The truth about Rx medication addiction

Whenever I hand a prescription for pain pills to a patient, I tell them, “Remember not to drink any alcohol when taking these medications.”

For years, we in the medical community thought that simple message was getting through. It turns out we were wrong.

Every 19 minutes someone dies because of misuse of prescription medications. Sometimes it is because they take too much. Many times it is because they forget or ignore the warning their doctor gave about combining the medications with alcohol. And tens of thousands of people die every year as a result.

As much attention as we pay to illicit drugs such as cocaine or heroin, the truth is prescription medications kill more people in this country than those illicit drugs combined. Perhaps it is a perception issue: “It came from a pharmacy, therefore, it must be safe.”

They certainly can be safe, but they can also be incredibly addictive, with more than 1.9 million Americans hooked on prescription pain medications alone.

These painkillers are particularly dangerous because they depress the central nervous system, slowing down breathing and the brain stem’s responsiveness to CO2 to the point where someone abusing these medications can simply stop breathing. Combine these painkillers with alcohol, another depressant, and you’ve got a recipe for disaster.

Researchers are racing to find something that can help, and there are a few promising things in development. A recent study, the first large-scale trial aimed at painkiller dependence, offered some hope.

Almost half of those addicted to painkillers - 49% - were able to reduce their drug abuse when taking Suboxone for at least 12 weeks. The drug works by reducing withdrawal symptoms and relieving cravings.

Unfortunately, the success rate dropped to less than 10% [8.6%] once patients stopped taking the drug. In the study, patients receiving intensive addiction counseling did no better than those who didn’t.

Naltrexone – sold under the brand names Revia and Vivitrol, an injectable, long-acting formulation – has also been used for prescription painkiller abuse. But naltrexone only has the potential to work in patients who are already off the painkillers long enough that the drugs are out of their system.

Truth is most of the researchers I have interviewed over the last decade all seem to agree on one thing: addiction is a brain disease. The latest science shows how the dependence on drugs or alcohol can change the brain chemistry, altering pain and reward centers. As a result of this latest science, the idea of therapy alone to treat addiction is waning.

I should point out that millions of patients use prescription pain medications every year safely, without becoming addicted, and certainly without dying. For nearly 30,000 people a year though, they pay the price with their lives.

As a doctor, I will look my patients in the eye every time I hand them a prescription to tell them the concerns about the pills they will take. It won’t just be a casual reminder about not taking the medications with alcohol, but a forceful warning backed up with scary but frightening statistics. I will remind them that they could become addicted, and they could die. That is our jobs as doctors, and it is one way to save thousands of lives.