If you want to know how people become addicted and why they keep using drugs, ask the people who are addicted.
Thirty-one of 75 patients hospitalized for opioid detoxification told University at Buffalo physicians they first got hooked on drugs legitimately prescribed for pain.
Another 24 began with a friend's left-over prescription pills or pilfered from a parent's medicine cabinet. The remaining 20 patients said they got hooked on street drugs.
However, 92 percent of the patients in the study said they eventually bought drugs off the street, primarily heroin, because it is less expensive and more effective than prescriptions.
They continued using drugs because they "helped to take away my emotional pain and stress," "to feel normal," "to feel like a better person."
Results of the study appear in the current issue of Journal of Addiction Medicine.
The information will be used to train medical students and residents at the UB School of Medicine and Biomedical Sciences and practicing physicians to screen for potential addiction among their patients, and to perform an intervention or refer for treatment before an addiction becomes life-threatening.
"We are seeing an increase in the number of patients addicted to prescription
drugs," says Richard Blondell, MD, professor of family medicine and senior author on the study, "so we wanted to better understand how they first got hooked.
"This information suggests that there is a progressive nature to opioid use, and that prescription opioids can be the gateway to illicit drug addiction. It also tells us that people who use prescriptions illegally may be at greater risk for subsequent heroin use than those who use prescriptions legally."
The study group was recruited from patients admitted to the detoxification unit in Erie County Medical Center in Buffalo who were addicted to opioids -- defined as opiates that are made from the opium poppy (morphine, codeine and heroin) or medications that are developed artificially (methadone or fentanyl).
Researchers collected demographic and socioeconomic information from participants, plus the types of drugs they used, age of first use, preferred opioids and how they administered the drugs. They also asked participants how they got started and how their drug use progressed.
Replies showed that the average age of users was 32; that 65 percent were men, 77 percent considered themselves white, and 74 percent had a high school diploma or equivalent.
Why did they begin using? Slightly more than half -- 51 percent -- said they first used the drugs for pain -- after surgery, for back pain or after an injury, and 49 percent said because they were curious and/or someone they were with had the drugs.
Those who became addicted from using drugs legally prescribed for pain were more likely to be older, female, have a college degree and more likely to take their drugs orally, rather than nasally or via injection.
Users' comments on how they got started using drugs other than for pain, and why they continued, were revealing. "Pill parties" were a common starting point. One person said the drug "was handed to me by my friend, this guy I know, someone who was at the party." Another patient said kids are using it "like Viagra."
Prescription drugs are available in high schools, "at the prom" and used by athletes "to make it through the game," and later to get high on weekends and during the off-season, according to the users.
When asked if any doctor had ever asked about a substance use problem before writing a prescription, of the 53 participants who answered the question, 74 percent said no.
Blondell emphasized that the prescribing physician is in the best position to prevent or address addiction in their patients.
"I tell patients that addiction can be an unintended side-effect that occurs occasionally with the use of these medications," says Blondell.
"Doctors need to be able to help them if this occurs, so doctors will need to monitor the use of these medications closely. I also tell patients to discard unused medication ASAP. to prevent addiction in themselves and those, such as teenage family members, who might get their hands on these leftover pills.
Marta C. Canfield, MD, who completed her residency in the UB Department of Family Medicine and now is in practice in Western New York, is first author on the study. Craig E. Keller, Lynne M. Frydrych, Lisham Ashrafioun and Christopher H. Purdy, all from UB, also contributed to the study.
The research was supported by a grant to Keller from the UB Foundation Family Medicine Endowment; by a grant to Blondell and Frydrych from the National Institute on Alcohol Abuse and Alcoholism, and by the UB Interdisciplinary Research Fund.
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