Narcotic Abuse Overview
Pain is one of the most common reasons people seek medical treatment. Doctors can prescribe several different drugs to relieve pain. The most potent pain-relieving drugs are narcotics.
In the United States, narcotics are widely prescribed to treat painful conditions. Narcotics are often prescribed in conjunction with other less potent drugs (such as nonsteroidal antiinflammatory medications) or as a pill that has a combination of a narcotic with either acetaminophen (for example, Tylenol) or aspirin (Arthritis Pain, Aspergum Cherry, Aspergum Orginal, Aspir-Low, Aspirin Lite Coat, Aspirin Low Strength, Bayer Aspirin, Bayer Aspirin Regimen, Bayer Childrens Aspirin, Bufferin, Bufferin Arthritis Strength, Easprin, Ecotrin, Empirin, Fasprin, Genacote, Halfprin, Norwich Aspirin, St. Joseph Aspirin, St. Joseph Aspirin Adult Chewable, Stanback Analgesic, Tri-Buffered Aspirin, Zorprin). Acetaminophen is also commonly found in many different products that are available as over-the-counter (OTC) medications. With the public often using OTC products that contain acetaminophen as well as prescription narcotics that might also have acetaminophen, the U.S. Food and Drug Administration (FDA) has become concerned about dangerous interactions from combining these medications. There is not just the potential for narcotic abuse but the concern that patients are accidentally ingesting too much acetaminophen from combining these products with the potential for severe liver damage or even death.
The use of prescription pain relievers without a doctor's prescription only for the experience or the feeling it causes is often called "nonmedical" use. Narcotic use is considered abuse when people use narcotics to seek feelings of well-being apart from the narcotic's pain-relief applications.
The U.S. Substance Abuse and Mental Health Services (SAMHSA) report that after marijuana, nonmedical use of painkillers is the second most common form of illicit drug use in the United States. According to SAMHSA, 21% of people age 12 and older (5.2 million individuals) reported using prescription pain relievers nonmedically in 2007. The U.S. Drug Enforcement Agency suggests that the number of people abusing any prescription drugs is even higher at 7 million individuals.
SAMHSA's Drug Abuse Warning Network reported that approximately 324,000 emergency department visits in 2006 involved the nonmedical use of pain relievers (this includes both prescription and over-the-counter pain medications). According to the U.S. Department of Health and Human Services, there were an estimated 90,232 emergency department visits related to narcotic analgesic abuse in 2001.
Narcotics have many useful pain-relieving applications in medicine. They are used not only to relieve pain for people with chronic diseases such as cancer but also to relieve acute pain after operations. Doctors may also prescribe narcotics for painful acute conditions, such as corneal abrasions, kidney stones, and broken bones.
When people use narcotics exclusively to control pain, it is unlikely that they become addicted or dependent on them. A patient is given a dosage of opioids strong enough to reduce their awareness of pain but not normally potent enough to produce a euphoric state.
Adequate pain control is the goal for the medical use of narcotics. Thus, patients or health-care professionals should not allow fear of addiction to interfere with using narcotics for effective pain relief.
Mark Zwanger, MD, MBA