PAINKILLERS

Opioids can relieve pain, but also fuel addiction

OXYCODONE: A GROWTH INDUSTRY
Un United States Opioids, like oxycodone, are controlled substances most often prescribed for pain management. They are chemicals based on opium's active component morphine that work by mimicking the actions of pain-relieving chemicals produced in the body. 55.6

OPIOIDS AND THEIR EFFECTS

Opioids act by attaching to specic proteins called opioid receptors, which are found in the brain, spinal cord and gastrointestinal tract and other organs in the body. When these compounds attach to certain opioid receptors in the brain and spinal cord, they can change the way a person experiences pain. Opioid medications can also alter regions of the brain affecting pleasure, resulting in a feeling of euphoria.

Effects on brain

Opioid

Opioid

UNITED STATES UNITED STATES ITED TATE IT TES

Retail oxycodone oxycodone xycodone xycodo mi grams millions of gr 4. 4.4
1997

48.3

Opioid

6.6
1998

9.7

15.3

19.9 22.4 19.9 22.4

cts How addicts ds take opioids

Other than ingesting pills, people who abuse opioids may seek to intensify the effect by snorting or injecting them.

Opioid receptor

Opioid receptor

1999 2000

2001

2002

2005

2006

200 2007

2008 2009

2010

96 968,473 grams KE KENTUCKY KY AN AND INDIANA

Retail oxycodone distribution in thousands of grams 2. 397.7 402. 327 183.6 44.3 .3 299. 299.3 9.3 117.6 83.2 182.2 18 114. 114.7
1997 1998 1999 2000 2001

Indiana

Often taken more frequently than legitimate pain patients.

Ingesting pills
Brain
OR OR OR Opioid receptors

706. 706.5

77 771.3

873.2 775.8 77

674. 674.5 Kentucky

35

952,556 grams

Results in the rapid release of the drug into the bloodstream. Injecting opioids increases the risk of HIV and other infectious diseases through use of shared needles.

Liquefying, injecting pills

OR

OR

2002

2003

2004

2005

2006

2007

2008

2009

2010

This results in a rapid release of the drug into the bloodstream and exposes the person to high doses.
OR

Crushing, snorting pills

SOURCE: Drug Enforcement Administration

BY THE NUMBERS 12 million

Number of Americans 12 or older who in 2010 reported using prescription painkillers without a medical reason to do so

Increase in the retail dis ease reta istribution of ox on oxycodon in g one grams on nationally from 1997 to 2010 tionally m 97 o

1,327% %

Health care costs from the non-medical use of prescription painkillers

$635 billion

Num umber of controlle ontr led substance prescr tions substa e pr cription dispense in Kentu spen sp sed tucky in 2009

11,124,085 4 5

Drowsiness, mental confusion Nausea and constipation Alone or with alcohol or other drugs, can depress respiration and even lead to death. Unintentional overdose deaths involving prescription opioids have quadrupled since 1999 and now outnumber those from heroin and cocaine combined.

Abuse side effects

Lung Lung Heart

Number of emergency department visits nationally in 2009 due to people abusing prescription painkillers

500,000

Num r Number of con ledontrolle subs nc substance pres nce escriptions tions prescr ed nnually by top pr cribed ann pres iber in Kentucky escriber ers

More than e n 40,000 0

SOURCES: National Institute on Drug Abuse, New York University Langone Medical Center, Courier-Journal reporting

Liver

PHYSICAL DEPENDENCE
Patients who are prescribed opioids for a prolonged period may develop a physical dependence, which is not the same as s addiction. Repeated exposure to opioids sometimes results in tolerance or withdrawal symptoms when the drug is abruptly stopped. WITHDRAWAL SYMPTOMS: May include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold ashes with goose bumps, and involuntary leg movements.
OR

OR Stomach

Largeintestines
OR OR

OR

WHO MIGHT GET ADDICTED?

A persons risk for addiction is inuenced by a combination of factors. tors. The more risk factors an individual has, the greater the chance that at taking drugs can lead to addiction. Risks include:

Small intestines

ADDICTION OVER TIME

Drug abuse can cause changes to the brain that erode a person's self contro and ability to make sound decisions, while sending intense control impuls to take drugs. impulses In respo po response to overwhelming surges in dopamine, the addicts brain adjusts by decreasing the number of dopamine receptors available s diminish nish diminishing the brains reward circuit. Drug addicts are compelled to abus drugs to bring their dopamine function back to normal, abuse re requiring ever larger amounts to achieve the initial dopamine high. Long-term abuse causes changes in other brain chemical ng-t -term ab stem inc ems, systems, including glutamate, a neurotransmitter that inu uence th inuences the reward circuit and the ability to learn. When opti op the optimal concentration of glutamate is altered by drug abuse, abus b abuse, the brain attempts to compensate, which can cause impair irme impairment in cognitive function. Drug addiction is a chronic, relapsing di laps lapsin lapsing diseas relapsing disease as are diabetes, asthma or heart disease d an ma and it can be mana managed successfully through treatment.

Biology

Genes, in combination with a persons environment, account for about half of someones vulnerability to addiction.

ncludes nc des nclude family, friends, socioeconomic status and quality y of life in general. Peer pressure, physical and sexual e xual ab e, stress, and quality of parenting can greatly abuse, str eatly inuence whether someone abuses drugs or becomes in ence inuen ecomes addicted. ad cted addict

Environment Enviro Envi

Genetic and environmental factors interact with critical Ge h developmental stages in a persons life such as adolesde cence. The earlier drug use begins, the more likely it will ce ikely progress to more serious abuse.

Development Develo De

STEVE REED/THE COURIER-JOURNAL

STEPS: Medical organizations, lawmakers seek ways to address the issues

Continued from Page A4

by the FDA in 2010, makes it harder for people to cut, chew, crush or dissolve the pills. But Purdue Pharma officials said that its too early to judge to what degree the reformulation of the product will translate to a reduction in misuse and abuse.

fecting well-meaning doctors. One requires physicians to use KASPER before prescribing Schedule II or III drugs, with exceptions for emergency services and hospice care. It also requires those prescribers to take a full medical history, conduct a physical exam and discuss the risk of drug tolerance.

prescribing. One would require doctors who prescribe controlled substances to get training or special certification on addiction and abuse of controlled substances and safe use of the drugs. The other, the Stop Oxy Abuse Act, would direct the FDA to limit approval of drugs containing controlled-release oxycodone for severe pain only.

terest in making generic versions of the old type, he said, meaning there could soon be a cheaper equivalent drug thats easier to abuse. Rogers and others battling prescription drug abuse said the problem is like an evershifting genie destroying thousands of Kentucky families. Stewart agreed. Were living through a