Strongest Painkillers Are Also Most Addictive

A string of overdose deaths and robberies all linked to the same powerful painkiller, fentanyl, raised concerns among police officials in parts of Pennsylvania, New York and Ohio that they would have yet another drug scourge to deal with.

All of the deaths occurred when people cut open fentanyl patches prescribed for treatment of chronic pain, and sucked out the drug, which the Drug Enforcement Administration describes as 50 times stronger than heroin and 80 times more powerful than morphine.

Fentanyl, like OxyContin, is one of the morphine-like painkillers used primarily for long-term treatment of chronic pain, and like OxyContin, it has caught on in isolated pockets around the country, according to the National Institute on Drug Abuse.

These drugs, along with other prescription drugs like Vicodin and Percocet, are the most recent in the long line of painkillers that have become powerful lures for abuse, and like others before them, such as opium and heroin, they are highly addictive.

"The potent painkillers are all opioids and these are all very addictive," said Dr. Carol Warfield, chief of anesthesia at Beth Israel Deaconess Medical Center in Boston. "They provide a lot of euphoria, and folks become physically addicted to them."

The euphoria these powerful painkillers provide is part of their attraction, but it is because users want more -- the rush -- that so many move from taking the drugs orally to snorting or smoking them to injecting them directly into their veins.

"The high is associated with the rise of blood level of the drug," Warfield said. "The faster the rise, the greater the high. That's why addicts prefer to inject."

And that search for the rush -- coupled with the physical tolerance to any drug that develops with repeated use -- leads abusers to try higher and higher doses.

Deadly Weekend

Fentanyl has been in use since the 1950s, and abuse of the drug within the medical profession has been documented since the 1970s, according to the DEA. However, fentanyl first drew widespread attention in 1991, when, during one weekend, 12 people in New York, Connecticut and New Jersey died of overdoses.

And in the years since, the link between fentanyl and death has dominated media reports about the abuse of the painkiller. Among the most recent cases was one in Tremont, Pa., in which a 21-year-old man, Joseph Brommer, was accused of giving two friends fatal doses of the drug, weeks apart.

"Young people are squeezing the drug out of the patches and using it illegally," DEA pharmaceuticals expert Dale Shick said. "They're taking a drug that is supposed to be used in small, time-released doses, and they're using it all at once. It's very dangerous."

Brommer admitted stealing the patches containing the drug from his mother's house and giving the drug to his two friends, police said at a hearing on the case earlier this year. But his attorney disputed the murder charges against the man, saying it was not clear whether the two died from the fentanyl or from other drugs in their systems.

While neither fentanyl or OxyContin has reached the nationwide epidemic proportions of methamphetamine, they are part of a trend that is disturbing.

Abuse Anomaly

The abuse of most drugs has either declined or leveled off among young people, according to the Monitoring the Future survey, conducted by the University of Michigan's Institute for Social Research with funding from the National Institute on Drug Abuse, the National Institutes of Health and the U.S. Department of Health and Human Services, but the use of painkillers other than heroin is on the rise among high school students.

According to the MTF, which has been conducted among 12th-graders since 1975 and was expanded to include eighth- and 10th-graders in 1991, only 3.3 percent of high school seniors reported having abused painkillers other than heroin in 1992. By 2000, that number had risen to 7 percent.

After the survey was changed to include OxyContin, Vicodin and Percocet in 2002, the percentage jumped again, and in 2004 9.5 percent reported abusing these drugs. None of the other categories of drug the survey looks at was as popular with teenagers.

Heroin use also seemed to rise through the late 1990s, at a time when use of many other drugs seemed to be on the decline, according to the National Survey on Drug Use and Health. Between 1995 and 2001, according to the survey, more than 100,000 people started using heroin each year, the highest numbers since the early 1970s.

By contrast, the NIDA estimates 30 million people, or more than 13 percent of the population aged 12 or older, abused prescription pain relievers in 2002.

The rise in use of prescription pharmaceuticals may be partly a result of the increasing availability of these painkillers, which are being prescribed more often as a treatment for chronic pain, in what some doctors say is a troubling trend.

"We've gone from a point within the medical profession when there was reluctance, probably too much, [to prescribe painkillers], to almost a permissive attitude when anybody who says they're in pain almost can get a narcotic," said Dr. Joel Saper, director of the Michigan Head Pain and Neurological Institute.

That has moved these drugs from hospitals and clinics into drugstores and people's homes. In most of the cases around Pennsylvania, western New York and Ohio this year, the fentanyl linked to the overdoses had been taken from a relative of one of the people involved.

Ending Pain Without the Pleasure

Researchers have tried to develop powerful painkillers that would not have the side effects that make these drugs so popular with abusers and would not be addictive, but have thus far been unsuccessful, Warfield said.

"There have been lots of attempts to come up with a powerful painkiller that would not be addictive," she said. "The painkillers that do that are the drugs that don't give you a high, over-the-counter drugs."

But the most powerful painkillers are all opioids, and the receptors in the body that they work on also seem to be some of the receptors involved in addiction, she said.

What is confusing is that these drugs do not become addictive for all users, even for users who become physically dependent -- that is, their bodies get used to the drug and need it to feel normal, but they do not want to take it. Warfield said this often occurs with cancer patients who are put on painkillers for months and months.

"They will come in and beg us to do something so they don't have to take them," she said.