Sunday, March 9, 2014
Second of six parts
PAINKILLERS IN MAINE: Stories, video interviews and links to resources.
Prescription painkillers are known as an equal opportunity drug.
Widely available and highly addictive, the pills can ensnare people who might never be exposed to illicit drugs, such as cocaine or heroin.
"We've had a 70-year-old grandmother whose doctor prescribed it for chronic pain. The Yarmouth soccer mom. The 20-year-old. I have to laugh when people say the typical drug abuser. What's that?" said Shannon Trainor, clinical director for Crossroads for Women, a Portland-based substance abuse treatment agency.
At the same time, experts say, there are definite risk factors that make some people more vulnerable to the changes in brain chemistry that lead to addiction. While access to the drugs and social factors fuel abuse, these risk factors can determine how fast a user gets hooked:
• Youth -- Not only are teenagers more likely to experiment with the pills, their developing brains are much more susceptible to addiction.
• Past abuse or trauma -- Sexual abuse as a child is a common experience among a surprisingly high number of addicts.
• Mood or anxiety disorders -- Many people drawn to the numbness of an opiate high are drowning the symptoms of some underlying medical problem.
• Family history -- Someone with alcoholic or drug-addicted relatives may have what is called the "addiction gene."
Addiction is a disease of the brain, a change in chemical pathways caused by the highs and lows of repeated drug use.
The human brain is built to pursue pleasure and avoid pain, and opiates are especially potent hijackers of the pleasure and pain signals in the brain.
The drugs, especially when abused and taken in intense doses, shift the brain's ability to experience pleasure beyond its natural range. Soon, the brain craves the drug to feel normal.
Opiate withdrawal, meanwhile, is intensely painful. Opiate receptors in the brain and different parts of the body go into a kind of shock. It doesn't kill you, addicts say, but you may wish it would.
"There is nothing as traumatic as unmedicated opiate withdrawal," said Mark Publicker, an addiction specialist at Mercy Recovery Center in Westbrook. "You're in hell."
Once an addict gets a taste of withdrawal, avoiding it becomes the brain's top priority, sometimes at the expense of virtually everything else in an addict's life.
It's no accident that Mainers in their 20s have the highest rates of painkiller abuse. OxyContin and other prescription painkillers first hit Maine's middle schools and high schools 10 years ago. The second-highest rate of abuse is among people now in their teens.
"Kids don't even realize it's an opiate. They don't know what they are taking," said Eric Heintz, a substance abuse counselor at Day One in South Portland.
Nearly one-quarter of Maine high school seniors in 2009 -- 23.9 percent -- said they had taken the drugs at least once, according to state data. Eleven percent of Maine's eighth-graders -- mostly 13-year-olds -- had used prescription drugs in their lifetimes, according to the survey.
"Opiate addiction is a pediatric onset disease in Maine," Publicker said. "Vicodin is more of a gateway drug than marijuana at this point."
Vicodin, which is a commonly prescribed painkiller for broken bones and wisdom tooth extraction, is often most available to teenagers.
The teenage years, when brains are still developing, are an especially bad time to take the pills, experts say.
Teenagers are more likely to become addicted, and heavy use at that age can have more long-lasting effects on the brain.
Teenagers or others who have family histories of alcoholism or drug addiction are well known to be at higher risk. It's effectively the same reason heart disease, depression and some cancers can run in families, doctors say.
The strong link between opiate addiction and child abuse is a relatively new discovery.
"It's something that we as a profession had missed," Heintz said. "Only recently has it become a focus in assessment and treatment."
Heintz estimates that 70 percent to 80 percent of the adolescents who come to Day One with prescription drug problems say they had been abused in some way, often sexually.
Publicker estimates that more than 90 percent of the people he treats were molested as children.
Dr. Mark Brown, a Bangor pediatrician who cares for the babies of opiate-addicted mothers, said he sees the same pattern in the women.
"That's pain that just doesn't go away," he said. "You medicate it away, and that's how it (addiction) happens."
Dr. Robert Blaik, a psychiatrist at Maine General Psychiatry in Portland, treats dozens of addicts and said virtually all of them are trying to blot out an untreated mental health problem. The addicts often describe it simply as feeling down, blue, sad or empty.
"All it takes is one experience with a short-acting opioid to realize" it can drown out such symptoms for a little while, he said. "Then you get into a course of up-down and up-down and you're hooked."
Blaik said economic insecurity can play a role, too, by intensifying mood and anxiety disorders. That may help explain why Maine and other poorer, rural states have been hit hardest and why abuse, addiction and crime continue to grow.
"You can't ignore it," Blaik said, "the self-medication issue is huge."
Staff Writer John Richardson can be contacted at 791-6324 or at: