Coping With the Stigma of Addiction

Stigma is one of the meanest and most difficult aspects of addiction because it makes it harder for individuals and families to deal with their problems and get the help they need. Society imposes stigma – and its damage – on addicts and their families because many of us still believe that addiction is a character flaw or weakness that probably can’t be cured. The stigma against people with addictions is so deeply rooted that it continues even in the face of the scientific evidence that addiction is a treatable disease and even when we know people in our families and communities living wonderful lives in long-term recovery.

Stigma is the reason there is so much social and legal discrimination against people with addictions. It explains why addicts and their families hide the disease. Discrimination always hurts stigmatized groups because they are excluded from the rules that apply to “normal” people. So insurance companies get away with refusing to pay for alcohol or drug treatment, or with charging higher deductibles and co-pays than for treating any other disease. People who need the help are often afraid to speak up. State and federal agencies feel safe in denying food stamps and baby formula to mothers who have past drug convictions because mothers who used drugs have few supporters in the political system and face lots of people who think they must be “bad mothers.” Though studies have found that helping employees to recover is more cost-effective than termination, some employers believe that firing an employee with a drinking problem is a lot easier than providing rehabilitation. A firestorm of protest would erupt if employers treated workers with cancer or heart disease the same way.

People who are victims of stigma internalize the hate it carries, transforming it to shame and hiding from its effects. Too often, people with alcohol and drug problems and their families begin to accept the ideas that addiction is their own fault and that maybe they are too weak to do anything about it. In many ways, hiding an addiction problem is the rational thing to do because seeking help can mean losing a job and medical insurance, or even losing your child when a social service agency declares you an unfit parent because you have an alcohol or drug problem.

The stress of hiding often causes other medical and social problems for the individuals and their families. This is especially true when an adolescent has an alcohol or drug problem. Fear often prompts kids to conceal the problem from parents. Then, when parents find out, stigma makes them feel guilty and somehow negligent. Illness and family dysfunction explode. When that happens, parents find it even harder to fight for the care and resources their child urgently needs from a social and medical system that blames the family and the child.

By David L. Rosenbloom

Doctor Shopping Making Drug Addiction Easy?

Doctor shopping is a way for many who are addicted to prescription medication to obtain their drugs.  The act of doctor shopping is seeing a number of different doctors to get prescriptions for drugs.  Over recent years there have been a number of  celebrities who have overdosed and died from prescription drug abuse.  Michael Jackson, Anna Nicole Smith, Health Leger and most recently Corey Haim to name a few.  In an attempt to stop doctor shopping thirty four states throughout the country have programs to monitor the prescriptions that a person obtains.

Doctors should not be blamed for an individuals struggles with drug addiction.  However there are doctors who are guilty of being starstruck and not telling celebrities “no” when it comes to giving out prescriptions.  How could Michael Jackson’s personal doctor not have known his client suffered from addiction? Corey Haim had struggled with drug addiction for years and a pharmacist doesn’t recognize him when he comes to get his prescription filled? This raises the question that if it is this easy for celebrities to get drugs from pharmacies how easy is it for an individual who isn’t easily recognized.

Prescription drug abuse is a growing epidemic in this country.  Of course these drugs can be obtained on the streets, over the internet or even stolen from warehouses.  However when someone like Corey Haim is able to obtain prescription drugs from seven different doctors it makes me think that a more secure “checks and balance” system needs to be put into action.  Prescription drugs are just as dangerous and addictive as illegal street drugs and more action needs to be taken to control people abusing them.  I feel that the fight against prescription substance abuse should start with the doctors who prescribe them and the pharmacist who fill the prescription.

For help with drug and alcohol addiction contact www.sunrisedetox.com .

Source: Recovery Connection

Opiate Withdrawal & Treatment

Opiates are a class of drug that is derived from the opium poppy, most commonly heroin and many narcotic pain medications which are some of the most addictive and harmful of drugs. There are also synthetic opiates that don’t come from the poppy plant, but which have a similar effect. Many prescription drugs are opiates, including Oxycontin, Percocet, Lorcet, Vicodin, Dilaudid and MSContin. People who abuse heroin or pain medications gradually develop a habit, having to take a certain amount of the drug every day in order to avoid withdrawal symptoms. This habit will intensify over time as more drugs will be needed to maintain the same effect. Some of the opiate withdrawal smptoms include:

  • Muscle aches
  • Vomiting
  • Chills
  • Diarrhea
  • Insomnia
  • Anxiety
  • Runny nose
  • Headache
  • Stomach cramps
  • Twitching, and/or muscle spasms
  • Nausea
  • The length of time these opiate detox symptoms persist also varies. A small habit may result in a short opiate withdrawal period of 3 or 4 days and only produce a few withdrawal symptoms. Larger habits may cause detox symptoms that last for weeks. The typical opiate withdrawal period is around 7 days, with the most intense symptoms peaking about 72 hours after last use. Because of the length of the physical and psychological withdrawal process, it is extremely difficult for people to get through it without the help of a detox center like Sunrise Detox. Most people will break down after 2 or 3 days and return to using the opiates, and feeding their opiate addiction.

    Some detox centers do not medicate their patients during withdrawal. This unpleasant method is known as “cold turkey” and here at Sunrise Detox, we don’t believe in it. Opiate withdrawal symptoms can produce potentially dangerous health situations including elevation in blood pressure and dehydration. Left untreated, the pain of the withdrawal symptoms can make it psychologically difficult to stay in the detoxification facility and makes the client more likely to leave detox prematurely.

    Mom Hits Bottom After Years of Drinking

    Lynn Wardlow says concern for her health and family helped convince her to quit.

    At the end of a country road, inside the walls of a quaint and calm Hattiesburg, Miss., home, a family was in crisis.

    Lynn Wardlow, a 50-year-old wife and mother of three, had been a drinker for more than 20 years. All the while, though, she ran a family business and raised her children.

    In January, “20/20? visited Wardlow. It was the day before she’d planned to give up alcohol for good.

    “My hands are shaking,” said Wardlow as she packed her bags. “God, I hope I remembered to bring underwear.”

    Watch the full story Friday on “20/20? at 10 p.m. ET

    Click HERE for further “20/20? coverage of mothers and alcoholism.

    In the morning, Wardlow would travel from the Gulf Coast to Palm Beach, Fla., check herself into a medical facility for detox and then enter a 30-day rehab program for her alcohol addiction.

    Meanwhile, Wardlow planned one last hurrah. She took a bottle from a cabinet in her bedroom.

    “Would this be my best choice for my last bottle of wine?” she asked.

    The last year in the Wardlow home had been particularly difficult, especially for the children — Bo, 21; Jessy, 20; and Marina, 17.

    “She’s been drinking every night for as far back as I don’t even know,” said Bo. “The last year there’s been a lot of drama, and it’d be nice if things were just normal for even just a little while.”

    Wardlow poured herself some wine. “My kids want me to just stop, stop, stop, but I like, I don’t think I can just stop,” she said.

    “And if I did, I don’t know if I would feel very good, or if we might have to go to the hospital, because I just stopped after I’ve been going, go, go, go for so long.”

    Wardlow’s children have witnessed things no child should ever see: their mother passed out in her closet, in a drunken rage at a bookstore, in a car attempting to drive after an alcohol-infused fight.

    “It’s hard to see someone you love have to be addicted to something in order to feel better,” said Marina.

    “It makes you feel like you’ve done something wrong,” said Jessy.

    Drunken Moms: ‘When She Gets Like That’

    The kids say their mother’s drinking had reached a critical point. Last April, Wardlow was diagnosed with hepatitis C, unrelated to her alcoholism. Unless she quit drinking, she could die.

    But even the threat of losing her life, the family said, hadn’t stopped Wardlow from consuming alcohol.

    “I want my mom to get better and not just for our sake but for her sake for her health,” said Jessy.

    Wardlow’s last night at home was tense. The alcohol fueled her anxiety of what was to come.

    “I think after two drinks, I’m like, you know what, these people aggravate me,” said Wardlow, who ran the family’s ceiling construction business. “And they aggravate me during the course of the day, and at the end of the day, I have a couple of drinks.”

    The kids knew better than to stick around once Lynn started drinking. Wardlow’s husband, Bob, soon became a target.

    “If you want to spend more time with Bill O’Reilly and your computer then go ahead,” Wardlow cracked.

    “When she gets like that, conversations can turn to arguments,” said Bob.

    “Or being an a**hole can turn to arguments,” said Wardlow. “Maybe I’m just able to say, you know what, [I've] had it up to here!”

    The next morning, her head a little clearer, Wardlow acknowledged that rehab may be her last chance.

    “I’ve affected my children. … Our relationships would be different if alcohol wasn’t a part of my life,” she said.

    But just before she walked out the door, the leftover wine from the night before called to her.

    “I’m not going to drink that,” Wardlow said, wavering before she gave in and took a sip.

    Wardlow’s family walked her down the steps. She gave them kisses. She grew emotional.

    “I’m not the only person who needs to be healed,” said Wardlow. “I’m not the only person who has been affected by this.

    “It’s gonna be good,” she assured her famliy. “I’m going to get better.”

    Two planes, three bloody mary’s and two beers later, Wardlow landed in Florida.

    She was greeted by Loren Seaman from the Orchid Recovery Center, where Wardlow would surrender herself for treatment.

    “Did you drink?” Seaman asked.

    “Well, hell yeah,” Wardlow said.

    Wardlow and Seaman had been talking for weeks on the phone to prepare for her arrival.

    But before her bags had even make it downstairs, a shoeless Wardlow headed off for one more drink.

    “We’re going to make a new martini,” Wardlow said. “It’s called the Lynn’s-quitting-drinking-and-going-to-rehab martini. Ready?

    Drunken Moms: Tough Recovery Odds

    Finally, it was time for Seaman to sign Wardlow into the center.

    “Have you ever been to detox?” Seaman asked. The answer was no.

    “It’s OK, I’m good,” said Wardlow, laughing. “I’m drunk, so right now I ain’t scared. Give me a day or two, and I’m probably going to be frightened out of my wits.”

    Over a million people submit to detox and rehab programs for alcohol addiction every year in this country. The odds going into rehab were against Wardlow. Studies show that 90 percent of people in recovery relapse.

    Wardlow had a session with Linda Burns, head of nursing at Sunrise Detox.

    “How much are you drinking a day, about?” Linda asked.

    “Four, five, six …” replied Wardlow.

    According to the National Institute on Alcohol Abuse, one third of alcoholics in the United States are women.

    Staff at both the Orchid and Sunrise Detox Center told “20/20? that about 95 percent of the women they pick up at the airport are intoxicated upon arrival. Wardlow was no exception.

    A Sunrise Detox tech measured Wardlow’s blood alcohol content upon admission.

    “You’re not too bad — .106,” the tech said.

    “What does that mean?” said Wardlow. “Would I be arrested?”

    “Oh, definitely, yeah.”

    “I would be arrested.”

    “Yeah.”

    “Point-zero-8 is the limit, and I’m at point 1-plus over. I’m over the limit to drive a vehicle.”

    “Yes, you would be wearing nice bracelets.”

    For the next five days — standard for alcohol addiction — Wardlow remained at Sunrise. She was medicated with a drug called librium to eliminate the side effects of withdrawal, which can range from tremors and insomnia to delirium or even seizures.

    From day one, Wardlow was restless.

    “If you reached in your pocket right now and pulled out a beer, it would be really hard for me not to drink it,” she told “20/20.” “Quite honestly, it would.”

    By day four, her impatience and boredom reached all-time highs.

    “I have not had a good morning,” she said, talking to a portable camera “20/20? gave her to document her journey. “I have cried on more than one occasion today. I have come to the realization that this is the closest thing to a jail that I have ever been in.”

    But it was only the beginning of a long and difficult journey.

    The next step for Wardlow was the Orchid Recovery Center, a drug and alcohol rehabilitation center designed specifically to treat women.

    “We’re just glad you’re here, Lynn,” said an Orchid staff member who welcomed her.

    “Thank you,” said Wardlow. “I’m glad I’m here too.”

    Drunken Moms: From Detox to Rehab

    Normally, TV cameras are not permitted to see inside the walls of a rehab facility. But with Wardlow’s permission, the Orchid Recovery Center allowed “20/20? unprecedented access to their treatment process.

    “You don’t know Lynn clean and sober,” Mindy Appel, Wardlow’s therapist at the Orchid, told her. “You don’t know that woman.”

    Unlike at detox, Wardlow’s days at rehab would be packed, from six in the morning until nine at night. She would have individual and group therapy sessions mixed with yoga, meditation, accupuncture and art.

    An all-female facility, the Orchid is run almost exclusively by women, many of whom have been through some type of addiction recovery of their own.

    The Orchid places enormous weight on the honing of life skills, encouraging women to shop and cook for themselves — all of the things they’ll have to do back home. But sometimes, even a simple trip to the grocery store can spell trouble. Once a woman from the center drank vanilla extract from the store. It’s 24 percent alcohol. The woman drank five or six big bottles, staff said — and came back reeking of alcohol and walking funny.

    For recovering alcoholics, triggers to resume drinking can be anything from beer commercials on TV to the wine store they used to frequent — anything that reminds them of drinking, said Orchid staff.

    Wardlow’s heavy lifting for the next 30 days would happen inside the office of Appel, her therapist.

    “We want to stay really focused, and I’m going to keep you on task here,” Appel told her.

    During her first session, Wardlow confessed her reasons for drinking went back to her relationship with her father.

    “So what was growing up like for you?” asked Appel.

    “I had times of sadness,” said Wardlow. “My father was an alcoholic… When I was 15 he decided it was time to go … so he died.”

    Genetics may also have had a role in Wardlow’s addiction. Studies show that children of alcoholics are four times more likely to develop the problem.

    A week into her treatment, “20/20? co-anchor Elizabeth Vargas paid a visit to Wardlow at Orchid. She appeared more calm and focused but still struggled with her addiction.

    Vargas asked her if it was hard.

    “It’s really hard,” she said. “It is hard and it’s, and it’s hurtful, and you realize how many people that you’ve hurt. And my children are amazing. I mean, I look at them, and I know I’ve not been a bad mother. I’m like, I know I’m a good mother. I’ve mothered them well — but how much better could it have been if these past 10 years, I hadn’t been living in the bottom, in the bottom of a bottle?”

    Wardlow described the cycle of her drinking.

    “I wake up the next morning, you feel horrible, and you say, ‘I’m gonna do better. I’m gonna do better. I’m gonna do better. So, but I don’t feel very good today. So this afternoon, I’m just gonna have a beer.’” Which turns into “three or four or five or six.”

    Are Mothers Drinking More?

    The team of therapists at the Orchid said regrets and expectations about being the perfect mother are often what push a woman deeper into her addiction.

    “There’s so many women that are so sophisticated at covering up and being, you know, the PTA mom and being the soccer mom and doing all things for everyone,” said Appel.

    But are women, particularly mothers, drinking more — or are we just finding out about it more?

    “I think we’re finding out about it more,” said Mindy Agler, another therapist on the Orchid team. “[It's] just not something you talk about. … If a man walks away from a family because he needs to focus on his recovery, everybody says OK, so he needs to do that. But if a woman leaves her family to go get treatment and then decides ‘You know what, I’m not ready, I got to go to a halfway house before I go back to my kids,’ everybody goes, ‘Oh my God.’”

    That double standard and the stigma of alcoholism can keep a woman’s disease under wraps. But past traumas, the therapists say, can also play a role.

    In her short time at the Orchid, Wardlow opened up about not only her alcoholic father but other traumatic experiences: an abortion at 17, and a horrific gang-rape on her 18th birthday.

    “She identifies, from 15 to 18, these were horrible years for her,” said Appel. “That she’s never, never dealt with.”

    The entire time, a question hung in the background: Would Wardlow make it through treatment, and would she be able to stay away from alcohol once she was back home?

    “I’ll be honest with you, I’m scared as hell,” she said. “I’m scared, I’m scared to go home.

    Wardlow left the Orchid with 30 days clean and a lifetime of hurdles in front of her. We visited Wardlow in Hattiesburg after her release. She was ready to add another day to her sobriety.

    “This is my little tablet,” she said, indicating a pad of paper. “And I wad up yesterday and I write today down, put my little tablet back up there, and if I drink, I have to put that tablet on zero — and I don’t want to have to do that.”

    The time back home had not always been easy.

    “We had to relearn how to live with one another,” said Wardlow. “The first week or two was pretty volatile. Not in a physical way, but there was lots of screaming and gnashing of teeth.”

    But there are signs of healing.

    “We’re all really proud of her,” said Marina. “I know if she sets her mind to anything, that’s what she’s going to do. I’m just glad that she finally set her mind to it.”

    “I think she’s trying to be more aware, and I think she’s trying to make up for, in some aspects, everything that’s happened and stuff,” said Jessy. “But I think she’s working on it. … I think she’ll do it. I believe in her.”

    Wardlow had followed her care plan closely. She had daily phone calls with her sponsor and attended support group meetings regularly.

    To stay with the recovery program, Wardlow can never consume a drop of alcohol — or take any habit-forming medication — again.

    “No mood-altering drugs, as far as any type of benzos or opiates or whatever,” she said. “I was on tremizal for joint pain. Also I was taking lunesta to sleep, and I’m not taking that any more either.”

    Wardlow left one support meeting with a chip marking how long it had been since she’d stopped drinking.

    “Ninety days! 90 Days,” she said. “Big three months. Three months sober.”

    By SEAN DOOLEY and SHANA DRUCKERMAN

    Methadone Addiction and Detox

    Methadone is a narcotic pain reliever, similar to morphine. It is often used as both a pain reliever or as a drug replacement for heroin or other opiate abuse. Taking methadone improperly will increase your risk of serious side effects or death. Like other narcotic medicines, methadone can slow your breathing, even long after the pain-relieving effects of the medication wear off. Death may occur if breathing becomes too weak.

    Quitting Methadone
    Once a person has begun a methadone program, it can be extremely difficult to stop since methadone is an addictive substance. While a typical opiate withdrawal can last about a week, methadone withdrawal can linger for months. Participants will tell you that detox from methadone can be brutal.

    A Sunrise Detox we offer methadone program participants an opportunity to get off the drugs completely, in a safe and comfortable manner. If you are currently on methadone, Sunrise Detox can get you through the detox process in a fraction of the time, and with drastically fewer withdrawal symptoms. The detoxification protocol we use is based on the amount of methadone being taken. We realize that people who have taken large daily doses and who have been on methadone for long periods of time require heavier medication to keep them comfortable during detox. Because we use a buprenorphine detox protocol, the methadone leaves the body faster, and lengthy withdrawal symptoms can be avoided.

    Methadone Addiction and Detox

    Methadone is a narcotic pain reliever, similar to morphine.  It is often used as both a pain reliever or as a drug replacement for heroin or other opiate abuse.  Taking methadone improperly will increase your risk of serious side effects or death.  Like other narcotic medicines, methadone can slow your breathing, even long after the pain-relieving effects of the medication wear off.  Death may occur if breathing becomes too weak.

    Quitting Methadone
    Once a person has begun a methadone program, it can be extremely difficult to stop since methadone is an addictive substance.  While a typical opiate withdrawal can last about a week, methadone withdrawal can linger for months.  Participants will tell you that detox from methadone can be brutal.

    Sunrise Detox offers methadone program participants an opportunity to get off the drugs completely, in a safe and comfortable manner. If you are currently on methadone, Sunrise Detox can get you through the detox process in a fraction of the time, and with drastically fewer withdrawal symptoms. The detoxification protocol we use is based on the amount of methadone being taken. We realize that people who have taken large daily doses and who have been on methadone for long periods of time require heavier medication to keep them comfortable during detox. Because we use a buprenorphine detox protocol, the methadone leaves the body faster, and lengthy withdrawal symptoms can be avoided.

    Opiate Detox and Withdrawal

    Opiates are a class of drug that is derived from the opium poppy, most commonly heroin and many narcotic pain medications which are some of the most addictive and harmful of drugs. There are also synthetic opiates that don’t come from the poppy plant, but which have a similar effect. Many prescription drugs are opiates, including Oxycontin, Percocet, Lorcet, Vicodin, Dilaudid and MSContin. People who abuse heroin or pain medications gradually develop a habit, having to take a certain amount of the drug every day in order to avoid withdrawal symptoms. This habit will intensify over time as more drugs will be needed to maintain the same effect. Most will need to enter an inpatient detox facility

  • Muscle aches
  • Vomiting
  • Chills
  • Diarrhea
  • Insomnia
  • Anxiety
  • Runny nose
  • Headache
  • Stomach cramps
  • Twitching, and/or muscle spasms
  • Nausea
  • The length of time these symptoms persist also varies. A small habit may result in a short withdrawal period of 3 or 4 days and only produce a few symptoms. Larger habits may cause symptoms that last for weeks. The typical opiate withdrawal period is around 7 days, with the most intense symptoms peaking about 72 hours after last use. Because of the length of the physical and psychological withdrawal process, it is extremely difficult for people to get through it without the help of a detox center. Most people will break down after 2 or 3 days and return to using drugs.

    Methadone is a narcotic pain reliever, similar to morphine. It is often used as both a pain reliever or as a drug replacement for heroin or other opiate abuse. Taking methadone improperly will increase your risk of serious side effects or death. Like other narcotic medicines, methadone can slow your breathing, even long after the pain-relieving effects of the medication wear off. Death may occur if breathing becomes too weak.

    Quitting Methadone
    Once a person has begun a methadone program, it can be extremely difficult to stop since methadone is an addictive substance. While a typical opiate withdrawal can last about a week, methadone withdrawal can linger for months. Participants will tell you that detox from methadone can be brutal.

    Drug and Alcohol Relapse Prevention

    Drug Residues Remain in Fatty Tissues

    Drugs are broken down in the liver into substances called metabolites. Although removed rapidly from the blood stream, metabolites can become trapped in the fatty tissues. The one thing in common—and the problem that needs to be addressed—is that these drug residues remain trapped for years.

    Tissues in our bodies that are high in fats are turned over very slowly. When they are turned over, the stored drug metabolites are released into the blood stream and reactivate the same brain centers as if the person actually took the drug. The former addict now experiences restimulation of a drug episode (or “flashback”) and subsequent drug craving. This is common in the months after an addict quits and can continue to occur for years, even decades.


    Drug and Alcohol Relapse Prevention

    The Cycle of Quitting, Withdrawal, Craving And Relapse

    When the addict initially tries to quit, cells in the brain that have become used to large amounts of these metabolites are now forced to deal with much decreased amounts. Even as the withdrawal symptoms subside, the brain “demands” that the addict give it more of the drug. This is called drug craving.

    Craving is an extremely powerful urge and can cause a person to create all kinds of “reasons” they should begin using drugs again. He is now trapped in an endless cycle of trying to quit, craving, relapse and fear of withdrawal.

    Eventually, the brain cells will again become used to having lowered drug metabolites. But, because deposits of drug metabolites release back into the bloodstream from fatty tissues for years, craving and relapse remain a cause for concern.

    Left unhandled, the presence of metabolites even in microscopic amounts cause the brain to react as if the addict had again actually taken the drug and can set up craving and relapse even after years of sobriety.

    Source: Narconan

    Prescription Opiate Use Spreading Among Addicts

    Usually reserved for terminally ill patients, drugs like OxyContin are becoming more increasingly popular among drug addicts. OxyContin, a strong and long lasting narcotic painkiller that is similar to morphine, has become the latest addition to the pharmacopoeia of illicit drugs for sale on the black market.

    It may seem that with all the federal regulations barring anyone less than terminally ill to be prescribed the drug that this wouldn’t happen. Although, as drug pushers find new ways to get the drug, either through using terminally ill patients to “farm” the drug from numerous doctors or through more direct means such as breaking into pharmacies or intercepting shipments of the drug, it is becoming increasingly available.

    According to a recent New York Times article by Francis X. Clines and Barry Meier, in one area of Kentucky 85 to 90 percent of the police field work is now related to OxyContin. The article also states that the drug is a morphine-like substance also found in drugs like Tylox and Percodan, although in those drugs the active ingredient, oxycodone, is concentrated in as little as 5 milligrams, in OxyContin it is as high as 160 milligrams.

    This increases the danger of lethal overdose in inexperienced users and in Kentucky the death toll has numbered 59 since last January, according to a quote from the US attorney from the eastern district of that state in the New York Times.

    The National Drug Intelligence Center has issued a recent bulletin in which it is stated that the drug’s spread on the illicit market is concentrated primarily in the Eastern States but is surfacing as far west as California.

    Source: Narconan

    The Delicate Balance Of Pain and Addiction

    Over the past two decades, conflicting medical ideas have surfaced about narcotic painkillers, the drugs that Rush Limbaugh blames for his addiction while being treated for chronic back pain. And both of them, not surprisingly, have centered on the bottom-line question: just how great a risk of abuse and addiction do narcotics pose to pain patients?

    Throughout much of the last century, doctors believed that large numbers of patients who used these drugs would become addicted to them. That incorrect view meant that cancer sufferers and other patients with serious pain were denied drugs that could have brought them relief.

    But over the past decade, a very different viewpoint has emerged, one championed by doctors specializing in pain treatment and drug companies eager to broaden the market for such drugs. It held that these medications posed scant risk to pain patients, and some experts now believe that it also had unfortunate consequences because it caused, among other things, physicians to develop a false sense of security about these drugs.

    ”The pendulum went in two opposite directions,” said Dr. Bradley S. Galer, group vice president for scientific affairs at Endo Pharmaceuticals, which manufactures two widely used narcotics, Percodan and Percocet. ”Luckily, now the pendulum is focusing where it should be, right in the middle.”

    The reassessment of narcotic risk comes at a time of skyrocketing rates of misuse and abuse of such drugs. Medical experts agree that most pain patients can successfully use narcotics without consequences. But the same experts also say that much remains unknown about the number or types of chronic pain sufferers who will become addicted as a result of medical care, or ”iatrogenically” addicted. The biggest risk appears to be to patients who have abused drugs or to those who have an underlying, undiagnosed vulnerability to abuse substances, a condition that may affect an estimated 3 to 14 percent of the population.

    Dr. James Zacny, an associate professor at the University of Chicago and a leading narcotics researcher, said there was a dearth of data about the long-term risks that narcotics pose. ”We don’t know a lot about the rate of iatrogenic addiction,” he said.

    It is not unusual for views about particular drugs and their hazards to change over time. But a look at the shift in medical thinking about the risk of addiction shows a struggle that was waged both as a guerrilla war among doctors and a high-powered drug industry initiative. It was also an effort that, while seeking a laudable goal, inaccurately portrayed science.

    Modern views about the threat posed to patients by narcotics were shaped in the mid-1980′s when pain treatment experts reported that cancer patients treated with such drugs did not exhibit the type of euphoria displayed by people who abused narcotics. That led some physicians to argue that strong, long-acting narcotics could also be used safely to treat patients with serious pain unrelated to cancer, like persistent back pain or nerve disorders.

    One leader of this initiative, known as the ”pain management movement,” was Dr. Russell Portenoy, who is now chairman of the pain medicine and palliative care department at Beth Israel Medical Center in New York. And soon Dr. Portenoy and others were pointing to studies that they said backed up their contention that the risk of powerful narcotics to pain patients was scant.

    ”There is a growing literature showing that these drugs can be used for a long time, with few side effects and that addiction and abuse are not a problem,” Dr. Portenoy said in a 1993 interview with The New York Times.

    Drug companies amplified that theme in materials sent to doctors and pharmacists. For example, Janssen Pharmaceutica, the producer of Duragesic, called the risk of addiction ”relatively rare” in a package insert with the drug. Endo termed the risk ”very rare” in presentations to hospital pharmacists. Purdue Pharma, the manufacturer of the powerful narcotic OxyContin, distributed a brochure to chronic pain patients called ”From One Pain Patient to Another,” contending that it and similar drugs posed minimal risks.

    ”Some patients may be afraid of taking opioids because they are perceived as too strong or addictive,” the brochure stated. ”But that is far from actual fact. Less than 1 percent of patients taking opioids actually become addicted.”

    The trouble, however, was that studies that looked at the experience of pain patients who used long-acting narcotics for extended periods of time did not exist. So narcotics advocates like Dr. Portenoy and drug companies like Purdue Pharma had looked elsewhere, at surveys of patients whose use of narcotics was limited. And those reports were not always put into proper context.

    A frequently cited survey of narcotics use, taken in 1980, found ”only four cases of addiction among 11,882 hospitalized patients.” A director of that survey, Dr. Hershel Jick, an associate professor of medicine at Boston University, said his study did not follow patients after they left the hospital and did not address the risk of narcotics when they were prescribed in outpatient settings.

    In another case, advocates of increased narcotics use also misstated a study’s results. It involved a study of chronic headache sufferers conducted at the Diamond Headache Clinic in Chicago that some pain care specialists repeatedly claimed had found only ”three problem cases” among some 2,000 patients.

    While the Diamond Headache Clinic did treat 2,369 patients in the study period, just 62 were studied because they met the criteria of having used painkillers alone or in combination with barbiturates for six months before entering the clinic. And the report’s findings were far different from the way they were characterized by narcotics advocates. It concluded, ”There is a danger of dependency and abuse in patients with chronic headaches.”

    Dr. Seymour Diamond, the clinic’s director, said in a recent interview that neither pain experts nor narcotics manufacturers like Purdue Pharma who cited his study contacted him to discuss how they planned to use it. And he added that he believed that it was mischaracterized.

    ”It distorts the picture and it clearly underplays the risks,” Dr. Diamond said.

    In a recent interview, Dr. Portenoy said he now had misgivings about how he and other pain specialist used the research. He said that he had not intended to mischaracterize it or to mislead fellow doctors, but that he had tried to counter claims that overplayed the risk of addiction. Still, he and others acknowledge, the campaign by pain specialists and drug companies has had consequences.

    ”In our zeal to improve access to opioids and relieve patient suffering, pain specialists have understated the problem, drawing faulty conclusions from very limited data,” Dr. Steven D. Passik, a pain management expert wrote in a 2001 letter published in The Journal of Pain and Symptom Management. ”In effect, we have told primary care doctors and other prescribers that the risk was so low they essentially could ignore the possibility of addiction.”

    Today, some narcotics manufacturers like Endo have changed or are changing the way they present abuse and addiction information. For example, Purdue Pharma, while maintaining the accuracy of its past position, now states in patient information that it does ”not know how often patients with continuing (chronic) pain become addicted to narcotics but the risk has been reported to be small.” Ligand Pharmaceuticals, which manufactures a time-released form of morphine under the brand name Avinza, makes a similar statement.

    For its part, a spokeswoman for the federal Food and Drug Administration, Kathleen K. Quinn, said the agency believed that ”the risk of addiction to chronic pain patients treated with narcotic analgesics has not been well studied and is not well characterized.”

    In a letter to The New York Times, Purdue stated that it had found no cases of iatrogenic addiction in a recently completed long-term study of chronic pain patients suffering from osteoarthritis, diabetes and low pain back. Purdue did not identify where it planned to submit the study for publication although the company said it involved an older group of patients whose average age was 55.

    Such results are encouraging. But several pain experts said that the full risks of narcotics will not be fully known until these drugs are tested in a wide range of pain patients of different ages and conditions.

    ”You may have a study telling how uncommon these problems are in patients over 50,” Dr. Portenoy said. ”But what does that tell you about the risks to younger patients or those patients who walk into a doctor’s office with a history of substance abuse or psychological problems.”

    By Barry Meier from The New York Times