The Changing Face of Opioid Addiction: Prescription Pain Pill Dependence and Treatment

By Byrne, Marilyn H.; Lander, Laura et al. | Health and Social Work, February 2009 | Go to article overview

The Changing Face of Opioid Addiction: Prescription Pain Pill Dependence and Treatment


Byrne, Marilyn H., Lander, Laura, Ferris, Martha, Health and Social Work


In recent years there has been a dramatic increase in the abuse of and dependency on prescription opioid pain medications (also known as narcotics). Viewed as safer than street drugs like heroin, prescription pain pill misuse is on the increase in all age ranges. Frequently abused prescription pain medications include hydrocodone (Lorcet, Lortab, Vicodin), oxycodone (OxyContin, Percocet, Percodan), codeine (Tylenol 2s, 3s, and 4s), fentanyl (Duragesic), and morphine (MS Contin). These drugs are commonly prescribed for acute pain (for example, tooth, post-injury, or surgery pain) or chronic pain (for example, back pain or pain associated with malignancy). Methadone, which is used both for the treatment of opioid dependence and for pain, is rising as a primary drug of abuse as well (Maxwell, 2006).

Statistics over the past five years have shown that the misuse of prescription pain medications by students in grades 8 through 12 continues to rise, whereas use of illegal drugs, tobacco, alcohol, and steroids has decreased. Data from admissions to treatment facilities show that heroin as a primary drug of choice decreased from 2000 to 2005; during that same time period, admissions for other opioids increased (Center for Substance Abuse Research, 2007). According to the National Survey on Drug Use and Health (NSDUH) report (NSDUH, 2006), nonmedical use of prescription pain medications has increased among young adults ages 18 to 25. More people initiated use of prescription pain relievers in 2004 than began using marijuana or cocaine. Often these drugs are relatively easy to obtain, are viewed as safer than illegal drugs, and are less shameful to use. Although prescription pain pills are from the same class of drugs as heroin, the difficulty of diagnosis of abuse and dependence on them is increased because of their legitimate use and surrounding misconceptions.

National Center of Health Statistics (Maxwell, 2006) data indicated that narcotic analgesics such as hydrocodone, oxycodone, and methadone were more likely to be the cause of death in accidental overdoses than either heroin or cocaine. The 213 percent increase in methadone accidental poisoning deaths between 1999 and 2003 was associated with the use of methadone as a pain medication rather than in opioid treatment programs (Maxwell, 2006). Such alarming statistics about the increase in the prevalence of prescription pain medication misuse with the corresponding damage to individuals and to society calls for study and better services.

Individuals who abuse pain medication present a unique population in their sociodemographic characteristics and drug use patterns. More than half of the new users of prescription pain relievers are female, the average age of first nonmedical use of pain relievers was 25, and almost 90 percent of new users are white (NSDUH, 2006). This increase in the abuse of opioids by this group raises the need to target this population for treatment and to examine the effectiveness of existing treatment modalities.

BUPRENORPHINE/NALOXONE AS A NEW PHARMACOLOGICAL TREATMENT

Buprenorphine/naloxone, is an evidence-based pharmacological treatment that offers a new and different option for treatment of opioid dependence. This medication blocks the effects of other opioids and is difficult to abuse. It has been demonstrated to be effective with heroin dependence (Fiellin et al., 2002; Ling et al., 1998; Prescrire Editorial Staff, 2006), and studies are now being conducted by the National Institute on Drug Abuse (NIDA) to demonstrate its effectiveness with those dependent on prescription pain medication (see NIDA Clinical Trials Network at http://www.nida.nih.gov/ CTN/protocol/0030.html). Beginning in October 2002, physicians who take a sanctioned course can prescribe buprenorphine/naloxone as a sublingual tablet for opioid addiction from a private office rather than exclusively through specialized drug treatment centers. …

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