Pubdate: Mon, 13 Oct 2003 Source: Atlanta Journal-Constitution (GA) Copyright: 2003 The Atlanta Journal-Constitution Contact: http://www.accessatlanta.com/ajc/ Details: http://www.mapinc.org/media/28 Author: David Wahlberg Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone) PAINKILLER ADDICTION DIFFICULT TO BEAT Conservative radio talk-show host Rush Limbaugh, who last week checked into a 30-day treatment program to break his addiction to painkillers, faces a challenge greater than trying to silence throngs of liberals. More than 4 million Americans are addicted to painkillers. Among those who seek treatment, only about half are successful. Dr. Karen Drexler, assistant professor of psychiatry at Emory University and director of the substance abuse treatment program at the Atlanta Veterans Affairs Medical Center, answered some questions about pain medications and addictions: Q: Rush Limbaugh's problems have been linked to OxyContin (oxycodone) and Lorcet (which includes hydrocodone). For what conditions are these drugs normally prescribed, and how are they different? A: OxyContin is for chronic pain that needs relief around the clock. It has a controlled-release format (though oxycodone is also available in immediate release form). Lorcet is for treatment of pain on an as-needed basis. Both are opioids, and both peak about an hour after you take them. Q: What other painkillers most often lead to addiction? A: It has more to do with how you take the drugs than the drugs themselves. OxyContin, if taken as directed, is not likely to cause dependence. But if you crush the tablet, you circumvent the slow-release mechanism. Drugs you take orally have a slower onset and are less likely to be addictive. But by smoking or injecting any opioids, it can take only 10 seconds to get to the brain. It's more potent and addictive that way. Anyone who takes opioids over time will build up tolerance. They may need higher doses to achieve the same pain relief. But people with tolerance are not always addicted. Addiction is the loss of control over drug use and the continued use despite negative consequences. Q: What percentage of people who take OxyContin, Lorcet or similar drugs develop addiction, and why does that happen? A: It's definitely a small minority. But among forms of drug addiction, it is more common than crack cocaine or street heroin use. That's because more people take pain medications. A survey last year by the Substance Abuse and Mental Health Services Administration said that 22 million Americans -- about 9.4 percent of the population 12 and over -- are dependent on drugs or alcohol or both. About 4.4 million of them are using narcotic pain relievers. Q: Are some people at higher risk of becoming addicted to painkillers? A: Yes, if you have been addicted to another drug or alcohol and if you have a family history of addiction to any substance. People who take drugs to get high are also at higher risk. Q: What are the warning signs of addiction, and when is treatment necessary? A: Building up tolerance to the drug is one. Another is if someone goes to multiple physicians with multiple complaints and fills prescriptions at multiple pharmacies. And if the person can no longer carry out their daily functions or if they're missing work or having trouble with relationships. You should talk to your doctor, who might try an alternative medication or physical therapy for pain relief, or refer to a substance abuse treatment program. Q: What kinds of treatments can stop addiction to painkillers? A: Drugs such as clonidine and methadone can ease withdrawal symptoms during detox. Methadone is a slow-acting replacement narcotic that can be gradually tapered. But while detox is a necessary step toward rehabilitation, it is not rehabilitation itself. The mainstay is psychotherapy, either in residential programs or a few evenings a week. Most programs are abstinence-based, with the goal of getting off all substances. Many follow the traditional 12-step model. Cognitive behavioral therapy helps people recognize their high-risk situations and manage their urges. You learn to avoid the places where you got drugs and to use distraction techniques like talking to a friend, going jogging or chewing gum. Q: What about "rapid detox," coming off drugs in a few days? A: It relies on giving the drug naltrexone while the patient is under general anesthesia. The drug blocks opiate receptors, so if you abuse drugs, you won't feel the high you're looking for. The person doesn't feel the symptoms of withdrawal because of the anesthesia. It can be helpful in highly motivated groups, especially professionals whose careers are on the line and want to get back to work quickly. But I generally don't recommend it. Anesthesia can have its own side effects. Q: How often is treatment successful? Don't a lot of people relapse? A: Addiction is a chronic illness, like diabetes or high blood pressure. It develops after many months or years of substance use. Once a person develops a blindness to the problems a drug causes, those changes last a long time. The rate of staying abstinent is about 40 [percent] to 60 percent. The longer you stay in a treatment program, the better your chances of success. Methadone is a very effective treatment for people who have tried abstinence and not been able to make it work. - --- MAP posted-by: Derek