Nation in crisis: painkiller progression

Doctor explains current drug epidemic –– and how to combat it

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Patients should stop thinking of powerful pain medications like Oxycontin and Vycodin as slightly stronger versions of Tylenol and Advil. Rather, they should think of them as “heroin pills.”

That’s according to Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing and chief medical officer for Phoenix House, a national, nonprofit drug treatment agency.

“To make [opioid pain medications], you start with opium,” Kolodny said in a Herald interview last week. “To make heroin, you start with opium. The effect [of opioid pain medications] in the brain is indistinguishable from heroin.”

In the beginning

Before 1995, doctors rarely prescribed opioid painkillers, except when a patient had reached the end of life –– that is, there was nothing more that could be done medically, except to offer the patient comfort in his or her waning days, Kolodny said.

“You would not have seen a family doctor giving someone Vycodin with refills for back pain,” he said. “That wasn’t done.”

Then a host of major pharmaceutical companies embarked on a mass marketing campaign aimed at doctors that touted the benefit of opioid pain medications –– near instant relief from even the harshest of pain –– while downplaying the risk –– severe addiction. And so physicians began overprescribing opioid pain relievers.

The result: The most widespread drug addiction crisis in United States history.

“The U.S. is in the midst of an unprecedented drug overdose epidemic,” reads a recent federal Centers for Disease Control report, “Addressing Prescription Drug Abuse in the United States.” “Drug overdose death rates have increased five-fold since 1980. By 2009, drug overdose deaths outnumbered deaths due to motor vehicle crashes for the first time in the U.S. Prescription drugs, especially opioid analgesics, have been increasingly involved in drug overdose deaths.”

The highest rate of opioid overdose deaths, Kolodny said, is among middle-aged medical patients, ages 45 to 54. “They can get all the pills they want” by prescription, Kolodny said.

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