Abuse of prescription painkillers is a "growing, deadly epidemic," according to the Centers for Disease Control and Prevention.
On Oct. 24, the Food and Drug Administration recommended putting new restrictions on hydrocodone, sold as Vicodin and other brand names.
Dr. Andrew Kolodny believes the restrictions are necessary and will prevent new people from developing addiction. But, he says, there are millions who already have the disease and need access to effective treatment.
"If they don't have access to legal sources [of painkillers], many of them will turn to the black market," he tells NPR's Arun Rath, "and if they can't find black-market pills, they'll buy heroin on the black market."
While abuse of painkillers has become focus of concern and action, their connection with heroin is also noteworthy.
The number of people who had used heroin in the previous year increased between 2007 and 2012, from 373,000 to 669,000. Meanwhile, federal data from 2011 finds that nearly 80 percent of people who had used heroin in the past year had also previously abused prescription painkillers classified as opioids.
Opioids — derived from opium — include morphine, oxycodone, hydrocodone and heroin, says Kolodny, who is the chief medical officer for the national drug treatment network Phoenix House and president of Physicians for Responsible Opioid Prescribing.
Opioids share a similar molecule, he says, and "when they attach to the brain's opiate receptor, they all cause a very similar effect."
They give "both a positive reinforcement — the effect when you take the drug — but also very strong negative reinforcer, which is that you'll feel very sick when you don't have the drug," he says. "Those two factors together make opioids extremely addictive."
'Incremental Steps' To Addiction
Several years ago, John Nygren says, his teenage daughter started having trouble.
"She would not come home in the evenings at times. She was not going to school. There were incremental steps along the way, where we saw there were problems," he says.
Nygren is a fourth-generation Wisconsinite, from the small town of Marinette. He now represents the town in the State Assembly.
His daughter, Cassie Nygren, became addicted to the prescription painkiller OxyContin. Eventually, she was drawn to heroin — and overdosed on it in 2009.
Her mother found her on the bathroom floor, "struggling to breathe," John Nygren says. A needle was still in her arm.
The paramedics arrived in time to save her life, but she has continued to battle addiction. She's been in and out of treatment and is currently serving time in county jail.
John Nygren is using his position to change things in Wisconsin. When his daughter overdosed, she was not alone in that bathroom — those who had been with her left. Nygren says that was probably because they were afraid of the authorities getting involved.
He has introduced legislation to give people legal protection when calling 911 about an overdose. It's part of a package of bills to cope with the opioid crisis in his state.
The Rise Of Painkillers
The problem that is not isolated to Wisconsin.
According to the CDC, the amount of prescription painkillers sold to pharmacies, hospitals and doctors' offices quadrupled between 1999 and 2010.
"With the increase in prescribing, what we've seen is that it's led to parallel increases in rates of addiction and increases in rates of drug overdose deaths," Kolodny says. "And it's gotten so bad that the CDC is now telling us there are more people in the United States dying each year from drug overdoses than car crashes."
Kolodny says the United States is completely alone in this trend.
"The United States has about 4 percent of the world's population, and we're consuming more than 80 percent of the world's oxycodone supply. We're also consuming more than 99 percent of the world's hydrocodone," he says.
In many cases, the prescriptions are entirely legitimate, says Dr. Elinore McCance-Katz, who specializes in addiction psychiatry and is first chief medical officer at the Substance Abuse and Mental Health Services Administration.
"Opioid medications are effective pain relievers and used by the majority of people for that purpose. Individuals do not become addicted to these medications when used as clinically prescribed," she says. "But there are people who have vulnerability to addiction."
McCance-Katz says that opioid addiction is a chronic illness, but, fortunately, "very treatable."
"As people get treatment — and that treatment includes medication and psycho-social treatments — they do recover," she says.
Numbing The Pain
In Glendale, Calif., 18-year-old Preny Ebrahimi is on the other end of treatment.
In her family's apartment, with her mother looking on, she says she struggled in school with attention deficit disorder. Around the time she was 13 or 14, Ebrahimi says, she fell in with the wrong crowd.
First, there was marijuana. Then there were the prescription painkillers, which were easy to find. Then there was methamphetamine, and one day she tried smoking heroin.
"After that day, I just fell in love with the feeling and the numbing pain, and I just kept doing it and doing it and doing it," she says. "And it just ate away at my life."
She says she was using "every day, every hour" for about 18 months.
Eventually, Ebrahimi bottomed out. She had stopped using heroin on her own, but that brought on withdrawal. She stole her father's car to meet a dealer and nearly ran over her father driving away. When she got home, her family confronted her.
"And everybody was just trying to talk to me, and I was going crazy because I didn't want to talk, I just wanted to go be alone and do it," she says. "They were like, 'We don't know what else to do. You need to stop.' "
The pain became too much, Ebrahimi says — for her family and for herself.
"The high itself, that numbing pain, it was just not worth it anymore to put my family and myself through. And I just wanted to stop," she says.
Ebrahimi's parents had her placed in juvenile detention, and a judge mandated residential drug treatment at Phoenix House. She stayed there for five months. It has been a long road — one that has clearly taken a toll on her family.
But Ebrahimi has been clean and sober for almost three years. She has a job now and plans to start college in the spring.
"These years sober have been the best years of my life. I've gained so much trust back," she says. "It's a feeling like no other, honestly, going through all that and being here right now, a place you'd never thought you'd be."