The narcotics involved in these deaths are not necessarily illegal ones like heroin. Abuse of prescription opiate painkillers increased by 111% between 2004 and 2008, according to figures from the Substance Abuse and Mental Health Services Administration. Over two million Americans abuse them, and deaths involving OxyContin, Valium and Xanax doubled between the years 2001 and 2011. Vicodin, a prescription painkiller, is now the second most abused drug after marijuana among high school students, according to a 2010 study from the University of Michigan.

Some of these changes may be linked to the economic recession. The price of cocaine has risen so fast that people may be turning to prescription drugs that are cheaper.

The U.S. Drug Enforcement Administration (DEA) and local prosecutors are increasingly investigating and pursuing criminal charges against physicians who dispense prescription painkillers. More families are filing malpractice suits after the deaths of loved ones from opiate overdoses. Two high profile cases involving celebrity overdoses are examples of the trend.

Prosecutors in California charged Michael Jackson’s physician, Dr. Conrad Murray, with involuntary manslaughter, which carries a penalty of four years in prison. They alleged that Dr. Murray breached standard care practices when he administered Propofol to Jackson. Propofol is an anesthetic used in surgery and rarely abused as a narcotic drug, but it is not a controlled substance. The Jackson family has also filed a wrongful death suit against Dr. Murray. Prosecutors will have to prove that Dr. Murray and not Jackson himself administered the drug.

The second celebrity case involved Anna Nicole Smith, whose doctor was accused and acquitted of violating the controlled substance law after she died from taking a variety of prescription drugs.

More physicians, especially in states like Florida where prescription drugs are widely available from "pain clinics," are facing malpractice and criminal charges. Most of these cases involve opiate painkillers. The DEA arrested and convicted 15 physicians in 2003, compared to 43 just five years later. Prosecutors are aggressively closing down pain clinics that dispense opiates.

"Our marching orders are that we will not turn down a pill case coming into the office," said Florida state prosecutor Nick Cox. "It is more efficient to pursue the source of the pills – the prescribing doctors – than the patients who abuse the drugs."

Doctors are defending themselves by saying that the treatment of pain is based upon subjective reporting from patients, and there is no way of knowing which of them are addicted or drug-seeking.

As one law professor put it, "Doctors are not supposed to be law enforcement agents. They are supposed to believe their patients."

Young people who are abusing prescription drugs, most often opioid painkillers, tell researchers that the drugs are readily available from family and friends. Perhaps they are referring to their grandparents’ medicine cabinets.

A new report from the Government Accountability Office found that Medicare is subsidizing drug abuse through its Part D program, which provides coverage for prescription drugs to people over 65 years of age. The most frequently abused drugs were painkillers in the opium family such as oxycodone and hydrocodone, with brand names like OxyContin and Percocet.

The report found that over 170,000 Medicare beneficiaries got drugs from five or more medical professionals. One person in Georgia obtained seven prescriptions from four doctors to stockpile a 150-day supply of oxycodone in less than a month. A California man got 1,397 fentanyl patches from 21 different professionals within a year. A man in Texas assembled a three-year supply of hydrocodone within a year’s time, obtained from 25 different doctors.

The report was unclear if such Medicare beneficiaries were using doctors to "support and disguise addictions" or if they were selling their drugs to others. Doctors told investigators they did not know their patients were receiving prescription drugs from other doctors.

"High utilization of pain medications is not necessarily an indication of abuse, but could be an indication of poorly coordinated care in the treatment of pain symptoms," according to the report.

Medicare patients are using an increasing number of prescriptions for opioid painkillers. In 2010, nearly 57,000,000 such prescriptions were written compared to 46 million in 2007, representing a 24% increase.

Government authorities said that it may be necessary to use electronic health records and electronic transmission of prescriptions to drugstores in order to reduce fraud and abuse. Private insurance companies are currently under contract with the government to manage the Medicare prescription benefit. One problem with the current system is that a beneficiary who is committing fraud can get medications by enrolling in a prescription drug plan offered by another insurance company and thus go undetected.

Experts say this event emphasized the depth of this rapidly growing problem. Most employer drug testing methods currently in use wouldn’t catch employees who abuse painkillers and other prescription drugs. Of the 4.5 million employee drug tests conducted last year, only 12 percent tested for the drug Oxycontin, according to the lab Quest Diagnostics. At the Boeing factory, Oxycontin was one of four types of different prescription drugs found.

Seventy-five percent of all drug testing happens before an employee is hired, which makes it difficult to detect those who become addicted while on the job. With gaps in periodic testing, the evidence shows that prescription painkiller abuse is still on the rise. From 2005 to 2009, 40 percent more workers in America tested positive for painkillers and those drugs were connected with more accidents in the workplace, Quest said.

U.S. Drug Enforcement Administration spokesman, Rusty Pain, says the problems with prescription drug addiction and abuse rates are happening in places that would surprise Americans. If you think about the profile of a typical prescription drug addict, it will not be typical of other types of illicit drug use but rather found in normal areas like colleges and workplaces.

Experts say the prescription drug addiction problem has reached beyond Hollywood, as almost 3 percent of Americans have reported using prescription painkillers for non-medical purposes.

What Is Tapentadol?

The new drug Tapentadol offers new pain-relieving potential but with similar risks. It is a new narcotic pain reliever much like morphine. The U.S. FDA has approved Tapentadol hydrochloride for the treatment of acute pain. It is a synthetic analgesic which acts on the central nervous system to relieve acute pain that is moderate to severe.

Tapentadol functions in two ways. First, it works as an opioid. Opioids turn on narcotic receptors located in the brain, the GI tract and the spinal cord. Secondly, Tapentadol works as a non-opioid by inhibiting the reuptake of a chemical in the brain called norepinephrine to produce an analgesic effect.

Precautions When Using Tapentadol

As with any strong medication, precautions should be observed when handling the drug. It should only be taken by the person for whom it was prescribed and when stored, adults should be sure that the medication is secured. The medication’s potential for addiction and dangerous side effects necessitate careful attention to its use. Actually, use of the medication should be monitored by the prescribing physician during the entire course of treatment.

While taking Tapentadol, a person should avoid consuming alcohol. This may mean checking food and other medication labels for alcohol content. The danger of mixing two substances which work to suppress the body’s normal central nervous system function is serious. Furthermore, never take more Tapentadol than has been prescribed. Should a person no longer experience what they consider to be sufficient pain relief, they ought to consult with their physician rather than decide on their own how much of the drug to take.

The drug should be avoided by persons with certain conditions which would make taking Tapentadol unduly dangerous. For example, people with severe disease of the kidney or liver, persons with bowel obstructions, and those taking MAO inhibitors should not take this medication. A person experiencing an asthma attack should also avoid ingesting Tapentadol. Other conditions which would make taking Tapentadol dangerous include brain injury, epilepsy or seizure disorder, gall bladder or pancreas dysfunctions, breathing disorders, curvature of the spine, and a history of drug or alcohol addiction.

Side Effects of Tapentadol

Tapentadol can cause side effects, including nausea, sleepiness, dizziness, headaches and vomiting. Because the drug can impair a person’s ability to think and react, care should be taken when driving a car or other vehicle. Also, due to the drug’s dependency issues, a person should avoid sudden cessation of the medication. To date, the drug’s effect upon unborn children is not known.

If at any time a person accidentally takes too much Tapentadol, they should seek emergency care immediately. Overdosing on Tapentadol could prove fatal.

Nearly one-quarter of Canadians say they have chronic pain. In homeless shelters about one-third of residents are living with the highest level of pain, registering as "chronic pain grade IV." Dr. Stephen Hwang, an inner city hospital physician, believes this is the first study done of its kind to follow the management and severity of pain among homeless residents in local shelters. Science Daily recently published these results, which highlight the need for improvement in dealing with chronic pain management in the homeless community.

Hwang believes the community needs outreach programs to assist the homeless in finding health care facilities to aid them with their chronic pain. Many homeless are also dealing with a history of addiction and mental illness and oftentimes they miss appointments due to lack of transportation.

Hwang notes that there is a need for health care professionals to better familiarize themselves with the housing situation of their patients, as well as providing more adequate screening for those homeless individuals suffering from pain issues. The study showed that only half of the participants involved in the research were actually being treated by a physician for their pain problems.

Physicians have obvious concerns about prescribing opioid drugs due to the history of substance abuse among the homeless population. But Hwang feels this shouldn’t be cause to avoid addressing their management of pain altogether. The homeless individuals felt that some of the obstacles they faced in managing their pain were due to the stress of shelter living and sleeping conditions that are not always optimal.

Dentists are not aware of their contribution to the problem of opioid abuse in the U.S., says the author of a study highlighted in Medical News Today. At times these dentists do not know the proper number of doses to prescribe to patients or what to do with leftover pills. Leftover prescriptions often become the source for children and young adults to attain pills because they aren’t getting thrown away or disposed of properly.

Dentists are third in line to prescribe the most opioids with instant release ability in the country. George Kenna, assistant professor at Brown University for Warren Alpert Medical School, says that many dentists haven’t even realized there is a problem with prescribing the opioids. Kenna is a pharmacist as well and says that painkillers like oxycodone and others often become a source of drugs in households due to the leftover problem and lack of proper training for dentists and pharmacists. Seven out of every ten people who have used these painkillers acquired them through a friend or member of their family and had acquired them nonmedically.

A program on Risk Management of Opioids led by Kenna and other dentists and experts on addiction came up with several recommendations for dentists to help reduce this problem. The group of experts and pharmacists stated a need to write smaller quantities and limit the amount of refills and to simply not prescribe painkillers to those you do not know. Prescribers should also be leery of those who say their pills were stolen or have been lost. The authors of the article say they need more research to decide how to best meet patient needs without furthering the problem.

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.

Numerous false pharmacies are allowing patients to order prescription medications online, minus the physician’s prescription. A recent report published in the Health Affairs journal suggests that Internet pharmacies may be prompting the rise in prescription drug abuse numbers, backed by research from the University of Southern California and Massachusetts General Hospital.

Access to faster Internet connections may be a specific factor in the rise in prescription drug abuse, say the researchers. States who expanded their high-speed Internet availability during a seven-year span from 2000 to 2007 also showed the biggest jump in numbers of patients treated for abuse and addiction of prescription medications.

In general, a rise of ten percent in access to high-speed Internet connections was matched by a one percent rise in patients admitted for prescription drug addiction or abuse treatment. The greatest level of increase was noted for prescription painkillers that were in the narcotics category, with drugs to treat anxiety showing the second-highest rise. In comparison, the numbers of people seeking treatment for addictions to cocaine or alcohol – along with other drugs that can’t be purchased over the Internet – showed lesser increases or slight declines.

Because actual data on how many people are abusing prescription drugs would be nearly impossible to achieve, researchers looked at numbers of patients admitted to treatment centers for drug and substance abuse using a U.S. Substance Abuse and Mental Health Administration data collection. Each state’s levels of the expansion of high-speed Internet offerings and their numbers of patients receiving substance abuse treatment were explored separately.

A close connection was also suggested in the research when specific drugs were analyzed, including Oxycontin and Percocet. As the numbers of illegitimate online pharmacies expanded, so did the abuse of these specific medications. Aside from pain medications, illegal online pharmacies sell sedatives, stimulants and tranquilizers, many times from geographic locations beyond U.S. borders.

While efforts to stop illegal online pharmacies have been put into place, researchers believe these efforts may need to focus more closely on those shops that lie outside the U.S. In 2009, the U.S. Pharmacy consumer Protection Act was put in place to stop the delivery of controlled substances that do not have a physician’s prescription. The prescription, says the act, must follow a visit between the patient and the physician ordering the medication. Also in 2009, the Food and Drug Administration warned numerous Internet-based pharmacies about violations to laws related to controlled substances, including selling medications to patients without a prescription.

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?

Researchers from the Feinberg School of Medicine at Northwestern University found that only 31 percent of participants knew that Tylenol contains acetaminophen, while 75 percent knew that Bayer contains aspirin and 47 percent of people knew that Motrin contains ibuprofen. In addition, 19 percent of people knew that Advil contains ibuprofen.

Dr. Lee M. Sanders, an associate professor of pediatrics at University of Miami Miller School of Medicine, who was not involved in the study, said that acetaminophen overdose (some accidental, some intentional) is the leading case of liver failure among adolescents and young adults. He added that people often take multiple medications that contain acetaminophen without realizing that they all contain the same ingredient.

For the study, the researchers surveyed groups of 45 English-speaking adults in two cities to determine their knowledge and use of over-the-counter painkillers. The participants represented low-income and lesser-educated people who are at the greatest risk for accidental overdose or abuse of over-the-counter medications, according to Sanders. Almost half of both groups read at or below a six-grade level.

The study found that 41 percent of the participants read the ingredients on the medication labels, and that some of the ingredients are confusing to people. For example, acetaminophen is also called APAP on some drug labels.

Sanders said that his previous research has found that there is similar confusion among parents who treat their young children with liquid over-the-counter medication, and that he believes that labels should be less confusing for consumers.

The researchers said it would be helpful to print a symbol on drug labels that indicate the active ingredient (such as acetaminophen) so people can easily identify what they are taking. They also suggest making clearer warnings regarding the risk of liver damage on drug labels.

Source: MSNBC, MyHealthNewsDaily, Amanda Chan, Many Confused by What’s in Popular Painkillers, May 3, 2011