Summer House

Cocaine and methamphetamine are two drugs that are often linked together because they produce similar effects and because they belong to the same class of drugs called psychostimulants. In addition, they both have the potential for causing dependence and abuse which further strengthens the bond associate between them. Though there are many similarities, a fair number of differences do also exist, which will be discussed here.
 

Where Do They Come From?
 

Methamphetamine is man made, while cocaine is derived from the coca plant.
 

Is There A Difference in the Way They Are Used?
 

Both can be smoked, injected intravenously or snorted. The difference being that methamphetamine can be taken in pill form. In addition, cocaine can be used medically as an anesthetic and as an appetite stimulant while methamphetamine has no proven medical use.

Where and By Whom Are the Drugs Used?
 

Out of the two drugs, Methamphetamine has a much more defined area of use as well as stereotype of user. Statistics show that use of methamphetamine is highest in western areas of California, Honolulu, Hawaii, and western areas of the continental United States. Urban areas of California, Oregon, Arizona, Colorado and Washington, show increased use of methamphetamines. In recent years however, use of methamphetamine has increased in rural and urban areas of the South and Midwest.
 

Cocaine use varies so there is no geographic pattern that clearly delineates where the drugs are used. Cocaine use however, is usually significantly higher in large cities and metropolitan areas as opposed to non-metropolitan areas.
 

A possible reason for the difference between cocaine and methamphetamine addiction by area is that in rural areas, cocaine is not as easily accessible. Methamphetamine however, can be made in a garage or basement with household products, making it quite easy for individuals to make their own high.
 

Do They Produce The Same Effects?
 

* Perhaps the reason why cocaine and methamphetamines are confused is because both produce a very well received rush almost immediately. This is followed by feelings of extreme happiness or euphoria which is referred to as a rush.
 

* Methamphetamine’s high can last from eight to twenty four hours and fifty percent of the drug is removed from the body in twelve hours. Cocaine’s high on the other hand, lasts from twenty to thirty minutes and fifty percent of the drug is removed from the body in one hour.
 

* Both cocaine and methamphetamine, when injected intravenously or smoked, can cause an almost immediate rush which is followed by a high.
 

* When ingested nasally, which is referred to as snorting, neither methamphetamine nor cocaine cause a rush or a high. A similar effect is produced when methamphetamine is ingested orally.

Are the Physiological Effects Similar?
 

* Both methamphetamine and cocaine can cause immediate effects of irritability, anxiety, increased heart rate, blood pressure, body temperature and possible death. Methamphetamine’s and cocaine’s short-term effects also can include increased activity, respiration, and wakefulness, and decreased appetite.
 

* Chronic use of cocaine or methamphetamine can cause dependence and possibly stroke.
 

* In either case, cocaine or methamphetamine can lead to psychotic behavior. These behaviors are characterized by hallucinations, paranoia, violence, and mood disturbance.
 

* Some data suggests that violence is more common among methamphetamine users than among cocaine users. Drug craving, paranoia, and depression can occur in addicted individuals who try to stop using either methamphetamine or cocaine.
Is there a difference in neurotoxicity?
 

* Neurotoxicity refers to the toxic damage these drugs can incur on the brain, specifically on neuron transmission. Neurons are responsible for the processing and transferring of information. Methamphetamine can be neurotoxic in animal species ranging from mice to monkeys. Methamphetamine specifically damages neurons that produce serotonin and dopamine. Since the usual doses taken by humans are comparable to the doses causing neurotoxicity in animals, it is reasonable to believe that this also causes the same effect in humans.
 

* On the other hand, cocaine does not cause neurotoxic damage to dopamine and serotonin neurons.
 

Transmission of HIV/AIDS
 

Whether discussing methamphetamine or cocaine, a risk for HIV/AIDS still exists and must be considered when engaging in any type of sexual behavior.

Its very simple, substance abuse effects body functioning. Drug use can lead to long term physiological effects that can not only be acutely harmful, but can also result in chronic problems. The use of drugs is not the only issue. It is all the harmful behaviors that come along with substance abuse that tend to make matters worse.
 

Substance abuse harms the body in two distinct ways: via the effect of the substance itself and via negative lifestyle changes, such as irregular eating habits and poor dietary intake. For example, infants who were exposed to alcohol while in the womb often have physical defects and mental disabilities. In this case, the growing fetus has deficits both directly caused by the substance crossing the placenta and indirectly due to inadequate nutrition of the mother while she was drinking.
 

Recovery from substance abuse involves many different components, including proper organ functioning, assuring mental well being and proper metabolism. A huge factor in the healing process is proper nutrient supply. Nutrients are essential for not only for energy, but also to keep the immune system strong which helps to fight off infection and keep one strong.
 

Though it is clear that substance use in general is not healthy, like anything else, different substances have different effects on the body. In this article we will discuss a few of the more popular drug categories and how they each can affect body functioning.

Opiates

Which Drugs Are Opiates?
 

This category includes: codeine, morphine, and heroin. All of these affect the gastrointestinal system. One of the main symptoms associated with opiate use is constipation. When one withdraws from opiates classic symptoms of withdrawal include: diarrhea, vomiting, and nausea. The danger here lies primarily in a depletion of valuable nutrients and electrolytes. This includes imbalance in the amount of potassium, sodium, chloride, and calcium. Electrolytes are important for a variety of things, including proper cardiac, or heart, functioning.
 

To combat the severity of these symptoms, one should eat meals that are balanced (i.e. proper amounts of vegetables, grains, fats, and proteins). A high fiber diet with things such as whole grains, beans, peas and vegetables is advisable due to constipation associated with opiate use.
 

Alcohol
 

Out of all the drugs utilized in the US, alcohol is the major cause of nutritional deficiencies. The most prominent deficiencies include the following:
 

* Pyridoxine or Vitamin B-6
* Thiamine
* Folic Acid
 

An individual lacking in these nutrients may develop anemia which is a low blood count, for women a deficiency in folic acid can cause poor pregnancies, and B vitamin deficiency can also cause neurological problems. Lack of thiamine (B1) in particular, can lead to Korsakoff’s syndrome. It is important to understand that it is not necessarily the alcohol that cause the disorder, but the effect of alcohol of the absorption of nutrients that is damaging.
 

Alcohol damages the liver and pancreas in particular. These two organs are necessary for detoxification and processing (liver) and the pancreas effects blood sugar and absorption of fat. If these two organs are not working properly, one can have an imbalance of fluids, calories and electrolytes.
 

Permanent damage can take place in the form of cirrhosis which is liver damage, diabetes, seizures and malnutrition. Liver damage can also result in decreased clotting factors, which means an individual has the chance of bleeding unnecessarily. Women also have an increased risk for osteoporosis and may require calcium supplementation.
 

Stimulants

What is a stimulant?
 

This includes cocaine, methamphetamine and cocaine. Use of these drugs can lead to a decrease in appetite and weight loss which will eventually lead to malnutrition. As the name implies, stimulants stimulate the body thereby causing many users to stay awake for unhealthy periods of time. This can range from one night of missed sleep, to being awake for days at a time. This may result in dehydration and subsequent electrolyte imbalance. One should return to a normal, balance diet which may be difficult given the abuse the body has suffered especially if there has been severe weight loss.
 

The Marijuana Munchies
 

Marijuana can increase appetite, which, in chronic users can lead to being overweight. For these individuals it is probably best to cut back on sugar, fat and overall caloric intake.
 

Nutrition and psychological aspects of substance abuse
When people feel better, they are less likely to relapse. Since balanced nutrition helps improve mood and health, it is important to encourage an improved diet in people recovering from alcohol and other drug problems. Individuals recovering from substance abuse have just given up a huge part of their life and for this reason, it is better for these individuals to focus on not using again as opposed to putting all their energy into a drastic diet change.

How to Incorporate a Healthy Diet into Recovery
 

Perhaps the most important thing for prior substance abusers to remember is routine. For instance, regular meals throughout the day are recommended. An increase in proteins, complex carbohydrates and dietary fiber are highly recommended. Due to the irregularity of diet that tends to accompany substance abuse, most individuals will needs to supplement diet with vitamins and minerals. As every individual is different, it is recommended that recovering addicts meet with a dietician. A trained professional can then develop a plan that is specific to the person’s needs. The vitamins that are most often lacking include zinc, vitamins A and C and most of the B vitamins.
 

Keeping Your Sugar Steady Can Decrease Cravings
 

As many drug addicts do not eat regularly, they may forget what it feels like to really be hungry. Not eating steadily can cause a fluctuation in blood sugar levels which can lead to feelings of unsteadiness throughout the day. For a recovering addict, these feelings may be interpreted as drug cravings which could lead to one using. This is yet another reason to keep a steady and healthy intake of food.
 

The Importance of Water
 

Dehydration is common for substance users and it is very important to emphasize the need for fluids during and in between meals. As appetite can return during recovery, it is important to emphasize fluid intake as well as proper food consumption. For all the reasons discussed prior, it would be detrimental to recovery for an individual to begin eating the high calorie foods with little to no nutritional value due to all the abuse the body has already endured. Drinking water will help the body to absorb nutrients which is something most of these individuals are lacking.

Substance abuse recovery is a difficult road to follow. Good nutrition is something that can help to make that road a little easier to walk down. Encouraging healthy eating and a healthy lifestyle, is something concerned loved one can do to help ensure the people in their lives stay clean.

Addiction to drugs and alcohol encompasses more than a behavioral intervention. The reason for this is drug addiction is a complex disease, however, it is treatable. Like chronic illnesses such as hypertension and asthma, relapse can occur with drug addiction even after extended periods of continued abstinence. For this reason, repeated treatments may be necessary. Treatments should be tailored to the individual in order to be more effective and long lasting, therefore allowing people to live long and productive lives.
 

In a study conducted in 2004, 22.5 million American needed treatment for substance abuse. Out of this large number, only 3.8 million received help (NSDUH2004).Leaving substance abuse and addiction cases untreated, though in the short-term can save money, in the long-term can lead to many extraneous costs to society. Some of these things include: court and criminal costs, emergency room visits, prison costs, child abuse and neglect, foster care, welfare costs, healthcare utilization, reduced productivity and unemployment.
 

For every dollar spent on addiction treatment, there is a four to seven dollar reduction in the cost of crimes related to drugs. In 2002, it was estimated that $181 billion dollars was the cost to society for drug use. Over $500 billion was spent when including tobacco and alcohol costs. This includes lost productivity, healthcare and criminal justice costs. Substance abuse programs that are run successfully and efficiently can help society in more than one way. Not only can they assist the person in need, they can also help reduce the amount of sexually transmitted disease that are spread such as HIV/AIDS and Hepatitis. In addition, crime and costs to society can also be reduced. So, the question comes, how can one develop an effective treatment program?
 

Effective Treatment Guidelines
 

Research has been conducted since the 1970s shows that treatment can help people avoid relapse, change destructive behaviors, and take them out of a life of substance abuse and addiction. Treatment tends to be a long term process and can require several episodes of treatment. This research has helped lay down the structure on which effective treatment programs should be based.
 

• Treatment does not need to be voluntary to be effective.
• For certain types of disorders, medications are an important element of treatment, especially when combined with counseling and other behavioral therapies.
• No single treatment is appropriate for all individuals.
• Treatment needs to be readily available.
• Effective treatment attends to multiple needs of the individual, not just his or her drug addiction.
• Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
• Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.
• An individual’s treatment and services plan must be assessed often and modified to meet the person’s changing needs.
• Medical management of withdrawal syndrome is only the first stage of addiction treatment and by itself does little to change long-term drug use.
• Possible drug use during treatment must be monitored continuously.
• Counseling and other behavioral therapies are critical components of virtually all effective treatments for addiction.
• Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, and should provide counseling to help patients modify or change behaviors that place themselves or others at risk of infection.
• As is the case with other chronic, relapsing diseases, recovery from drug addiction can be a long-term process and typically requires multiple episodes of treatment, including "booster" sessions and other forms of continuing care.
 

An All Encompassing Treatment
 

When treating an individual for addiction treatment, it is important for the individual as a whole to be looked at. Usually, treatment begins with detoxification which is followed by treatment and relapse prevention. Initially, in order to ease the individual into treatment, medications may be needed in order to control symptoms of withdrawal. All encompassing care includes mental health services, medical care and of course aftercare. In order to make sure that someone in recovery continues to stay there is to make sure all bases have been covered. Follow up options such as community or family based recovery support systems can be essential to acquiring and maintaining a life that is free of drug use and abuse.
 

Medications

Medications can help in various different fashions. In some cases, coming off of a substance can be life threatening and medication is necessary. Often times, the symptoms of withdrawal can be so severe that medication is necessary. This is not considered treatment; it is however, the first step in the process of recovery. Going through withdrawal treatment is not sufficient. If one does not receive further treatment, it is like not receiving treatment at all.
 

Using chemical substances can help to establish brain functioning that may have gone awry. At present medications are available to help reestablish pathways for addiction related to heroin, morphine (opioid) and nicotine (tobacco). Other medications are currently being developed for treatment of cocaine and methamphetamines (stimulants) and marijuana (cannabis) addictions.
 

Methadone and buprenorphine act as antagonists on brain receptors which means that they block the pathways which opiates like heroin take. This helps to block the drugs effects, suppresses symptoms of withdrawal and can even reduce the incidence of cravings. Ideally, this helps patients to stop drug seeking behaviors and activities that may be criminally related. Thereby, patients should be more focused on treatment having reduced many outside stimuli.
 

Behavioral Treatments
 

This is a very important part of effective therapeutic treatment. Stopping substance abuse habits is only effective if behaviors change, therefore, attitudes have to be changed so that a healthy lifestyle is maintained. Life skills need to be altered, unhealthy patterns need to be changed. In addition, medication effectiveness is usually better, and this can help people stay in treatment longer which will hopefully improve the likelihood of the individual staying clean.
 

Outpatient behavioral treatment can include a wide variety of programs. Most include group or individual counseling. Some of the more popular forms of treatment include the following behavioral treatment programs:
 

• Motivational Incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.
• Cognitive Behavioral Therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
• Motivational Interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment.
• Multidimensional Family Therapy, which addresses a range of influences on the drug abuse patterns of adolescents and is designed for them and their families.
 

Residential treatment can be very helpful, even more so for individuals with severe problems. Therapeutic communities are structured programs in which patients remain for half a year to twelve months. Those in treatment usually have long histories of drug addiction, have often been involved in criminal activity and may have reduced social functioning. Treatment communities have become so evolved that they may also be structured to accommodate women who are pregnant or have children. The purpose of treatment communities is to help the individual learn how to behave in society without drugs.
 

In conclusion, with the proper mix of effort on the part of the individual, the proper care by practitioners, medications and community, a formula for success on the part of the substance user can be acquired. With that formula put in motion, an addict can become a former one and go on to live a happy and fulfilling life.

The body’s reaction to the removal of a substance it has become dependent on is called withdrawal. Withdrawal causes craving for more of the substance being removed. The period of time when the body is trying to overcome its addiction is called detoxifica-tion (detox). Detox is the first step in overcoming a substance addiction such as drugs or alcohol. Detox is a pertinent step for the patient is to be successfully rehabilitated.
 

Opiate drugs such as heroin and methadone, and prescription medications including Hydrocodone, Oxycontin, Xanax, Vicodin and Lortab, require medical detox supervision. There are however, other illegal drugs such as marijuana, crystal methamphetamine, and cocaine that do not require medical detox. Since there is psychological dependence associated with these drugs, it would be wise to complete a period of stabilization. The process of drug detox requires the patient to be closely monitored by keeping vital signs, giving support and administering medications if needed. There are numerous withdrawal symptoms or side effects when a patient stops or dramatically reduces drugs after heavy or prolonged use. Those side effects include: sweating, shaking, headaches, drug cravings, nausea, vomiting, abdominal cramps, diarrhea, sleeplessness, confusion, agitation, depression, anxiety, and other behavioral changes.
There are two commonly used drugs to enable the patient to feel relief from these symptoms. First, Klonepin, which reduces physical symptoms, and Buprenophex, which is an anticonvulsant. These drugs must also be monitored as cessation produces withdrawal symptoms. Generally, the time period for drug detox is three to seven days under medically monitored supervision.
 

Alcohol detox, like drug detox, is usually accomplished in an inpatient medical facility. Duncan Raistrick identifies the key to a successful, planned detoxification is preparation. Raistrick goes further to detail that the first job of therapy is to bring the patient to a point of readiness to change their drinking behavior. Second, patients need to be given accurate information about what to expect during detoxification.
 

There are two withdrawal categories: minor, meaning early withdrawal and major, meaning late. The severity of withdrawal depends greatly on the duration of alcohol used. Alcohol Withdrawal Syndrome (AWS) falls into three main categories: central nervous system (CNS) excitation, excessive function of the autonomic nervous system (ANS), and cognitive dysfunction.5 Richard Saitz, M.D., M.P.H., states, since alcohol enhances gamma-aminobutyric acid’s (GABA) inhibitory effects on signal-receiving neurons, neuronal activity is lowered. This lowering leads to an increase in excitatory glutamate receptors. Tolerance occurs as GABA receptors become less responsive to neurotransmitters, which in turn requires more alcohol to produce the same inhibitory effect. During detox, the GABA is ineffective and unable to suppress the excitatory glutamate receptors. Detox is intended to relieve physical symptoms such as: shaking or tremors, headaches, vomiting, sweating, restlessness, loss of appetite, sleeplessness, Delirium Tremens (DT’s), hyperactivity, and convulsions. Alcohol detox medications are similar to drug detox medications: Buprenophex, certain benzodiazepines and anticonvulsant medications. Alcohol detox completion can take from three to fourteen days.
 

Norman S. Miller notes that medical management of alcohol and drug withdrawal during detoxification often is not sufficient to produce sustained abstinence from recurrent use. Therefore, further addiction treatments are needed to prevent relapse to alcohol and drug use following treatment of withdrawal.
 

In conclusion, drug and alcohol detoxification can effectively prepare the addicted abuser for rehabilitation and treatment.
 

Some physicians believe the withdrawal phase is related closely to the drug addiction - the worse the withdrawal, the more likely the continued use of the chemical to prevent withdrawal. Several factors are key to successful detoxification.
 

1. Acknowledge that there is a problem and decide to do something about it.
2. Get rid of all the drugs and paraphernalia.
3. Drop friends and associates that are tied to our drug problem.
4. Seek and accept spousal support, or support from friends, or relatives.
5. Prepare for symptoms with the support of a professional.
6. If tranquilizer drugs are needed for a few days or longer, they must be handled sensitively, as one addiction can easily replace another.

NEW YORK (Reuters Health) - Young adults who abuse amphetamines may be raising their risk of suffering a heart attack, a new study shows.

Texas researchers found that among more than 3 million 18- to 44-year- olds hospitalized in their state between 2000 and 2003, those who were abusing amphetamines were 61 percent more likely than non-users to be treated for a heart attack.

What’s more, the rate of amphetamine-linked heart attacks rose by 166 percent over the 4-year study period. That compared with a 4-percent rise in cocaine-related heart attacks, the researchers report in the journal Drug and Alcohol Dependence.

"Most people aren’t surprised that methamphetamines and amphetamines are bad for your health," lead researcher Dr. Arthur Westover said in a statement.

"But we are concerned because heart attacks in the young are rare and can be very debilitating or deadly," added Westover, an assistant professor of psychiatry at the University of Texas Southwestern Medical Center at Dallas.

Amphetamines stimulate the central nervous system and some are used to treat attention-deficit hyperactivity disorder, or ADHD. But they are also frequently used illegally; one potent form of amphetamine, methamphetamine, is a growing problem in many U.S. cities.

Cases of heart attack in young people have been linked to amphetamine abuse before, but the current study appears to be the first large- scale look at the epidemiology of the problem.

Westover and his colleagues used a statewide database to examine information on more than 3.1 million 18- to 44-year-olds discharged from Texas hospitals between 2000 and 2003. Overall, 11,011 of these patients (0.35 percent) were treated for a heart attack.

The database also contained information on whether a patient had been diagnosed with any type of drug-abuse problem. The researchers found that patients with a diagnosis of amphetamine abuse or dependence were at increased risk of suffering a heart attack.

Amphetamines have various effects that could precipitate a heart attack, Westover and his colleagues point out. The drugs are well known to speed up heart rate and blood pressure, but they can also trigger spasms in the heart arteries and promote blood clotting.

In people who already have "plaque" deposits in their heart arteries, amphetamines may cause a plaque to rupture, which can then lead to a heart attack.

Besides the risk to individual amphetamine users, Westover said, "we’re also concerned that the number of amphetamine-related heart attacks could be increasing."

"We’d rather raise the warning flag now than later," he added. "Hopefully, we can decrease the number of people who suffer heart attacks as the result of amphetamine abuse."

Las Vegas Sun — Nevadans consume about twice the national average of several prescription painkillers, making us among the most narcotic-addled populations in the United States, a Sun analysis has found.

The consequences are deadly. More people in Clark County die of prescription narcotics overdoses than of overdoses of illicit drugs or from vehicle accidents. In 2006, Nevadans were the No. 1 users per capita of hydrocodone — better-known by the brand names Vicodin or Lortab. 

We took enough of the drug to equal 48 Vicodin pills for every man, woman and child in the state for a year.

And the numbers are climbing. From 1997 to 2006, the most recent year for which data are available, the per capita rate of hydrocodone used in Nevada jumped by 273 percent.

Nevadans are turning to other narcotic painkillers at an even faster rate.

The per capita use of oxycodone, best-known by the brand name OxyContin, climbed sevenfold from 1997 to 2006, while methadone use jumped 12-fold.

Nevada is ranked fourth in the nation for methadone, morphine and oxycodone use per person, the Sun analysis found.

Following crack cocaine in the 1980s and methamphetamine in the past decade, prescription narcotics are “the next big drug epidemic,” said Matt Alberto, deputy chief of investigations for the Nevada Public Safety Department, the lead prescription drug policing agency in the state.

Emergency room physician Dr. Edwin “Flip” Homansky, medical director of the Valley Health System and a member of the Nevada State Board of Health, said the dramatic rise in prescription narcotic use should be examined.

“When you see increases like that, it’s a warning sign to all of us,” he said, referring to the Sun’s analysis.

The Sun reached its findings after analyzing several thousand pages of Drug Enforcement Administration reports on the state-by-state distribution of controlled substances to pharmacies and health care practitioners. (The DEA monitors the production and distribution of prescription narcotics, which fall into the highest category of regulation for prescription drugs.) After breaking down the data by state populations to reach per capita figures, the Sun determined the highest per person consumption of each prescription narcotic, as well as how consumption has changed over time.

Nevada leads a national trend in the growing use of narcotic painkillers. The National Institute on Drug Abuse reports the number of opiate prescriptions escalated from about 40 million in 1991 to 180 million in 2007 — a 350 percent increase at a time when the nation’s population increased by 19 percent.

A few doctors are doing most of the prescribing. A Sun analysis of a Nevada Pharmacy Board database that tracked all the prescriptions for controlled substances in the state, not just narcotics, showed that in 2007, 1 percent of medical practitioners in the database prescribed 51 percent of controlled substances in the database, and 5 percent of them prescribed 88 percent of the drugs.

No identifying information was made available to the Sun, but experts presume that the heaviest prescribers are pain management and cancer specialists.

Although analyzing individual prescribing habits could hint at who might be overprescribing narcotic painkillers, scrutinizing the database with that intent is banned by statute. Pharmacy board officials said that’s to allow doctors to make judgments and prescribe medicine without fear, which could compromise patient care. The database can be examined by police as part of an active investigation, but authorities can’t use it to go fishing for doctors who can be criminally prosecuted for overprescribing narcotic painkillers.

Assemblywoman Sheila Leslie, D-Reno, said it’s important to understand the factors surrounding the rise in prescription narcotic use and abuse, so legislators may need to “take a closer look” at the law that prevents analyzing the state’s highest prescribers.

Narcotic painkillers are derived from opium, a drug made from poppies that has been used medicinally for thousands of years. Opiate use was common in the United States in the 19th century, and by the early 1900s, when it was recognized that doctors were overprescribing opiates and addiction was a problem, their use was regulated and the drugs fell out of favor. They were mainly prescribed to cancer or terminal patients until the 1990s, when their use was expanded to people with chronic pain. Now we’re in a prescription narcotics boom.

The increasing use of prescription narcotic painkillers in America illustrates the evolving understanding and treatment of pain.

Among the chief challenges to doctors who prescribe potentially addictive painkillers is that pain can be described only subjectively, by the patient. It can’t be measured clinically, like blood pressure or pulse rate.

As a result, pain treatment is both an art and a science. Is the doctor to believe the patient is in pain, or is the doctor being conned by an addict or a drug dealer on the hunt for painkillers? Even the best pain management specialist will say he can’t always tell the difference.

The lines separating prescription narcotic dependence, abuse and addiction are blurry, making it difficult to say whether the skyrocketing drug use is a welcome relief, an epidemic, or something in between.

And experts disagree on how to interpret the growing use of narcotic painkillers. Law enforcement complains about the illegal activity, addiction specialists decry that more people are becoming hooked on drugs, and pain management specialists talk about the benefits of narcotics.

Research on narcotics’ effectiveness in treating pain is inconclusive. In fact, there’s some evidence they can increase pain.

Alarmed experts from all fields agree the rising rate of prescription narcotic use shows no sign of abating.

•••

The use of narcotics to treat pain got a tremendous boost in 1995 from the American Pain Society. Its corporate members include the pharmaceutical companies Purdue, maker of OxyContin; Abbott, maker of Vicodin and UCB, and Watson, maker of the hydrocodone drugs Lortab and Norco.

The society set guidelines saying proper pain management includes urging patients to report unrelieved pain. At the time studies had shown that cancer patients were suffering needlessly because they were not being given enough painkillers.

In January 1999, the Veterans Affairs Department, citing the American Pain Society’s statement that pain is one of the main reasons people consult a doctor, launched a campaign known as “Pain is the Fifth Vital Sign.”

The initiative encouraged health care providers to monitor a patient’s reported level of pain — a subjective symptom — as they did the four measurable vital signs: blood pressure, breathing rate, pulse and temperature. Health care providers asked patients to rank pain on a scale of 1 to 10, and were then urged to treat it.

Dr. Mel Pohl, a Las Vegas addiction recovery specialist, criticizes the pharmaceutical industry’s role in making pain the fifth vital sign.

“The rationale was that we don’t want people to suffer,” Pohl said. “In the best case that’s what it was about. In the worst case, somebody was working this out with the (financial) bottom line in mind. Probably both factors are part of it.”

Soon after, the methods advocated by Veterans Affairs were endorsed by the Joint Commission, the agency that monitors and regulates hospitals. Every hospital is now expected to measure pain in a similar manner.

Dr. Jim Marx, a Las Vegas addiction medicine and pain management specialist, praised the advances, saying doctors now realize they can safely treat patients for pain. This allows patients such as blue-collar workers in Las Vegas to continue in their jobs, he said.

The advent of direct-to-consumer marketing by pharmaceutical companies has also contributed to the rise of prescription narcotics. In 1997, the Food and Drug Administration allowed drug companies to hype their brand-name medicines directly to consumers, which has helped remove any stigma attached to their use. Doctors say patients are now demanding drugs by name.

Homansky, the emergency room doctor, recalled the case of a tourist who said she’d left her bottle of hydrocodone pills at home and needed more. After Homansky recommended a nonnarcotic treatment, she stormed out of the hospital, cursing the staff along the way.

“We’ve had people who get physically abusive, verbally abusive and expect that we’re just there to provide them whatever they want,” Homansky said.

The pharmaceutical companies also market their narcotic painkillers by unleashing cadres of sales representatives on doctors and hosting dinners where physicians offer testimonials about the companies’ medicines.

“There’s a lot of money in the drug industry and they push really hard,” one pain doctor said.

No one can say with certainty why so many narcotic painkillers are used in Nevada, but experts make several educated guesses. The lifestyle of night life and partying leads to more drug-seeking and abuse, doctors said. Also, pain is a complicated symptom of multiple diseases that’s intensified by psychological distress. Las Vegas is a transient place where many people are without social and family support and where the nation’s highest rate of suicide shows a population with mental health problems, doctors said.

The city’s physician shortage also likely plays a role, several experts said. Doctors stressed for time may treat the symptomatic pain rather than explore the problem that’s causing the pain. And once the treatment begins it may continue under the logic that it’s what the patient is accustomed to.

Doctors may further be predisposed to cave in to patients’ requests for narcotics because of how they are reimbursed by insurance companies: by the number of patients they see, not the time spent with each. This may lead providers to take the path of least resistance by writing a prescription. Pohl, the addiction recovery specialist, said it takes doctors “five minutes to say yes and 45 minutes to say no” to a patient’s demand for drugs.

•••

Larry Pinson was browsing in a shop recently when a greeting card caught his eye: “The best part of getting sick is Vicodin,” the card read. “So make sure you save me some, and don’t tell your doctor!”

When greeting cards joke about illegal narcotic abuse, Pinson said, “We’ve got a problem.”

The United States makes up less than 5 percent of the world’s population, but is supplied 99 percent of its hydrocodone and 71 percent of its oxycodone, according to the National Institute on Drug Abuse.

As executive director of the Nevada Pharmacy Board, Pinson presides over the licensing of thousands of pharmacists, pharmacies, technicians and wholesalers, plus about 7,000 doctors, nurse practitioners and dentists who prescribe the drugs and about 180 drug distributors.

About a decade ago the board became aware of the emerging practice of “doctor shopping,” the illegal practice of conniving patients’ visiting multiple providers to get drugs, either to feed an addiction or to sell.

So the Nevada Pharmacy Board created a database that would list every prescription written in the state for certain controlled substances, with the name of the provider and the patient, and the date of the transaction. The monitoring program would help catch patients who might be “doctor shopping.” Regulators from about three dozen other states have followed Nevada’s lead.

A growing number of health care practitioners are using the online database to track their patients’ use of prescriptions. In 1997, the first year of its existence, the database was used 480 times. The number grew exponentially to 65,372 reports in 2007, nearly double from the previous year.

The database flags patients who make a certain number of visits to doctors within an allotted time frame, though officials will not say exactly what type of patient behavior triggers the system, for fear addicts will adjust their behavior accordingly. The database then alerts the doctors to patients who may be shopping for drugs.

Pain management specialists in Las Vegas say the prescription monitoring program is one of many safeguards they use to ensure patients are not abusing painkillers.

“Our attitude is that when a patient leaves our office with a month’s worth of medication, it’s the equivalent of leaving the office with a loaded gun,” said Dr. Michael McKenna, a Harvard- and Stanford-trained pain specialist in Las Vegas.

Among the precautions pain specialists can take to guard against abuse are requiring contracts with patients that discourage doctor shopping, urine tests to verify drug use and monthly visits to track prescriptions and lessen the number of pills a patient has at a given time.

But not every provider takes these precautions.

Jennifer Hilton says that after she had a tooth filled, her dentist handed her a prescription for Vicodin even though she was not complaining about pain. She bristled at the unsolicited prescription because she’s a program coordinator for an inpatient drug addiction program for adolescent girls that’s run by Westcare, a Las Vegas nonprofit that specializes in substance abuse treatment.

Hilton admonished her dentist to ask whether his patients have addiction problems before handing them Vicodin prescriptions.

She said the dentist replied that patients should inform him if they have a drug problem.

“I’m sure some of my clients would have loved to have him as a dentist,” Hilton said, incredulous.

Las Vegas medical professionals repeatedly fail to take addiction seriously, Hilton said. On every clinic visit her teenage drug addicts hand doctors a medical feedback sheet that says: “This person is in a residential treatment facility. Please do not prescribe them anything of a narcotic or addictive nature.”

Still, about one in three kids returns with a narcotic painkiller prescription.

Las Vegas doctors say they are aware of physicians who prescribe whatever drug patients desire, so they will return. It’s good for business.

One drug addict told the Sun addicts share information about the doctors who are quick to write prescriptions.

“If you want (the drugs), you know where to go,” the woman said.

She said a few doctors ran her name through the Nevada Pharmacy Board’s database, recognized her as a doctor shopper and refused to give her drugs. But they never helped her or talked to her about treatment options, she said. Instead they sent her on her way.

The woman, who did not want to be identified, said she is trying to quit drugs and is detoxifying at home. Her only hope is her own motivation to get clean. Her only support is from fellow addicts in her 12-step program.

“I could go to the doctor tomorrow and mess it all up,” she said.

Dr. Jerry Jones, a Las Vegas obstetrician-gynecologist who is president of the Clark County Medical Society, said there may be a few unethical doctors who are overprescribing narcotics. “Most primary care doctors are extremely cautious and conservative about their narcotics prescriptions,” Jones said.

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Experts struggle to explain the notably high use of narcotic painkillers in Nevada. Two popular explanations are based on myths or outdated assumptions propagated in the medical community.

Every medical professional interviewed by the Sun cited what each said was Nevada’s aging population — assuming older people need more drugs because they suffer from more cancer or painful chronic conditions.

But U.S. Census figures show that Nevada is actually the 11th-youngest state in the country.

National experts said the same thing, and indeed the median U.S. age — reflecting aging Baby Boomers — rose from 35 in 1997 to 37 in 2007, according to Census figures. But the population aged 65 and older decreased in the same time frame from 12.6 percent to 12.4 percent.

The other common explanation for the high rate of narcotic use was that pain is undertreated in the United States and that Nevada doctors are prescribing more, as they should. But data suggesting the undertreatment of pain are dated and don’t reflect the exponential growth of prescription narcotic use in the past decade.

James Zacny, a psychopharmacologist at the University of Chicago who studies opiates, said the undertreatment of pain is no longer a concern for most patient populations. “I’ve heard the pendulum has swung the other way,” he said. “Now there’s some concern about overprescribing.”

The tragic irony is that painkillers may not work as well as people think. Many doctors say they’re not ideal for long-term use for chronic pain. And some studies show, paradoxically, that they can increase pain. McKenna said the research is relatively new, but shows that some patients actually improve when the medication is withdrawn.

“Pain is very complicated,” McKenna said. “But throwing opiates alone at pain is probably not the best approach.”