More than 20 years ago Patrick Gallagher began his long, troubled acquaintance with “a guy called pain,” as he wryly puts it.
In the late ’80s, Gallagher, now 68 and living in southeast Florida, had surgery for his lower-back pain. But as the 1990s wore on, he also developed excruciating upper-back and neck pain, exacerbated by worsening compression of the spinal column. This time he opted for conservative treatment, including lots of physical therapy.
By his late 50s, though, disability had forced him to quit work as a publishing executive—the traveling was too difficult—and then to abandon a beloved job in academia. He began drinking more than usual. Finally he sought the help of a back pain specialist on Florida’s west coast, who doubled his dose of a powerful opioid painkiller called OxyContin. And boy, did he get relief. “Sipping my rum punch as the moon rose over the gulf, I felt like I’d died and gone to heaven,” Gallagher recalls.
But the pills and booze began to cause serious worry for his loved ones. In 2005 they confronted him. His 13-year-old granddaughter, the apple of his eye, let him know just how much it troubled her when he would fall asleep at family get-togethers. Gallagher took the family’s intervention to heart, and he went into treatment tailored to older patients at the Hanley Center in West Palm Beach, where he would learn a whole new way of managing his pain—and his addictions.
Gallagher’s experience represents the latest twist on a very old problem: Prescription medications are now playing a major role in drug abuse and addiction. Today, narcotic pain relievers, such as Vycodin, Darvan and Demerol, are second only to marijuana as the country’s most abused drug, according to a survey by the federal Substance Abuse and Mental Health Services Administration (SAMHSA). Tranquilizers are number four on the list. And an even more disturbing statistic: Fatal poisonings from street and prescription drugs rose 68 percent from 1999 to 2004, with the increase overwhelmingly due to prescription pain medicines.
The latest stats show the drugs are responsible for more accidental deaths than cocaine and heroin combined, a “dramatic” shift in the pattern of risk, according to Leonard J. Paulozzi, M.D., who analyzes these trends for the U.S. Centers for Disease Control and Prevention. The number of fatal overdoses seems to peak in middle age, among people 35 to 55 years old. A CDC study looking at people who died of a pharmaceutical overdose in West Virginia during 2006 found that most had consumed a highly potent cocktail of opioid analgesics mixed with tranquilizers, alcohol or illicit drugs.
Substance abuse problems in general continue to be least common among adults past middle age, but there’s some evidence that prescription drugs are playing a larger role in that age group, too. SAMHSA reports that from 1995 to 2005, among people 65 and older admitted for drug treatment, the percentage whose main problem was alcohol dipped from 84.7 percent to 75.9 percent, while the group primarily abusing an opiate grew from 6.6 percent to 10.6 percent.
The simplest explanation for this trend is that many more people are being exposed to the drugs. For example, per capita retail purchases in the United States of oxycodone—the active ingredient in the opioid Gallagher took—multiplied ninefold in the decade up to 2007, according to the CDC study on overdosing. Aggressive marketing played a role in the increase, but at least as important was the determination to offer more humane treatment for chronic pain, including, if necessary, narcotic medication.