The 2001 National Household Survey on Drug Abuse revealed that 36 million Americans have abused prescription-type drugs -- that is, used them at least once in their lifetime for purposes other than treating a medical condition. This includes about 10 million people aged 12 to 25. The survey also reports that the annual number of new users of pain relievers for nonmedical purposes has been increasing since the mid 1980s, from about 400,000 new users to 2 million in 2000.

Of particular concern are narcotic analgesics -- pain medications that contain opioids and can lead to addiction. These are natural chemicals derived from opium or synthetic chemicals with effects similar to opium. Medications in this class include morphine and codeine; some brand names include Vicodin, OxyContin, Percocet, Demerol and Darvon. According to the Drug Abuse Warning Network, emergency room visits related to narcotic analgesic abuse more than doubled between 1994 and 2001.

When used correctly to treat pain, these medications usually do not result in euphoria, and most patients don't become addicted to the drugs. However, as the number of first-time users of prescription medications grows, so does the associated risk of addiction, said Carol Falkowski, director of Research Communications at Hazelden and a drug trend specialist. According to the Treatment Episode Data Set, a federal treatment data system, the number of people admitted to addiction treatment centers with nonmedical use of pain medications as their primary drug problem rose from 14,044 in 1994 to over 20,000 in 1999. Nearly half of these patients (44 percent) reported no substances of abuse other than prescription drugs.

"People being treated for the excruciating pain associated with cancer have an extremely low rate of addiction to opioids," said Dr. Marvin D. Seppala, vice president of Medical Affairs for Hazelden. "But there have not been good studies examining people with other forms of chronic pain, such as a ruptured disk."

It is not known to what extent people recovering from addiction are abusing painkillers. Recovering people fear that their use of pain medications may cause a relapse, and that's a legitimate concern. Some feel that the use of such drugs for medical purposes goes against the philosophy of their Alcoholics Anonymous group. But this is not true. AA and other Twelve Step groups recognize the "medical necessity" to address pain and other medical conditions with medications.

For people -- recovering and nonrecovering alike -- who must grapple with decisions about taking pain medications now, Seppala offers the following guidelines:

Physical dependence alone doesn't mean addiction. "If you've been taking pain medications for several weeks and then stop them, you will probably experience some withdrawal symptoms," Seppala says. "But this alone does not mean that you're addicted to pain medications, or, if you're in recovery, that you've relapsed."

According to recent guidelines from the American Pain Society and American Society of Addiction Medicine, behaviors that suggest addiction go well beyond withdrawal. Examples are:

• failure to take medications on schedule.
• taking multiple doses of pain medication at the same time.
• frequent reports of lost prescriptions.
• "doctor shopping" -- attempts to get prescriptions from several doctors.
• use of narcotics for reasons other than pain relief.
• failure to use pain treatments other than medication.

Ask questions and express concern. If your doctor prescribes pain medication, be well informed. Ask, "Why am I taking this medication? How long will I take it? How much will I take each day?" If you're in recovery, let your doctor know this and express your concern about using any mood-altering medications.

Ask for clear directions on taking pain medication. "Take two tablets once every eight hours" offers better direction than "take four tablets per day" or simply "take as needed."

Ask about treatments other than medication. For instance, some types of pain improve with physical exercise. Biofeedback treatments and relaxation exercises are other options. Simply taking charge of your overall health -- changing your diet, getting more sleep, and reducing stress at work and home -- may also help. Get support. Ask someone you trust to control the timing and dose of your pain medications. And if you're in recovery, talk to your sponsor or support group about this issue. For more information on pain medications (both prescription and over-the-counter), go to the American Pain Society Web site at http://www.ampainsoc.org/. Recovering people can get guidance from a pamphlet called "The AA Member: Medications and Other Drugs."

--Published April 7, 2003