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How Big Is the Opioid Abuse Problem?

Prescription narcotic abuse is a serious issue, says Jim Zacny, PhD, a professor in the department of anesthesia and critical care at the University of Chicago. He points to the 2007 National Survey on Drug Use and Health. It found that as many as 5.2 million people reported using prescription opioids in the last month for non-medical reasons. That's more than double the number of people who used cocaine.

But many of the people illicitly using these drugs are not in pain. So the important question is this: how high is the risk of abuse for someone living with serious back pain?

There's some good news: the risks of actual addiction may be lower than assumed. "Among people with legitimate pain issues, it's a very small group who actually develop the disease of addiction," says Webster.

Zacny agrees. "There's this myth out there that if you take an opiate, you automatically become enslaved to it," he says. "That's not the truth at all."

However, addiction isn't the only issue. Webster observes that a much larger number of these people -- perhaps 20%-30% -- do wind up misusing or abusing the drug.

Opioid Addiction vs. Abuse

What's the distinction between drug addiction and drug abuse? Many people with real back pain aren't addicted, but they may begin to use their medication incorrectly. They might take too much, simply because the prescribed dose doesn't seem to be helping enough. Or they might use their medication to cope in other ways.

"People with pain sometimes take pain medicine inappropriately to feel a little high or improve their mood," says Karen Miotto, MD, an addiction psychiatrist at the UCLA Neuropsychiatric Institute. "They might take one after a fight with a spouse or a hard day at work." Some people with chronic pain also have issues like anxiety and depression. They might start leaning on their pain medication to help them with these conditions too.

While we tend to focus on addiction, misuse and abuse can also be dangerous. Opioids are powerful drugs with real risks.

"In the last three to five years, we've seen a significant increase in the number of unintentional overdose deaths caused by prescription painkillers," Webster tells WebMD. "At least half of them are in people who have legitimate pain problems with legitimate prescriptions." Taking these drugs in ways your doctor didn't intend simply isn't safe.

"Our culture encourages the attitude that if one pill is good, two is better," Webster says. "With opioids, that can be lethal."

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