According to the 2006 Na tional Survey on Drug Use and Health, an estimated 1.6 million Americans abuse or are dependent on pain relievers.
By J. Calvin Chatlos, M.D. Princeton HealthCare System
Prescription medications help millions of Americans each year cope with short-term pain.
Used responsibly, these prescription pain killers help patients recover from a range of medical issues, from surgeries and injuries to uncomfortable dental procedures.
But, too often, short-term treatment for pain turns into long-term abuse.
September is National Alcohol and Drug Addiction Recovery Month, which is designed to help educate the public that substance abuse is a national health crisis, that addiction is a treatable disease and recovery is possible.
Prescription drug abuse is an increasing problem in the United States. According to the 2006 National Survey on Drug Use and Health, an estimated 2.6 million Americans used prescription drugs non-medically for the first time in 2006. Of those, 2.2 million used pain relievers.
That number has increased dramatically since 1990, when the number of people reporting they had abused painkillers totaled 573,000. Among those at greatest risk for abusing prescription drugs are teenagers.
Some of the most commonly prescribed pain relievers — known as opioids — include the drugs oxycodone (Percocet, Roxicet, OxyContin), hydrocodone (Vicodin), and propoxyphene (Darvon, Darvocet). These drugs can produce drowsiness, nausea, constipation and, depending on the amount of drug taken, depress respiration. Opioids, however, can also produce a euphoric and relaxed feeling, and while they are effective in treating short-term pain, they are also narcotics, making them highly addictive and a hard habit to break without medical help.
Once you begin taking pain relievers, even for a short duration, your body begins adjusting to them. By extending their use beyond the prescribed duration — typically five or six days — you begin to develop a tolerance and need more to achieve the same feeling, and may become physically dependent. According to the 2006 National Survey on Drug Use and Health, an estimated 1.6 million Americans abuse or are dependent on pain relievers.
Stopping the medication may actually make you feel worse and experience symptoms of withdrawal, which often include restlessness, anxiety and panic attacks, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes and goose bumps, and involuntary leg movements.
While many people can exist regularly on opioids for years, they may exhibit behavioral changes that indicate dependence. These changes may include:
• Low motivation;
• Mood changes;
• Irritability and anger;
• Depression;
• Panic attacks, and
• Personality changes.
Family, friends, and co-workers begin to notice that something is just not right. And often, as the dependence increases, bank accounts start to dwindle as patients start buying the medications on the street. Empty bottles also may signal a problem.
Together with family and friends, physicians play a large role in recognizing dependence. Many patients who have developed a dependence will begin asking doctors for greater quantities or stronger doses of their medication. They may try refilling their prescriptions earlier than necessary or may “lose” prescriptions. In addition, pharmacists can be on the lookout for prescriptions being written by multiple doctors by patients who engage in “doctor shopping” — seeing different providers to obtain multiple prescriptions.
If you suspect a friend or loved one may be dependent on prescription pain killers, it’s important to bring it to their attention in a non- confrontational manner and suggest they talk with a physician. You may consider starting the conversation by saying: “Something is different. It may have to do with the pain medication you’re on.”
A doctor can help recommend the appropriate treatment and will likely refer the patient to an addiction professional for counseling and therapy that will assist in rebuilding relationships and restoring a patient’s ability to function at work and in the community.
Often opioid addictions are treated with medications such as methadone, which eliminates withdrawal symptoms and relieves drug cravings. Methadone has been used successfully in treating drug addictions for 30 years. However, it is administered in single doses requiring patients to report to a clinic daily for treatment, making it difficult for patients to lead normal lives.
A second option is a relatively new drug approved by the Food and Drug Administration in 2002 after more than a decade of research. The drug buprenorphine — with the brand name Suboxone — can be prescribed by certified physicians in an office setting, is long lasting, and well tolerated. The drug reduces symptoms of withdrawal and cuts down on their duration. Moreover, Suboxone has been reported to provide relief for people experiencing chronic pain, but who have become dependent on other drugs.
As we celebrate National Alcohol and Drug Addiction Recovery month, it is a reminder that with appropriate treatment, patients can overcome substance abuse and reclaim a healthy and productive life.
Princeton House Behavioral Health, a unit of Princeton HealthCare System, provides treatment and care for people who need psychiatric support, have chemical dependencies or who struggle with a combination of emotional and addiction problems. The Retreat at Princeton is a 28-day rehabilitation program for adults with chemical dependencies who would otherwise be functioning in their daily lives, at Princeton House Behavioral Health. For help, call 24 hours a day at 800-242-2550.
Dr. Calvin Chatlos, a board-certified addiction psychiatrist, recently served as the medical director of The Retreat at Princeton and is presently a staff psychiatrist at Princeton House Behavioral Health.

