Where once marijuana was deemed to be “the gateway drug,” now another is taking its place: prescription drugs. Without doubt, the supply and use of prescription drugs has risen in the United States. For example, The Economist notes that, in less than a decade in the twenty-first century, the number of Americans using antidepressants soared from 6% to 10%. Yet even as prescription drug use rises in general, it is a particular kind—opioid analgesics (painkillers), like Vicodin, OxyContin, and Percocet—which are the cause for most concern. Nora Volkow, in testifying before Congress, estimated that 2.1 million people in the United States suffer from substance use disorders related to prescription opioid pain relievers.
For many Americans, prescription drug addiction begins at the dentist or the doctor. After surgery, patients are often prescribed painkillers to help mitigate post-surgical discomfort. A group of Harvard researchers recently published a report in the Journal of the American Medical Association, noting that dentists are among the leading prescribers of painkillers. But by far the most alarming part of the study was that the highest number of prescriptions was for teenagers, between the age of 14 and 17 years, followed closely by those aged 18 to 24 years. If over-prescription of painkillers occurs, then it predominantly affects youth and young adults.
As NBC recently reported, many physicians and dentists will overprescribe painkillers in order to avoid having to write refills or have the patients revisit with complaints about pain. While attention has been paid to those who suffer from chronic pain and the addiction risks posed by long-term use of opioid painkillers, we are only recently coming to understand the problems posed by opioid painkillers as a gateway drug.
There is growing evidence of a link between increased use of opioid painkillers and increased heroin use, especially amongst adults. In 2012, it was estimated that 467,000 people in the United States were addicted to heroin. Nevertheless, disapproval of heroin use remains remarkably high amongst teens, even as measurements of availability (i.e. percent of teens answering “fairly easy” or “very easy” to get) remains between 20-30%.
Not only are opioid painkillers strong potential gateway drugs, they are part of a spike in drug overdose deaths. In 2010 alone, 16,651 died in the United States from overdoses of prescription opioid pain relievers. Despite what has been called an “opioid overdose epidemic,” the National Institute on Drug Abuse reported that,
Past-year prescription opioid misuse (reported in the survey as “narcotics other than heroin”) continued to decline, reflecting a significant decrease over the past 5 years. In addition, heroin use is at the lowest rate since the MTF survey began in all ages surveyed. There was a continued steady decline in the perception of availability of heroin among all ages surveyed despite increasing use among adults.
The hope is to head-off the overdose epidemic in youth which often leads to dependence on even more dangerous drugs like heroin. The availability, abundance, addictiveness, and perception of safety associated with prescription opioids makes them a serious risk for addiction. Researchers, therapists, and policy-makers are working to develop more effective means of preventing opioid deaths and seek alternative strategies for pain management.
Hamilton, Gloria J. “Prescription Drug Abuse.” Psychology in the Schools 46 (2009): 892-98. http://onlinelibrary.wiley.com/doi/10.1002/pits.20429/abstract.
Johnston, Lloyd D., et al. Monitoring the Future: National Results on Adolescent Drug Abuse. National Institute on Drug Abuse, US Department of Health and Human Services, National Institutes of Health, 2008. https://books.google.com/books?hl=en&lr=&id=rea9HJO0_UEC&oi=fnd&pg=PP2&dq= prescription+drug+addiction+teenagers &ots=ncXfh0DRrz&sig=Nl3VvgnA476VdiLRLR7v-1ssF8w#v=onepage&q&f=false
Manchikanti, Laxmaiah. “National Drug Control Policy and Prescription Drug Abuse: Facts and Fallacies.” Pain Physician 10 (2007): 399-424. http://www.cfbhn.org/Documents/RX/ National%20Drug%20Control%20Policy%20 and%20Prescription%20Drug%20Abuse%20Facts%20and%20Fallacies.pdf
_____. “Prescription Drug Abuse: What is Being Done to Address This New Drug Epidemic? Testimony Before the Subcommittee on Criminal Justice, Drug Policy and Human Resources.” Pain Physician 9 (2006): 287-321. https://www.asipp.org/documents/PrescriptiondrugabuseWhatisbeing.pdf
Snow, Kate and Parminder Deo. “The Deadly Triangle: Dentists, Drugs and Dependence.” NBC News, June 21, 2016. http://www.nbcnews.com/health/health-news/ deadly-triangle-dentists-drugs-dependence-n596601.