How did it get to this point, and—more importantly—what can be done to curb this abuse?
The short answer to the first question is access. As the numbers above show, doctors are simply writing more prescriptions today—and for a wider variety of painkillers. Experts say that upward trend started in the early 1990s, when the Institute of Medicine released a statement expressing concern that physicians were not identifying and treating pain adequately and, as a result, patients were suffering.
"That's when the pendulum started swinging from under-prescribing for acute pain to over-prescribing," explains Dr. Sharon Levy of the Center for Adolescent Substance Abuse Research at Boston Children's Hospital. At the same time, pharmaceutical companies were bringing to market stronger, longer-lasting opioid drugs to treat pain.
While this development no doubt offered great relief to many people, it also opened the door to these drugs—with their high addiction potential—being over-prescribed, misused and diverted. "It was the perfect storm," Dr. Levy says.
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All of this was compounded in 1997 by an FDA decision that significantly changed the landscape. That year, the agency issued guidance enabling pharmaceutical companies to more easily pitch their drugs directly to consumers. Suddenly, TV commercials and magazine ads started appearing, touting the benefits of drugs treating depression, anxiety, rheumatoid arthritis, erectile dysfunction and every human ailment in between. Patients were able to march into their physicians' offices, tick off their symptoms and ask for the specific drug they saw advertised the night before.
The result, drug-abuse experts say, is a population with easier access to more, and stronger, drugs. And because these pills are prescribed by a doctor or dentist, "the belief is that prescription medications must be safe," says Dr. Lee of the Hazelden Betty Ford Foundation.
In addition, physicians—and dentists, in particular—have also come under strong criticism for prescribing many more doses of these powerful painkillers than may be necessary. Dr. Nora Volkow, director of NIDA, points out that it's not unusual for doctors to prescribe a week or even two weeks' worth of painkillers when three days may be more than enough.