When her dentist recently told Zipa Hahn of Washington, D.C. that she’d need a tooth pulled, Zipa asked for assurance that he’d give her any narcotics she needed to deal with the pain during her recovery. But instead of promising her a treasure trove of drugs, her dentist told her he’d recently changed his prescribing practices for tooth extractions: Zipa would get one narcotic pill to take at home when the anesthetic wore off. After that, she’d need to switch to nonprescription meds for any lingering discomfort, though she could call him if her pain didn’t ease up.
Zipa’s dentist is hardly alone. Many healthcare professionals are drastically changing their prescribing practices when it comes to treating pain. That’s because the U.S. is in the grips of a desperate epidemic of prescription painkiller drug abuse. The Centers for Disease Control and Prevention (CDC) estimates that at least 12 million people in the U.S. over the age of 12 use prescription painkillers for a non-medical reason. Close to 5,500 begin misusing the drugs every day, according to Pamela Hyde, head of the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Some become addicted because they’ve heard the drugs produce a potent high; others do so after taking the drugs for pain relief.
“Making the drugs harder to get is one way experts hope they can reduce the abuse—though that obviously can also make life much harder for patients who appropriately rely on strong painkillers—under a doctor’s supervision—to manage their pain,” says Cynthia Reilly, B.S. Pharm.D., Director, Medication Safety and Quality Division of the American Society of Health-System Pharmacists, in Bethesda, Maryland. Just a few weeks ago, the Food and Drug Administration (FDA) held a hearing to consider making it harder for doctors to prescribe Vicodin, the most widely used prescription painkiller.
The agency has not released a decision yet, but rule changes under consideration would prevent doctors from giving patients an immediate refill option for a Vicodin prescription. Patients who felt they needed to stay on the drug would have to make a follow-up appointment with the doctor, and pharmacies would only be allowed to fill written prescriptions, not ones that have been faxed or phoned in. The goal is to reduce fraudulent prescriptions. The panel of experts at the FDA heard stories of patients becoming addicted after just a few doses, as well as those who kept ratcheting up their dose of the drug and ultimately overdosed.
Research from SAMSHA finds that while addiction to painkillers can span all ages, many communities are focusing on high school students, to prevent addiction, or getting young adults into treatment before they miss years of school and work training as a result of addiction or jail time. Colleges and graduate school health centers, though, are reporting that they often now refer students requesting pain medication to the counseling center to see if a patient could be abusing pain medication.
According to Partnership at Drug Free.org, a nonprofit organization in New York City, doctors are seeing more people in their 20s and 30s requesting prescription pain-relief drugs. One doctor says that to be certain patients actually need the drug, everyone who requests pain medication gets a check-up, including an X-ray (to look for the source of pain); a review of their medical and prescription drug records; and a drug test. That doctor—along with many others— don’t prescribe drugs for relief while they wait for test results, which can make for an extraordinarily painful experience for those who actually need the medication.
According to a 2011 CDC report, the death toll from overdoses of prescription painkillers more than tripled in the ten years prior and more than 40 people die every day from overdoses involving narcotic pain relievers like hydrocodone (Vicodin), methadone, oxycodone (OxyContin), and oxymorphone (Opana). “Overdoses involving prescription painkillers are at epidemic levels and now kill more Americans than heroin and cocaine combined,” said CDC Director Thomas Frieden, M.D., M.P.H., in a press release.
In a speech to public health officials last year, Dr. Frieden called on doctors to reserve narcotic painkillers for people with the most severe pain and to try safer methods pain-relief methods when possible, including meditation, biofeedback, and nonprescription drugs. Drugs are, of course, a quick and mostly effective method that doctors can complete with a prescription in minutes. Exercise, meditation, and other non-drug options, on the other hand, can take time to prove effective, and doctors are not always reimbursed for the time it takes to work with a patient on non-drug options to ease their pain.
Patients need to be partners in the process, says Reilly. Short-term use of narcotic pain relievers can easily turn into addiction, and doctors who start pain treatment with non-drug or nonprescription options could be saving your life, health experts say.
Has the epidemic of painkiller abuse touched your life? Have you had trouble getting prescription pain relief when you legitimately needed it?