Playing with Pain Killers: Over the Past Decade, Doctors Have Focused New Energy on Managing Their Patients' Pain, and Sales of Prescription Painkillers Have Tripled since 1996. for Most People, These Drugs Are a Blessing. for Some, They're a Nightmare

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It all started innocently enough. Three years ago, when Michelle Brown got pregnant, her doctor wrote her a prescription for Lortab, a potentially addictive painkiller similar to Vicodin, for relief from migraine headaches. Her migraines eventually got worse; the Lortab made her life bearable. But it had a devastating side effect: "Slowly," says Brown, who is from Sanford, Maine, "I started to get addicted." She became a classic "doctor shopper," hopping from one physician to the next to get multiple prescriptions. She discovered Percocet, and soon she was mixing Lortab with OxyContin, a new, superstrength pain-killer she got through a dealer. By early last year, Brown, 25 years old, and the mother of two small children, worked up the nerve to commit fraud. Pretending to be phoning from her doctor's office, she called her local pharmacy, read her physician's identification number off a prescription bottle and won, she says, "my key to the palace."

For millions of Americans, painkillers are a godsend. Cancer patients suffer the agony a little bit more easily. People battling severe arthritis can, for the first time, take walks and play with their grandchildren. Realizing that for years doctors neglected to include pain management in patient care, the medical establishment has, over the past decade, taken a new, more aggressive approach to treating pain. In January a national accrediting board issued new standards requiring doctors in hospitals and other facilities to treat pain as a vital sign, meaning that they must measure it and treat it as they would blood pressure or heart rate. Even Congress has gotten into the act, last fall passing a law declaring the next 10 years the "Decade of Pain Control and Research."

In this environment, pharmaceutical companies are experimenting with new formulations of painkillers, and existing painkillers themselves are more widely distributed than ever before. While the pharmaceutical market doubled to $145 billion between 1996 and 2000, the painkiller market tripled to $1.8 billion over the same period. Yet at the same time, the incidence of reported first-time abuse of painkillers has also surged. Many of these painkillers aren't new, and "there's not necessarily something wrong with" the increase in controlled substances, says Michael Moy in the Drug Enforcement Administration's Office of Diversion Control. "But once you put something into the food chain, someone's going to want to bite."

Although there are no perfect statistics on how many people misuse or abuse prescription drugs, in 1999 an estimated 4 million Americans over the age of 12 used prescription pain relievers, sedatives and stimulants for "nonmedical" reasons in the past month, with almost half saying they'd done so for the first time. According to the DEA, the most-abused prescription drugs include the oxycodone and hydrocodone types of painkillers, which contain potentially addictive opioids (the two drugs differ slightly in chemical structure, but both work similarly on the body). And emergency-room data suggest that certain drugs have seen dramatic spikes in abuse in recent years. ER visits involving hydrocodone medications like Vicodin and Lortab jumped from an estimated 6,100 incidents in 1992 to more than 14,000 in 1999, oxycodone painkillers like Percodan and OxyContin rose from about 3,750 to 6,430 and the anti-anxiety drug Xanax (including generic formulations) increased from 16,500 to more than 20,500. Illegal drugs, abused in much higher numbers, also increased: cocaine from 120,000 to 169,000 and heroin and morphine from 48,000 to 84,400.

Reports of painkiller abuse from Hollywood catch the attention of the public more than any statistic ever will. In the last six months, Melanie Griffith and Matthew Perry each checked into rehab, publicly acknowledging their addiction to prescription painkillers. TV shows fill their scripts with the problem: on "ER," Dr. John Carter gets hooked on painkillers after he's stabbed, and on the new show, "The Job," Denis Leary plays a detective who takes painkillers on a stakeout. …