Hydrocodone is the most frequently prescribed opiate in the United States. It is only sold in combination with other ingredients such as acetaminophen (eg. Vicodin) and delivers pain relief comparable to morphine. It is a short-acting medication which is often prescribed in four to six hour doses.

Oxycontin is unmixed Oxycodone whose time-release coating enables the tablet to be effective over a 12 hour period and was designed to prevent abuse of the powerful drug. However, undeterred addicts have been illegally obtaining the pills and then crushing the tablet to bypass the time release coating. Addicts then inject, snort or mix the pulverized pill with beverages to receive a faster effect.

One means of obtaining the drug illicitly is ‘doctor shopping’. The addict or seller presents themselves in several physician offices complaining of pain and seeking prescriptions. Recently, several states have begun to utilize computer systems to track such behavior and prevent it Questionable online pharmacies have been another pill source. The seriousness of the problem has led to federal intervention with investigators closing down many dubious internet pharmacies.

As their drug venues diminish, addicts are resorting to other, more violent means of meeting their supply needs. Neighborhood pharmacies have begun to suffer at the hands of desperate sellers and buyers. Pharmacies have seen an 81% increase in armed robberies from 2006-2010 and the US Drug Enforcement Agency reports the number of pills stolen has skyrocketed to almost a million and a half. Each one of those painkillers has a street value of $100 or more.

Long Island, New York was only the most recent scene of a violent desperation that seems to be evident across the country. There were only two robberies in pharmacies in New York state in 2006. That statistic rose to 28 in 2010. Last year, Tennessee experienced 38, Indiana 45, California 61 and Florida, who leads the nation in abuse of prescription painkillers, reported 65 pharmacy robberies. Not every robbery was as devastating as the case in Long Island, NY, but the sheer number of cases means that the risk has escalated.

In addition to efforts on the part of federal and state authorities, drug manufacturers are doing what they can to halt the problem. Oxycontin in particular is being re-formulated to create tablets that are more difficult to crush and which won’t combine well with liquids. In addition, a chemical is being added which would make the drug uncomfortable for snorting and which could produce symptoms similar to withdrawal when pulverized.

Oxycontin is called Hillbilly Heroin on the street and is considered a gateway drug to the less expensive heroin. Some fear that addicts will turn to the cheaper and what could be soon the more available drug. The spate of ruthless pharmacy robberies across the country testify to a growing abuse problem and a serious national concern.

According to a new study conducted at the State University of New York at Buffalo (UB), many of those suffering from prescription painkiller addictions moved onto street drugs if their prescription became unavailable or too expensive. Researchers suggest that the switch also takes place because most individuals find that street drugs like heroin are more effective than prescription drugs because they go straight into the bloodstream.

According to some, heroin is less expensive than OxyContin. Robert Masone, president of the Ohio Society of Interventional Pain Physicians says that the cost of two to three OxyContin pills of 80 milligrams each can be as much as $200. And, if the doctor refuses to renew your OxyContin prescription, supplies of heroin are still readily available. In fact, in Ohio where heroin addictions are on the rise, some claim that heroin is easier to access than beer and that in Dayton, people are getting hooked because free samples are pitched into car windows.

Dayton methadone clinic, Project Cure, is relocating its facility because the neighborhood is so bad. It is hard for recovering addicts leaving the facility to stay sober because heroin dealers are waiting at the bus stop just around the corner from the clinic. Vie Ross who is a counselor at Project Cure says that many patients seek out illegal street drugs once they discover that heroin provides a comparable high for a lower price. Lt. Brian Johns, head of the narcotics unit in Dayton adds that the city has become a hub for cheap heroin that is drawing people from afar. Many, he claims, are even buying it in Dayton and reselling it in their hometown for a profit.

But Ohio isn’t the only state having problems with heroin. Between the four month period from December 2007 to April 2008, two university students studying in Oregon died from heroin overdoses. Each had been prescribed OxyContin by doctors for sports injuries. When the doctors would no longer renew the prescription, the students sought heroin.

Dwight Richard, clinical director of Project Cure claims that since 1994, prescriptions for painkillers have spiked by an incredible 900 percent. If we want to get this epidemic under control, prescribing doctors need to be more closely regulated and they need to be asking more questions about family history of drug addiction. The fact that many painkillers carry the risk of addiction as a potential side effect is not to be underestimated and begs the question – might not there be other, more viable alternatives?

The five-year federal plan to reduce prescription drug abuse in the U.S. is getting approval from several expert organizations, such as the American Psychiatric Association, physicians groups and groups like the Academy of Addiction Medicine.

Statements of support from these organizations and others have been sent as part of a cooperative strategy to combat prescription drug addiction and abuse, created by the Office of National Drug Control Policy at the White House. Additional partners on the plan are the Food and Drug Administration, the U.S. Department of Health and Human Services and the Drug Enforcement Administration.

The expanded efforts toward physician, pharmacist and patient education are among measures organizations are approving, according to a Medscape Today article. Under the new plan, physicians and providers will complete educational courses on how to administer pain medication and how to monitor patients’ usage. Other measures address ways to teach people to properly throw away unused prescriptions, the closing of pill mills and using tools like databases to monitor patients who move from doctor to doctor or pharmacy to pharmacy to get their pain medication prescriptions.

Emergency room visits related to overdoses from prescription drugs grew twofold in the five-year span from 2004 to 2009, exceeding 1.2 million visits. Proponents of the federal plan hope physicians will understand that new levels of regulations will be put into place for doctors who prescribe the drugs, especially opioid-based formulas, even if they’ve been prescribing pain medications for years. However, to renew their licenses, many doctors must already complete additional education or training in their state, and the requirements from the federal plan aren’t likely to require a significantly larger investment of resources or time.

While the level of educational hours doctors will be asked to complete for prescribing pain medications is still unknown, it could include two to eight hours, with additional ongoing courses offered. Calling the nation’s prescription drug abuse problem at crisis-level, policymakers and medical organizations are hopeful that the federal plan will make a positive impact.

To gain perspective on just how addictive opioids can be, consider that there were 2 million people last month who were reliant on the medication, according to Dr. Petros Levounis, director of The Addiction Institute of New York. Figures for heroin use were only 400,000 individuals by comparison. Opioids can also increase ones risk for heart disease, bone fractions, and potentially even death.

However, a new non-addictive pain-killer is on the horizon. Researchers at Stony Brook University say that their research has spawned a drug, currently undergoing clinical trials in England and Canada that will be introduced to the U.S. market soon. The team pinpointed a sodium ion channel involved with transmitting pain and helped develop a drug that would block it. The new drug offers hope for those suffering from arthritis, cancer, migraines, muscle aches and other chronic pain.

Traditional opiates work by distorting pain signals sent from peripheral nerves to the central nervous system. They alter judgment and can leave many addicted. The new drug, however, would not allow the pain signals to be transferred at all. Researchers say that the pain signals never even reach the central nervous system. Instead, they are fielded by the peripheral nervous system, which is why the new drug would not be habit-forming and is said to have no side effects.

Critics are not so quick to jump on the band wagon. Dr. Levounis is also skeptical. He adds that we have been promised these things before and cites drugs like Ambien, Ultram and Viagra as examples that were originally touted as non-addictive also. However, Dr. Levounis does think the research is a step in the right direction.

He claims that opioid painkillers are extremely addictive and states that the public needs to be aware. He even goes so far to say that their use to manage pain has been one of the worst decisions in the history of medicine. Unfortunately, the negative side effects associated with many drugs today quickly overshadow any positive impact they may have had on society.

A team of researchers at Thomas Jefferson University is testing a semi-synthetic opioid that could vastly improve the treatment of opioid-dependent newborns. The researchers say that giving buprenorphine, a medication used to help adults who are addicted to opioids, to addicted infants is safe, effective, and reduces days of treatment by 40 percent. Infants given morphine were treated for 38 days, whereas infants given buprenorphine were treated for 23 days.

Walter Kraft, M.D., associate professor in the Department of Pharmacology and Experimental Therapeutics at Jefferson, said that with further study, said that with further research, this drug could be a cost-effective way to treat addicted infants. If 16,000 infants each year are at risk of opioid addiction, and the cost of treatment is $2,000 a day for 30 days of hospitalization, annual costs of this treatment can be about $1 billion. Reducing hospital stays by just 20 percent would save $150 million per year.

The research team is the first to test buprenorphine on newborns. The medication was given sublingually (under the tongue) and absorbed. In 2008, the team published results from their first test of buprenorphine in infants. Half of the 24 infants were treated with buprenorphine, and the other half were given morphine orally. Those given buprenorphine stayed in the hospital for 32 days, and those given morphine were there for 42 days.

Kraft says the final step in testing will involve a double-blind randomized study, where doctors don’t know which treatment has been given. The researchers won’t give buprenorphine to infants needing treatment until the final step has been completed.

Source: Science Daily, Drug That Helps Adults Addicted to Opioid Drugs Also Relieves Withdrawal Symptoms in Newborns, October 6, 2010

Scientists from the Geisinger Health System in Pennsylvania found that there are four main risk factors for becoming addicted to prescription painkillers: being younger than 65, having a history of depression, abusing other drugs in the past, and using psychotropic medications.

The researchers gathered DNA information from 705 patients who were being prescribed opioid painkillers such as morphine and codeine for back pain for more than 90 days. They also examined a gene located on chromosome 15, which has been linked with alcoholism, cocaine addiction, and nicotine addiction, and found that gene mutations on this chromosome may be linked to opioid addiction.

Joseph Boscarino, an epidemiologist and senior investigator at Geisinger’s Center for Health Research, said that their study suggests that people with these risk factors are 26 percent more likely to become addicted to painkillers, and that screening patients for the risk factors prior to prescribing narcotic painkillers could help prevent addiction. He added that the same risk factors could increase the risk of addiction in patients without chronic pain.

Source: HealthDay News, Robert Preidt, Study Identifies Risks for Painkiller Addiction, September 2, 2010

The study, published in the Journal of Addiction Medicine, will be used to train medical students and residents at the University at Buffalo School of Medicine and Biomedical Sciences, as well as physicians who are already treating patients. The researchers hope the study will help doctors screen for addiction among patients so that at-risk patients can be referred to treatment or given an intervention. 

Richard Blondell, MD, professor of family medicine and senior author of the study, said that researchers and doctors are seeing more and more patients who are addicted to prescription medication, and wanted to better understand how they first started using the drugs.

He said their study suggests that prescription opioids can lead to illicit drug addiction, and that people who abuse prescription medication may be at a greater risk for later heroin use.

The participants in the study were patients who were addicted to opioids, such as methadone, OxyContin, and fentanyl. The researchers gathered information from the participants, including the drugs they used, the age when they started using, the ways in which they took the drugs, how they started using, and how their drug use progressed.

The average age of drug users was 32. 65 percent were male, 77 percent defined themselves as white, and 74 percent graduated from high school but had no college education. Fifty-one percent said they started using the drugs after surgery or an injury or for consistent pain, and 49 percent said they were curious or a friend or family member had the drugs.

People who became addicted after being legally prescribed the medication were more likely to be female, older, have a college degree, and take drugs orally instead of snorting or injecting. Most people said they continued taking the drugs to help alleviate emotional pain and stress and to help them feel "normal." 

An interesting point was that out of the 53 patients who answered the question, 74 percent said that their doctors didn’t ask whether they had a substance abuse problem before handing over the prescription. 

Blondell said that the physician prescribing the medication has the best chance to prevent addiction or help patients get treatment, and that all physicians should tell their patients that addiction can be a result of using certain medications. He added that doctors need to monitor their patients’ use of the medication closely, and to properly dispose of leftover medication.

Source: Science Daily, Drug Addicts Get Hooked Via Prescriptions, Keep Using ‘to Feel Like a Better Person,’ Research Shows, August 21, 2010

In 1998, prescription drug abuse among Americans ages 12 and older was at 2.2% of admissions nationwide. By 2008, the percentage quadrupled to 9.8% of admissions. This dramatic rise in the abuse of prescription pain relievers swept across all genders, ages, ethnicities, education and employment levels, and regional areas.

In 1998, 1.8% of male admissions had reported abuse of prescription pain relievers. By 2008, this percentage increased to 8.1% of male admissions. In 1998, 3.5% of female admissions reported abuse of prescription pain medications, but by 2008, this percentage rose to 13.3%.

Admissions for all races and ethnic groups showed steep rises for reported prescription drug abuse. Caucasian admissions for prescription drug abuse rose from 3.2% in 1998 to 14.4% in 2008; African American admissions rose from 0.8% to 2.0%; Hispanic admissions rose from 0.8% to 3.1%; and Asian American admissions rose from 3.6% to 5.2%. Most dramatically, however, was a six-fold increase in admissions for prescription drug abuse among American Indians–from 1.3% in 1998 to 8.0% by 2008.

Although all age groups demonstrated an incline in admissions for prescription drug abuse, those between the ages of 18 to 34 had the highest rates over the ten-year period. Those between 18–24 years of age rose from 1.5% of admissions in 1998 to 13.7% in 2008. Admissions aged 25–34 years reported prescription drug abuse in 2.1% of admissions in 1998, and 13.5% of admissions in 2008.

Admissions of adults ages 18 and older in 2008 grew three to four times the amount of admissions from 1998, regardless of their educational level and employment status. Statistics from other age groups showed alarming increases as well, such as 0.6% of admissions ages 12–17 in 1998 rose to 5.2% in 2008, admissions ages 35 to 44 years rose from 2.9% to 7.6%, and admissions ages 55–64 years rose from 1.9% to 6.1%.

The rate of admissions for individuals who were either employed or unemployed at the time they entered treatment (regardless of whether they were full time, part time, unemployed, or not in the labor force) displayed almost identical statistics, as all categories of employment increased more than fourfold. Similarly, admissions for prescription drug abuse from all educational levels increased by 350–500% within the ten-year period.

Adults with an education beyond high school represented the highest amount of admissions (3.8% of admissions in 1998, and 12.1% in 2008), but adults who had never received an education beyond middle school saw the largest percentage increase, from 1.9% in 1998 to 9.7% in 2008–a five-fold increase. Furthermore, admissions for prescription drug abuse quadrupled in nearly all regions of the U.S., including the Northeast (from 2.2% to 11.2%), Midwest (2.1% to 8.2%), South (3.0% to 13.9%), but tripled in the West (1.9% to 6.1%).

Nonmedical use of prescription pain medications is more than a public safety hazard, it has become an epidemic. While all these medications have the potential to assist healing and alleviate pain, many Americans have made prescription drug abuse a recreational endeavor, and the illegal drug market is making its biggest market on prescription drugs than ever before.

According to SAMHSA, however, 55.9% of those admitted to substance abuse treatment for prescription drug abuse report that they obtained the medications from a family member or friend for free. Another 8.9% admit that they purchased the drugs from a friend or family member. Many drug addicts and dealers perform ‘doctor shopping’ to score multiple prescriptions for pain relieving medications and obtain their prescriptions from various pharmacies throughout their home state or beyond.

Prescription drug monitoring programs have proven to be a valuable resource for law enforcement and medical professionals alike in their efforts to reduce prescription drug diversion, but many of these state programs lack enough funds to run their programs efficiently. The abuse of prescription drugs has clogged the nation’s health care system, from insurance, emergency care, to medical resources, and also depletes the nation’s economy due to loss of productivity, increased law enforcement, rising criminal justice, and soaring rates of overdose deaths.

SAMHSA’s study is based on the Treatment Episode Data Set (TEDS), a national database that collects information on the primary, secondary, and tertiary substances of abuse among addiction treatment facilities’ admissions ages 12 and older. The study was sponsored by the Office of National Drug Control Policy and the Drug Enforcement Administration.

The senior investigator was Kenneth Hargreaves, D.D.S., Ph.D., professor and chair of the Department of Endodontics in the Dental School at the UT Health Science Center. Amol M. Patwardhan, M.B.B.S., Ph.D., a graduate of the Health Science Center’s Department of Pharmacology who worked under Dr. Hargreaves’ supervision, is the lead author.

"Nearly everyone will experience persistent pain at some point in their lifetime," Dr. Hargreaves said. "Our findings are truly exciting because they will offer physicians, dentists and patients more options in prescription pain medications. In addition, they may help circumvent the problem of addiction and dependency to pain medications, and will have the potential to benefit millions of people who suffer from chronic pain every day."

Pain has been called a "complex epidemic" in the United States. Nearly 50 million Americans live with chronic pain caused by disease or injury. Few physicians or dentists specialize in the field of pain medicine. With pain medication options largely limited to opioids (such as morphine) and aspirin-like drugs, some patients become addicted or dependent upon these drugs, or suffer side effects such as kidney or liver damage.

Researchers at the UT Health Science Center found a new family of fatty acids, produced by the body itself, that play an important role in the biology of pain.

"Capsaicin is an ingredient in hot chili peppers and causes pain by activating a receptor called transient potential vanilloid 1 (TRPV1). We started out seeking the answer to the question "Why is TRPV1 consistently activated in the body upon injury or painful heat? We wanted to know how skin cells talk to pain neurons," Dr. Hargreaves said. "What we found was much more surprising and exciting. We have discovered a family of endogenous capsaicin-like molecules that are naturally released during injury, and now we understand how to block these mechanisms with a new class of non-addictive therapies."

Researchers used flaps of skin from laboratory mice that were heated in a water bath at temperatures greater than 43 degrees Celsius. The degree of heat used was significant because the human body normally begins to feel discomfort and pain at 43 degrees Celsius and higher, Dr. Hargreaves noted.

TRPV1 resides on the membranes of pain- and heat-sensing neurons. When a person eats a hot chili pepper, for example, he immediately feels a burning sensation because the capsaicin, the primary ingredient in the chili pepper, has activated the TRPV1 protein in the pain neurons. In high concentrations, capsaicin can also cause a burning effect on other sensitive areas of the skin.

The fluid from the heated skin was then applied to sensory neurons cultured from two sets of laboratory mice, including one set of animals in which a gene was deleted or "knocked out." Neurons from the wild type (non-altered) mice were sensitive to capsaicin, the main ingredient in chili peppers. The neurons of the knockout mice, in which the TRPV1 gene was deleted, were not sensitive to capsaicin and were used as the control.

"We found that in the skin flaps heated at greater than 43 degrees Celsius, the cells’ pain neurons showed tremendous activity in the wild type, but not in neurons from mice that lacked TRPV1," Dr. Hargreaves said. He indicated that this novel phenomenon was taking place because the cells, in response to the heat, began to create their own natural endogenous capsaicins, which they later identified as a series of compounds or fatty acids called oxidized linoleic acid metabolites (OLAMs).

Linoleic acid is one of the most abundant fatty acids in the human body. Under conditions such as inflammation, low blood pressure and some other illnesses, linoleic acid is rapidly oxidized to form biologically active metabolites. However, little else is understood about these substances. The metabolites that were consistently seen in increased amounts in the mouse skin biopsies exposed to heat temperatures greater than 43 degrees Celsius are called 9- and 13-HODE (hydroxyoctadecadienoic acid).

"This is a major breakthrough in understanding the mechanisms of pain and how to more effectively treat it," Dr. Hargreaves said. "These data demonstrate, for the first time, that OLAMs constitute a new family of naturally occurring capsaicin-like agents, and may explain the role of these substances in many pain conditions. This hypothesis suggests that agents blocking either the production or action of these substances could lead to new therapies and pharmacological interventions for various inflammatory diseases and pain disorders such as arthritis, fibromyalgia and others, including pain associated with cancer."

The research has led Dr. Hargreaves’ team to develop two new classes of analgesics using drugs that either block the synthesis of OLAMs or antibodies that inactivate them. These drugs could eventually come in the form of a topical agent, or a pill or liquid that could be ingested, or in the form of an injection. Both approaches have the potential to block pain at its source, unlike opioid narcotics that travel to the brain and affect the central nervous system.

Co-authors of the study with Drs. Hargreaves and Patwardhan from the UT Health Science Center San Antonio are: Armen N. Akopian, Ph.D., assistant professor of endodontics; Anibal Diogenes, D.D.S., Ph.D., assistant professor of endodontics; Susan Weintraub, Ph.D., professor of biochemistry; Nikita Ruparel, D.D.S., Ph.D., a graduate student in the Department of Cellular and Structural Biology, and Charis Uhlson, a research associate at the University of Colorado Health Sciences Center. Robert Murphy, Ph.D., professor of pharmacology at the University of Colorado Health Sciences Center, is also a co-author.

According to the Canadian Press, the website reported that Dave Watson said in a deposition that he told then-Trojans coach Pete Carroll about his addiction in February 2008, but was allowed to keep his job and use a vehicle provided by USC.

Watson was involved in a car accident in May 2008, in which he pleaded no contest to DUI charges and received three years’ probation, SI.com reported. The driver of the car Watson hit is now suing Watson and USC.

In the three months between Watson’s alleged discussion with Carroll and the crash, Watson was prescribed 1,680 tablets of pain medication, SI.com reported, citing the deposition. Carroll reportedly fired Watson eight months after the accident, saying the defensive line coach was too hard on players.

Watson said under oath that he had developed a significant addiction to painkillers after sustaining a serious knee injury while playing for the University of Minnesota.

Accoring to SI.com, a hearing is scheduled for Jan. 26 in a Los Angeles courtroom to address Carroll’s pending deposition in the civil case.