.

        And random drug testing: hair, urine, or saliva, should be used for all patients on opioids for more than 3 months.

      • Hi. I understand what you mean by doctor’s checking the States Prescription monitoring system but some find ways around everything. There is a way around that, I prefer not to post here. I do NOT want to encourage those that may do it, rather than looking for solutions to these kind of problems. If you want to email me at my address, and leave yours, I will forward my thoughts on what I mentioned above. I love your thinking as a Doctor and wish there were many of you out there. Thank you for your comments.

  5. Posted by Mary Contrary on August 25, 2012 at 7:06 am

    Why are so many people “addicted” to prescription pain meds? I resent the implication that legitimate pain sufferers are “addicts” I have spinal arthritis, have the hardware where the disc was gone completely, and even since the surgery had been hospitalized for 3 days on IV pain meds & muscle relaxants because my back locked up & I was literally in too much pain to move! I’ve also had rotator cuff repair & now have a torn bicep & chronic neck pain from several car accidents over the years, 2 rear enders & 2 head on, one putting me in the hospital for 3 days. I do NOT get ANY kind of a buzz at all from my pain meds, and do not take them until the pain makes functioning tough to do. That is called dependence, not addiction! I depend on my pain meds to keep my pain at a level where I can function as a “normal” human being. I can not honestly remember the last time I have had a pain free day, it’s been so many years. I keep my meds locked in a safe, I ration them out in daily doses & put them in little tiny ziplock bags made for that purpose & only carry my daily doses with me. I am very careful to not tell people what meds I take & burn my labels instead of throwing them in to the trash for fear a real addict might find out where they can break into, to get a fix. I wish you goody two shoes people who want to demonize all of us could walk a mile in the shoes of us who really do need our pain meds in order to function like those of you who don’t deal with real pain on a regular basis. Where is your compassion? I work in healthcare & I see people in pain, severe pain, and doctors refusing to give adequate pain control, for fear of… maybe people like you all who demonize those who just want to stop the pain. Yes there are some who do abuse the system, but it’s the same as demonizing people like me again, who must have the real seudaphed for our sinus congestion, not the pseudo-seudaphed PE crap which doesn’t work for us, because a small number, when taken in context of population, do bad things with huge quantities. Just a little background on me, I was a virgin on my wedding day, still married to that same man almost 40 years later, have 4 grown kids, all of which need the real seudaphed, I have NEVER been drunk, not even once ever! I have NEVER tried any kind of illegal drugs, or smoked. Basically if you look up goody two shoes in the dictionary… I hold down a full time job in healthcare, pay all of my bills on time & live within my means. I do know there are people who have pain that can not be seen on x-rays, or CTscans, as a former Fibromyalgia sufferer (cured by diet), but I have a box full of CT scans & MRI’s & surgical reports to prove I have legitimate & real pain. I think no one should be able to sit on boards making rules or laws, or MD’s prescribing pain meds unless you are a chronic pain sufferer. It’s so easy to sit on your high horses & proclaim us all as a bunch of “junkies” if you don’t have to live in our skin.

    Reply

    • You make a good point. Actualyy, this blog is about opioid addiction, not chronic pain. Many patients ARE able to take their medications appropriately. They will have physical withdrawal if they stop their meds suddenly, and they may develop tolerance as time on pain pills goes by…but that doesn’t make them addicts. To be an addict, you must have the psychological part as well,. This means you have the obsession and compulsion to use opioids even when you aren’t in withdrawal or pain. Addicts may take more medication than prescribed for that reason, frequently run out of pills early, and buy from illicit sources. Addicts use medication in unapproved ways, like snorting, injecting, or even chewing for faster onset. Addicts take more pills than they intend, because of the compulsion to use more. Addicts use pain medication to treat negative moods. Addicts often use other illicit drugs like marijuana or cocaine, and sometimes use alcohol or benzos to “boost” the effect of the opioids.

      Not every addict will have all symptoms, and there can be a fine line between appropriate use of pain meds and inappropriate use.
      But yes, from what you describe, you don’t meet the diagnostic criteria for addiction.
      You also make a good point by saying all the addiction in this country is makiing it harder for non-addicts to continue on opioid medication that’s working for them. We should look at each patient separately to avoid overreaction. We don’t want to veer back to the other extreme and be too stingy with opioids for patients who don’t have addiction, while still monitoring patients for signs they might be developing addiction.

      Reply

  6. Posted by Janie on November 27, 2012 at 11:09 pm

    yes I am so sick of hearing how people need these pain pills,,, NO they do NOT and how would I know , my husband fell off a roof about 20 foot high and broke his neck twice and his back in four places and 9 out of twelve ribs on sept. 22 and by oct. 1 he was completely off all pain meds he totally refused to take them because of all these addictions and he said I will not be one of these people so find a another excuse , unless you are dying with a painful disease I have no sympathy for anyone who complains of back and neck pain because MY HUSBAND doesnt even take a tylenol and it has been only 16 days after his accident the more perscriptions the doctors want to write him , he will just say NO THANKS I CAN DO WITHOUT THEM !!!!! end of that subject

    Reply

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