Though the painkiller epidemic originated on the east coast in the Appalachia region, it is now stretching its grips across the entire United States. Data from the Centers for Disease Control and Prevention (CDC) in 2008 attributed almost 15,000 overdose deaths to oxycodone and hydrocodone, and this problem does not appear to be going away anytime soon. The DEA also showed a marked increase in sales of oxycodone during the last decade.

Gregory Bunt who serves as the medical director of Daytop Village Drug Treatment Centers in New York says the reason for the increase is two-fold. He attributes the increase to the ailing health of aging baby boomers and the fact that doctors these days are much more likely to treat pain with medication versus suggesting other alternatives.

While opiod painkillers do a great job of relieving pain, they also produce euphoria, which often leads to their abuse. Bunt adds that addiction is fueling sales of these painkillers as patients will simply hunt for another doctor if their primary decides to stop prescribing them. For some it’s as easy as crossing states borders to avoid sophisticated computer tracking systems and others resort to mail order pharmacies.

The widespread abuse of these legal painkillers is setting off alarm bells because many communities are unprepared when it comes to resources needed to deal with increased rates of dependency. Although beneficial for many, the dangers of addiction of these drugs are just as real as heroin or cocaine when used improperly.

These findings were the key focus in a Medical News Today post. The studies and commentary suggest the continued use of opioids could stimulate growth, as well as the spread of malignant tumors. Pain killers containing opioids, including morphine, have often been the drug of choice for the treatment of chronic cancer and postoperative pain for the last 200 years.

Over the last 10 years, however, studies on the long-term effects of such medications suggest opioids can actually stimulate the growth of cancer cells. The University of Chicago Medicine, as well as the University of North Carolina Medical Center, have both produced works that suggest the mu opioid receptor has a significant role in the progression of tumors.

In the study produced by the University of Chicago Medicine, opioids that already exist within the body have been proven to improve the malignant propensity in human lung cancer cells placed in test mice. This enhancement occurred even when morphine was not added.

This particular test demonstrated that cells from a variety of lung cancers have anywhere from five to 10 times the number of receptors as lung cells without cancerous properties. When opioid receptors were added to the human lung cancer cells, the opiod receptor was measured growing more than double compared to tumor cells without the extra receptors.

At the same time, the cells with opioid receptors were 20 times more inclined to spread to additional sites outside of the original affected area. Tumor growth and spread was blocked by opioid receptors, such as methylnaltrexone or naloxone, suggesting these medications may be the better choice for those dealing with long-term or postoperative pain.

Doctors admit having inadvertently created a huge black market for these prescription painkillers. The CDC reports that doctors’ prescribing practices have caught up with them. In 2009 there were over 37,000 deaths caused by improper or over-prescribing of prescription painkillers and stimulants by American doctors. This number now exceeds the number of deaths from both car accidents and firearm mishaps.

On the streets, 20 Vicodin pills, perhaps purchased through insurance for minor amounts, can sell for $1,000-$2,000. Prescriptions for stimulant drugs have skyrocketed and Vicodin is the single most prescribed painkiller. The cost of these prescription medications is significantly higher than the cost of cocaine or even heroin on the streets. Because of over-prescribing, the streets are awash with the prescribed drugs and drug peddlers are making huge profits.

According to the CDC, painkillers are the single most dangerous of all the drugs available. Since they are not being prescribed by psychiatrists but rather other types of physicians, they have not been identified as killers.

Physicians believe there is a lot more we can do to better educate the public and medical field about this problem we have propelled. It starts by being more cautious, talking more and educating patients and having a higher bar for prescribing these drugs.

According to a recent post on the News Junky Journal there has been a huge increase in fatalities from overdoses related to opiates in the past decade. They are increasingly being prescribed by health care professionals and online pharmacies that illegally sell them in bulk with no prescription needed.

British Medical Journal researchers discovered that from 1999 to 2007 opiate deaths had risen from just over 4,000 to 14,459. These deaths involved young people who accidentally or unintentionally overdosed. The report showed that young adults have such a carefree outlook towards prescriptions that they don’t recognize the dangers of using prescription pills for recreation.

In the last year, the National Institutes of Health conducted a study and found that hydrocodone had been abused by 8 percent of U.S. seniors in high school. Florida is a hot spot for pill mills and government officials on the local level have been working on stricter laws to close them down. Oxycodone purchases decreased by 97 percent since 2010 due to the new laws in FL that limit or ban most doctors there from prescribing or selling them in offices or clinics.

The National Survey on Drug Use and Health says that seven of every 10 abusers of prescription drugs obtained their medications from a family member or a friend who had a legitimate prescription. Two-thirds of those who take opioids for nonmedical reasons obtained them from the family’s medicine cabinet.

A Significant Role

Dentists hand out 12% of the prescriptions written for non-timed release opioids – the second largest set of prescribers in the country behind general practitioners. Changing dental prescribing practices could be one way to address the issue.

Dentists are taught in dental school how many painkillers to prescribe following difficult or painful procedures. Perhaps, researchers suggest, it is time to reconsider those time-cherished and inculcated guidelines.

At school, dentists are instructed to prescribe 20 pills following invasive procedures. A research team led by Brown University psychiatry professor George Kenna thinks that dentists should reconsider that strategy. If most abusers are accessing "leftover" medications in the family medicine chest, Kenna posits the notion that smaller prescriptions could reduce the readily available "stash."

Recommendations for Dental Prescriptions

Kenna led a team of dentists, pharmacists and addiction experts in writing the cover article for the most recent edition of The Journal of the American Dental Association (JADA). The article focused on the role dentists play in prescription painkiller availability and what dentists can do to reduce the likelihood that dental prescriptions will be misused. The JADA article outlined several recommendations:

• Talk with patients about whether or not they require opioids and the likelihood that they will use the full prescription.
• Write smaller prescriptions initially with limits on future refills.
• Avoid writing prescriptions for new patients or those about whom little is known.
• When possible, access monitoring programs that can check a patient’s drug history.
• Discuss with patients the importance of locking up or destroying unused medications.
• Lock up/secure prescription pads.

After modifying prescription practices, patient education can be part of a dentist’s strategy toward reducing "leftover" painkillers. Many households keep cabinets loaded with surplus painkillers like oxycodone and hydrocodone out of fear of future pain. The researchers recommend that dentists make plain to their patients the potential dangers of unsecured painkillers in the home. If patients are willing to part with their unused medications, the dentist can apprise them of DEA-sponsored drug "take back" days in lieu of flushing them (which could affect the water supply). Finally, dentists can point patients to data which suggest ibuprofen is as effective as addictive painkillers in managing pain associated with inflammation.

Not only can dentists adopt new prescribing parameters and engage in patient education, but they can add two components to patient care that might positively impact the control of opioids:

• As uncomfortable as it may be, dentists can add questions about substance abuse to the health histories taken from incoming patients.
• Dentists can work to improve the coordination of care with oral surgeons in order to better monitor patient prescriptions.

Dr. David Kloth, spokesman for the American Society of Interventional Pain Physicians and a pain management physician from Connecticut, says most doctors are innocent in prescribing drugs because they haven’t had the proper training and don’t know how to identify an addict. Around 80 to 90 percent of doctors in the U.S. have no training or instruction with the proper use of prescription drugs. Two leading doctors from ASIPP believe that lawmakers should make it a requirement for all physicians to partake in training to prevent the abuse of prescription drugs. They believe physicians should have to register with the DEA before they are allowed to prescribe some medications known to be extremely addictive pain killers such as opioid based drugs.

Kloth believes doctors wouldn’t go through training voluntarily and that in order to help solve the problem, training should be mandatory. Kloth says that generally physicians are too busy and don’t volunteer to do any extra training or certification that isn’t required by law. 38 of the 50 states already have these training programs in place and several others have passed bills but simply cannot afford to begin these programs. Patients are able to go other places and find the medications because of the mobility offered to us with technology.

In a study of 300 individuals, researchers at RAND Corp. examined patients at the behavioral health services facilities in Los Angeles. The study took place over a three year period of time from 2006 to 2009. Most of the patients were suffering from major depressive disorder, and in an effort to find the best possible method of treatment for them, health professionals experimented with different methods of care.

The facilities alternated treatment every quarter. The first four months, patients were treated with traditional care for substance abuse only. The next four months, patients were also given cognitive behavioral therapy (CBT). CBT gained popularity in the 1960s and is a method of talk therapy that is aimed at changing dysfunctional emotions, thoughts, and conduct underlying anxiety and mood disorders as well as problems with substance abuse. The idea is that by changing thoughts, we can alter behavior.

Patients receiving both traditional care and CBT faired best. Patients started showing marked improvement after just three months of treatment. However, after six months of treatment, 44 percent of those receiving just the regular care for substance abuse showed few signs of remaining depression, but that number increased to 64 percent when CBT was added. Even after leaving the treatment facility, those who received CBT had fewer instances of relapse in terms of days of drug abuse or drinking than the control group.

The use of cognitive behavioral therapy to treat mood disorders and substance abuse is nothing new. A derivative of CBT called problem solving therapy (PST) has been used to treat aging baby boomers as they deal with depression, which can often lead to substance abuse and vice versa. PST assists patients in working through dysfunctional emotions associated with such issues as the loss of loved one, loneliness, or feeling insignificant after retirement. When dealing with these situations, everyday life can seem overwhelming. PST is a systematic way that helps people deal with their emotions and problems in a healthy way.

Many times people do not understand how thoughts impact their behavior. CBT offers hope by showing these individuals what destructive thought patterns look like and how to change them. Keeping a positive mental state of mind is key to dealing with life’s challenges, and learning how to effectively manage problems and dysfunctional emotions can help those suffering to avoid falling back into a state of depression.

Vicodin in its generic form, a combination of hydrocodone and acetaminophen, is listed by the Food and Drug Administration and the Drug Enforcement Administration as a Schedule III – the same class as many types of anesthetics or steroid drugs. In comparison, codeine and the prescription opioid oxycodone are listed as a Schedule II. At the highest restriction, Schedule I, are drugs like heroin.

Unlike many other opiates, Vicodin prescriptions can be accessed by a physician’s telephone order, even though the addictive potential is believed by many health experts to be the same as drugs like heroin. By itself, the drug hydrocodone may not be as easy to prescribe, as it carries a Schedule II category listing. When acetaminophen is added, however, hydrocodone combinations like Vicodin become listed at Schedule III.

Pain clinic experts say the drug’s Schedule III classification means physicians may also assume that prescribing Vicodin carries less danger for addiction than other similar drugs, and may assume they may not face harsh DEA penalties for offering Vicodin often to patients.

In several states, there are specific regulations connected to DEA drug scheduling, which can allow for easier and more frequent distributions of generic painkillers – not only generic Vicodin, but for medications like Percocet, which is a Schedule II.

Loss of life from accidental overdose of prescription painkillers has grown in numbers to a level beyond even deaths from both heroin and cocaine. More people die from accidental overdose of prescription painkillers in some states than in car accidents, and new federal initiatives are aimed at reducing prescription drug abuse rates by several percent in the next five years.

Vicodin is the most widely abused prescription painkiller in the U.S., with an estimated 131 million doses given – up by almost 20 million since 2006. Data comes from a survey by IMS Health, and also shows that most of the prescriptions for painkillers could be avoided.

Not only does Vicodin abuse lead to serious and life-threatening addictions, it’s also increasingly linked to fatal overdoses, says a recent ABC World News report. Unintentional overdose from Vicodin ends more lives in 17 U.S. states than car crashes, says the Centers for Disease control and Prevention.

Globally, the U.S. also shows a crisis-level rate of Vicodin abuse. While less than 5 percent of the global population lives in the U.S., 99 percent of the Vicodin administered is used in America. Andrew Kolodny, New York’s Maimonides Medical Center Chair of Psychiatry, says the problem lies in the way Vicodin (hydrocodone) is labeled. The drug is listed as a Class III, but Kolodny suggests it be reclassified as a Class II, which carries more stringent usage guidelines.

In many U.S. states, the way a drug like Vicodin is handled and administered is directly connected to its level of classification. Kolodny has compared the addictive nature of Vicodin to street drugs like heroin, and states that it is just as high-risk as similar prescription painkillers that have tighter regulations.

It isn’t only physicians who are giving patients prescriptions for Vicodin. Surgeons, dentists and even podiatrists can prescribe the drug – which may be a reflection of its looser handling restrictions as compared to other prescription pain medications. Some pain experts believe painkillers like Vicodin should be restricted only for patients who are terminally ill, because in these cases, addiction is not as great of an issue.

Doctors who give prescription medications to people who already have drug addictions could face more scrutiny and restrictions as groups like the American Society of Addiction Medicine strive toward tighter regulations.

The problem is made more complex by the reality that some physicians, like several in Florida, actually work in both realms – they work with people suffering from drug addictions and also help patients manage chronic pain by giving them prescriptions for painkillers like Oxycontin and Vicodin. It’s a delicate matter, say addiction professionals, because the practice can encourage people struggling with drug addictions to move from pain clinic to pain clinic in search of prescriptions while veering away from treatments that could bring them to recovery.

According to University of Miami Miller School of Medicine’s Dr. Ihsan Salloum, a specialist in addiction psychiatry, pain clinics may create a situation where a person with an addiction can have increased access to the drugs.

Other pain clinics are actually undercover drug stops, fueled by black market drug trafficking. Concerns are also increasing toward some pain clinics who may strive to keep patients dependent on anti-addiction drugs in order to increase business.

Efforts to close illegitimate pain clinics can be slow. Federal law offers protection to physicians who are approved to provide prescriptions for narcotic drugs, and law enforcement agents must acquire an order from a judge before beginning an investigation of a pain clinic or physician.

In Florida, a series of pain clinics have opened up along a large stretch near Miami, numbering well over 100 in just one county. Data from the U.S. Drug Enforcement Administration says South Florida has the physicians who prescribe the nation’s highest levels of oxycodone. Outspoken marketing campaigns for the clinics, including coupons, newspaper ads and special information for clients from other states have added to the complexity of the situation. Some ads list prescription withdrawal medications by brand name, especially those available on an outpatient basis.

Many addiction experts have expressed serious concerns over pain clinics’ use of pill-based forms of treatment for addictions, rather than a whole-picture approach that includes counseling and lifestyle changes. In some states, such as New Jersey, only physicians who are board-certified in the field of managing pain can administer addiction treatment medications like Suboxone. Expert-level status in addictions is not required for physicians to give prescriptions for anti-addiction medications like Suboxone, in which a physician can be ready to prescribe after completing a course offered online.

Several fatalities from drug overdose are also believed linked to pain clinics over-administering medications, prompting law enforcement officials and drug research organizations to push for stricter regulations for pain clinics nationwide.