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Prescription Drug Abuse: Who Gets Addicted and Why?

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WebMD Feature

No one decides to get addicted to prescription pain pills. Alienating family and friends, failing at work, and launching a small-time criminal career aren't what anyone plans on when they swallow their first Vicodin.

One in five Americans report misusing a prescription drug at least once in their lifetime, but the overwhelming majority put the pills away with no lasting harm. So how does prescription painkiller abuse progress to full-blown opioid addiction?

"It's clear that some people have a genetic predisposition to addiction," says Andrew Saxon, MD, professor of psychiatry and director of the addiction psychiatry residency program at the University of Washington. "There's something different in their brains to begin with," and prolonged drug abuse likely creates further chemical changes, Saxon tells WebMD.

For people with an inborn vulnerability to opioid addiction, taking pain pills can lead to an intoxicating rush that makes the brain want more. Repeating the high reinforces the cycle, and sets the stage for drug addiction.

Why Pain Pill Addiction Is on the Rise

Experts don't know exactly how many people are addicted to prescription drugs today, but all agree it's on the rise. "It's partly an issue of availability," says Robert Jamison, PhD, associate professor of psychiatry at Harvard Medical School. "Vastly more people have access to these medicines today than 15 or 20 years ago."

Responding to patients and pain advocacy groups, doctors may have become less restrictive in prescribing opioid pain pills. There has been a surge in prescriptions for opioids over the past decade -- and the creation of millions of potential drug stashes in medicine cabinets across the country.

Teen drug abuse with opioids is now second only to marijuana in popularity. Almost one in 10 high school seniors report taking hydrocodone (Vicodin) within the past year. Not by coincidence, many of their parents are taking it too: Vicodin and its generic form were the most-prescribed drug of any kind for much of this decade.

"Everyone agrees, better pain control for people who need it is a good thing," says Saxon. "But today, people are being exposed to these drugs who never would have been in the past. For those with the predisposition, it sets them up for addiction."

To begin to understand why, you need to look deep inside the brain.

Sex, Drugs, and the Opioid-Addicted Brain

Opioids, like all commonly abused drugs, stimulate the areas of the brain that perceive pleasure. This results in the initial euphoria or sense of well being that many opiates produce. But these areas do more than just make us happy, according to Petros Levounis, director of the Addiction Center of New York and an associate professor of psychiatry at Columbia University. "Activity here tells us what's important in the world," he says.

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