Painkillers, when used responsibly, usually don't make the user “high” or lead to substance abuse. “People who take opiates because they're getting their teeth pulled generally don't” develop substance-abuse problems, says Thomas R. Kosten, a professor of psychiatry and neuroscience at Baylor College of Medicine in Houston. For most people, “if you're in significant pain, the drug takes the pain away,” and “you feel a little sedated, a little nauseous.”
“I've taken two Vicodin in my life, for dental procedures, and it just made me feel bad. I got nauseated,” says Michael H. Lowenstein, co-director of the Waismann Institute, a detoxification center in Beverly Hills, Calif.
But about one-in-eight people “get high” from prescription painkillers, which can lead to drug abuse and addiction. Many prescription-drug abusers “start with a legitimate medical complaint,” says Marvin P. Seppala, chief medical officer of the Hazelden Foundation, an addiction treatment facility in Center City, Minn.
Biological factors strongly influence who gets a rush from drugs and therefore has high risk of substance abuse, Kosten says.
For example, a person's genetic makeup may cause them to be both ultrasensitive to chemicals like opiates and to release more of the body's own stimulating chemicals in response to ingesting alcohol or an opiate drug. When people with that physical makeup take a powerful drug like Vicodin, their already super-sensitive bodies actually receive an additional shot of chemicals, which creates an intense high, Kosten explains. “They're having an experience that's very, very different,” and far more compelling, than what other people taking the same drug experience.
About 30 percent of Europeans and 50 percent of Chinese have a physical makeup that puts them at risk when they take prescription drugs with addiction potential, but most people at risk don't realize it, Kosten says.
Other factors also probably raise addiction risks, says Lowenstein. For example, “the majority of people we see” in detox “have some underlying issue” that's helped drive the drug abuse, “such as depression or anxiety.”
Alcohol and drug abuse “are nothing but a desired altered state of consciousness,” says Kitty Harris-Wilkes, director of the Center for the Study of Addiction and Recovery at Texas Tech University in Lubbock. “If I don't like the way I feel, I'll do something to change it.” Such a desire can exist in anyone, “whether you're 13 or 83.”
The urge to escape society's pressures and stress is at the root of much substance abuse today, she says. At schools like Texas Tech, for example, there is often a “higher level of chemicals” used in the Honors College, where more students feel they're under intense pressure, she says.
Nevertheless, people should not be afraid to take a drug for pain relief, especially if they keep their doctor informed and follow instructions, says Leslie Lundt, a Boise, Idaho, psychiatrist and author of Think Like a Psychiatrist: Understanding Psychiatric Medicines. If a patient is suffering from insomnia and has had no personal or family substance-abuse problems, “I say, ‘So all of a sudden you're going to become a prostitute on a street corner just to get your sleeping pills?’”
Doctors, especially anesthesiologists, are at high risk for prescription-drug abuse. “The best estimate is that 20 percent of doctors are addicted” to some substance, says Doug Thorburn, author of Drunks, Drugs & Debits: How to Recognize Addicts and Avoid Financial Abuse.
Anesthesiologists' high rate of substance abuse shows the frightening power of addiction, says Seppala. “In spite of having the knowledge and awareness of addiction risks that they do, many anesthesiologists still get into it,” he says. Anesthesiology residents are the most likely doctors to be addicted. “Some people who are already experimenting with substance abuse actually go into the field to get the drugs.” Others apparently get involved out of “curiosity,” Seppala says. Some anesthesia patients report that “it feels so good,” and the doctors “start to wonder,” he says.
Women may be at higher risk for abusing prescription drugs than illegal drugs, mainly because of ease of access. If one has both health insurance and a middle-class or higher income, it can be easy to get a legitimate prescription for an addictive drug and fill it at multiple pharmacies.
Seppala describes a 52-year-old stay-at-home mom who kept up an addiction for years because she had five doctors prescribing her the same amount of opioids repeatedly.
“She never showed up to get more pills before her prescription was scheduled to run out, and she never complained,” so no doctor or pharmacist ever flagged her as a potential abuser, he says. The woman had a history of migraines and “knew what they were like, so she could give a good description” of her pain to justify her prescriptions, he says.
Because she was able to pay out of her own pocket for so many drugs, “she was kind of an exception” to the norm, he says. She only entered treatment when, finally, facing a divorce and foreclosure on her house, she was unable to pay for the drugs, he says.
“A group we're seeing more of is teens and young adults,” often getting started on “their mothers' or grandmothers' medicine,” says Christy Valentine, an internal-medicine and pediatrics physician in New Orleans. “The number of teens who've tried one of these narcotic medications or say they know someone who has is rampant,” she says.
How do you know you're in trouble with a prescription drug? One strong indication is “that the drug becomes a central organizing pattern of your life” — you always know where it is, how much you have and where you can get more, says Harris-Wilkes.