Excerpt: When Painkillers Become Dangerous

Mr. Resnick's case highlights the complications of using medication to alleviate human suffering when the caregiver does not have a sophisticated understanding of addiction. This patient needed pain medication, and he needed specific referrals and treatment for the disease — addiction — that put him at risk for the motorcycle accident in the first place. Mr. Resnick's addiction became even more difficult to treat because of the complexity of trying to manage his pain with the very chemicals to which he was addicted. Later in this chapter, you will see how heroin, morphine, and Vicodin are related substances.

These complex issues are becoming more prevalent every day. The statistics are alarming. The National Institute on Drug Abuse (NIDA) reports that in 1999 an estimated 4 million people (about 2 percent of the American population age twelve and older) were currently (in the previous month) using prescription drugs non-medically. Of these 4 million people, 2.6 million were misusing pain relievers, 1.3 million were misusing sedatives and tranquilizers, and 0.9 million were misusing stimulants. These numbers obviously do not reflect the many thousands of people who may not recognize OxyContin and Other Prescription Pain Medication that they are misusing prescription medication but have become addicted as the result of following a doctor's orders. NIDA further reports from its 2003 Monitoring the Future survey of eighth, tenth, and twelfth graders that 10.5 percent of twelfth graders report using Vicodin for non-medical purposes and 4.5 percent had used OxyContin without a prescription.

We present in these pages a thorough examination of a growing problem for our country: addiction to prescription pain medication. We felt it was important to create a single, complete resource addressing this problem. Our focus will be on a specific drug in this class of medication: OxyContin. Throughout this book, we will look at the nature of addiction, its effect on the family, treatment modalities, and an intervention option.

How Pain Medication Works Prescription pain medications are essentially all related by their common effect on the body's endorphin system. The molecules of the medication mimic the effects of the body's own endorphins, but are much more powerful and last for longer periods of time.

Endorphins are involved in many biological actions, including respiration, nausea, vomiting, pain modulation, and hormonal regulation. There are several types of endorphin receptors, including the delta, mu, and kappa receptors. Each of these three receptors is involved in different physiologic functions. The blocking of pain comes primarily from effects on the mu receptor. The emotional effects of pain medication are quite complex. Pain medications exert their effects on the limbic system, or what is considered the emotion center of the brain, and can in many individuals induce a sense of euphoria.

The Juice of the Poppy

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