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"I felt like I was a slave to these pills, but I had to take them to keep my body going." Lisa M., a 42-year-old mother of two girls from a suburban town in Washington, speaks softly, as if still trying to comprehend the events that so catastrophically derailed her life. Lisa had been healthy, active, and outgoing, with a great husband and a beautiful house -- the kind of woman you'd hear about and feel a twinge of envy. But seemingly overnight, all of that changed.
In June 2005, Lisa, a petite, super-fit gym regular and fitness instructor, went to the doctor after holding in a sneeze and then feeling an immediate, crushing pain in her chest. "She told me I had a cracked sternum -- a freak injury," Lisa says. Her doctor prescribed rest and a generous supply of the painkiller Vicodin. Lisa had taken the medication before for dental work and after giving birth, and she'd never had any side effects.
And really, there didn't appear to be any negative side effects this time either. In fact, just the opposite. Not only did the pain disappear minutes after she swallowed the pills, but she felt relaxed and energetic, like she wanted to take more. So she did. "They made me feel like Superwoman," she recalls. "I had no pain, and tons of energy."
Lisa finished the first bottle of pills in a month, then went back to her doctor, who refilled the prescription when she said she was still sore. She finished the next bottle even faster and got another, each time telling her doctor -- who she says never challenged her requests -- that her injury continued to hurt. Did it? That was hard to say: Lisa was never off the medication long enough to find out. "I convinced myself that I needed Vicodin for the pain, but I'd really stopped thinking about whether my sternum had healed," she admits. "All I knew was that the pills made me euphoric, and if they came from my doctor's office, how bad could they be?"
Eleven months after her injury, her physician switched practices, leaving Lisa without a lifeline for refills. She started buying pills from Internet pharmacies, where she could get the drugs without showing the requisite MD's prescription.
The strange thing was, the high she got from the meds was wearing off faster. So she popped more pills; soon, she was taking 150 milligrams a day, three times the maximum prescribed amount, just to fend off withdrawal. A year after the initial injury, Lisa's days were dominated by her obsession with staying high -- and hiding it from her family. "I was so stressed," she says. "I didn't know what to do. The only way I felt I could handle the situation was to take more drugs."
Over the past 15 years, prescriptions for pain medications have risen dramatically in the United States. Sales for five of the biggest labels, including OxyContin and Vicodin, increased approximately 90 percent at pharmacies across the country between 1997 and 2005, according to the DEA. OxyContin use alone went up a whopping 600 percent. The increase, some researchers believe, is due in part to new versions of the drugs. Where previous painkillers zonked people out entirely, the latest formulas, especially time-release pills, are helping millions of pain sufferers continue to live active lives. And pharmaceutical companies are aggressively marketing these drugs to widespread audiences. Moreover, Americans are undergoing a shift in their attitudes toward pain itself. In the past a strained hamstring during Spin class or an achy shoulder after tennis was a sign to take it easy; now it's often a mere inconvenience that can be masked with the right medicine. Whether you're a weekend exerciser or more serious athlete, our society breeds an attitude of "do what you need to do in order to win," says Al Green, a member of the National Athletic Trainers Association. "Injuries are no longer an excuse not to work out. Players are prescribed painkillers without question."
That presents a quandary. If the drugs successfully ease a person's pain, why is it so bad to use them? "One way to ensure long-term negative health issues is to not let your body recuperate from injuries," says Vic Naumov, founder and executive director of the National Coalition for the Advancement of Drug-Free Athletics. "You have to heal completely before getting back out there or you risk permanent damage or another injury."
Painkillers have another potential risk: According to the DEA, more women now die of overdoses from prescription opioid pain meds than from heroin and cocaine combined. And emergency-room visits involving prescription painkillers increased 168 percent between 1994 and 2002. In 2006 an estimated 5.2 million Americans misused pain medications, despite the highly public legal case in which the makers of OxyContin pleaded guilty to misleading the public about the drug's risk of addiction and abuse. "In the U.S. there has been a worrisome increase in prescription-drug abuse," says Beth Israel Medical Center's Russell Portenoy, MD. The winner in all this pill popping? Drug companies. Their sales figures have skyrocketed, reflecting a near tripling of the money spent to market prescription drugs to the public -- to $30 billion in 2005.
Of course, it's not just gym-goers who get hooked. A lax approach to prescribing painkillers has affected the lives of everyday Americans as well. The meds are bought and sold over the Internet, borrowed from friends to stave off hangovers, even swapped at parties for other recreational drugs. "I'd been a productive member of society before I tried pain pills on a whim with an ex-boyfriend," says Jean B., 42, of Seattle. She wasn't actually in pain, she admits, but felt run-down and in need of an energy kick. "I tried it again -- and again. Then I couldn't stop. I finally went into treatment when I realized I was heading toward total meltdown."
Still, recreational use accounts for only a small percentage of addiction cases. Some studies suggest that a majority of women seeking treatment -- up to 70 percent -- become addicted following a legitimate prescription from a doctor.
Despite a growing body of knowledge about addiction, researchers still aren't certain why some people become addicts and others don't. Scientists now consider genetics and family history to be among the biggest factors. So Lisa, whose two brothers are both addicts -- one to alcohol, and the other to drugs -- was probably at risk from the start. Equally important are the differences in the way men and women process pain and its treatment, which researchers are in the early stages of recognizing. A study at the University of California at San Francisco found that certain opiate-based painkillers work better in women than in men, while an Australian study indicated that some nonopiates -- like over-the-counter ibuprofen -- are actually less effective in women. "What we're asking now is, how are women's bodies reacting differently than men's?" says Jon Levine, MD, PhD, a neuroscientist and author of the UCSF study. "Those answers will help us work toward gender-specific medications." At the same time, progesterone in women may make them more prone to addiction, because the hormone stimulates the production of dopamine, which chemically interacts with drugs in ways that can be described as a craving for more. "It's a bad combination," says Susan Foster, director of policy research at the National Center for Addiction and Substance Abuse at Columbia University. "Women metabolize drugs of abuse differently than men. The drugs seem to be harsher for them, and addictions develop sooner."
For Lisa, it happened so quickly that she went from being legitimately medicated to completely hooked in a matter of months. Her goal, she says, was simply to keep her life on a healthy track. Since ballooning to 185 pounds after she was pregnant with her eldest daughter 11 years earlier, Lisa had worked her 5'2" frame into the best physical condition of her life. For years, she had taught Jazzercise to local clients; she took daily exercise classes and was an avid runner. Suddenly, all that felt secondary to getting her painkiller fix. Every morning, she scrambled to quell the queasiness and sweat of early withdrawal with 30 milligrams of Vicodin. She kept a running clock in her head, instinctively knowing when she needed her next dose -- usually two to three hours later. A few hours after that, another 30 milligrams, always with the hope it would get her high. No longer energized by the pills, Lisa dropped everything that wasn't essential -- teaching exercise classes, then running, then working out altogether. "I've always been a person who could do it all -- clean the house, take care of my kids, take care of myself," she says. "But at that point I just took the medication and forced myself through the day."
By spreading out purchases over various Web sites during the 26 days her online pharmacies required between orders, Lisa was able to dodge detection as an abuser. By summer 2005, she'd gone from popping 7.5 milligram Vicodin pills to 10 milligram Norcos, a painkiller more readily available on the Internet. Since she managed the family's finances from her home computer, her husband never noticed the transactions (the pills cost about $100 a bottle). Nor did he realize the depth of her problem, Lisa says, because she was vigilant about not letting him see her when she was coming down from a high. The psychological impact, though, was frightening. Lisa felt a rift growing between them, but every time she mustered the courage to confess, she'd panic. "I didn't want to shatter my husband's image of me," she says. "I was supposed to be one thing, and I was turning into something else. I didn't know how he'd take that, and I was terrified. It seemed safer to pretend everything was fine."
Late that summer, while packing for a family vacation to California, Lisa found herself consumed with how to transport her large stash of drugs. She stuffed several bottles of Norcos into her purse, sweating at the thought of her husband's discovering them, perhaps during an airport security check, but unwilling to put them in a suitcase that might get lost in transit. During the trip, she had a terrifying vision of her future. "I knew I couldn't keep at this for years," she says. "I seriously thought my addiction could kill me."
A few days after returning home, Lisa sat in front of her computer, fingers poised to change her life. She entered a new term, "Vicodin detox." As a list of substance-abuse sites popped up on-screen, she realized she couldn't do it alone. Overwhelmed, she called her husband at work. "I broke down," she says. "I told him everything, and that I couldn't take it anymore -- that I was completely addicted to these pills, and I felt sick all the time. He was stunned; he really had no idea what I'd been doing, and I think that scared him even more." Her husband hung up and rushed home. The next day, he drove Lisa to a rehab center at the local hospital.
Like most women who get hooked on these pills, Lisa struggled in her effort to get clean, suffering a relapse a few weeks after her first stint in detox, followed by a second attempt to end the drug abuse in February 2006. Since then, everything seems to be working. For two years, she took doctor-prescribed Suboxone, an opioid maintenance drug like methadone that kept withdrawal symptoms at bay but didn't allow her to get high. And since March of 2008, she's been completely pill-free. "I couldn't stand going through detox again," she says. "That, along with my husband and kids, is what I think about when I start to falter." To help keep herself clean, Lisa no longer handles the family finances, so she doesn't have a way to hide her spending habits. She asked her husband to install a software filter on the computer, so she can't browse for online pharmacies. And she regularly attends Narcotics Anonymous meetings.
"I know I'm lucky to have recognized my problem before I lost everything," she says. "Now, the terror of addiction ruining my health has made me more focused on treating my body right." For Lisa, that means getting back to the thing that's always made her feel good: working out. "When I experience that horrible fatigue, I get on my treadmill or go to the gym," she says. "I feel better afterward. Every day is a challenge. But I'm getting stronger. Every day is an opportunity to get it right."
More than 30 million Americans take drugs such as acetaminophen and ibuprofen every day. But overuse is risky: Half of chronic migraines and as many as 25 percent of headaches are "rebound" episodes triggered by taking OTC pain meds for more than 15 days a month. "Our research shows that the body has certain systems that can turn off migraines," explains Stephen Silberstein, MD, director of Thomas Jefferson University Headache Center in Philadelphia. "If you take too many drugs meant to block the pain, you effectively block that mechanism, which can make the attacks more severe and frequent." Not to mention the more serious potential side effects of overdoing pain meds: Acetaminophen overdoses led to more than 56,000 ER visits and 458 deaths from liver failure in 2006. The bottom line: Follow the dosage directions on the label, and if your pain persists, see your doctor.
Originally published in FITNESS magazine, January 2009.