It began innocently, with two to three doses of Percocet 5 every day. A then-19-year-old Brianna McGee received the prescription to control the pain after a cesarean section. But after she took the painkiller for six months, the prescription ran out and she wanted more.
Ms. McGee didn‘t realize that she was already developing an addiction.
She was at a friend’s house when she saw the small blue pills spread out on a table. They were Percocet 30, more potent than the ones she had been prescribed. Ms. McGee crushed one and snorted it, thinking, “This is going to be fun.”
It took 2 minutes for the effects to kick in; 2 minutes for her to “fall in love.”
The 28-year-old Baldwin Borough resident, now a recovering addict of nearly a year, had dealt with substance abuse before, but the Percocet pushed her into a downward spiral that for seven years seemed irreversible. While suffering from addiction, Ms. McGee went to jail for a DUI, stole from her family members for drug money and lost every job she tried to hold.
Her path is not an uncommon one, particularly in Pennsylvania. A U.S. Centers for Disease Control and Prevention report released on July 4 places the state above the national average in painkiller prescription rate, with 88.2 opioid prescriptions for every 100 individuals. The highest rates were in Alabama and Tennessee, where doctors wrote 143 prescriptions per 100 residents. In Hawaii, the state with the lowest rate, doctors wrote 53 per 100 residents.
Opioids — also known as narcotics — are the most common form of painkillers prescribed. Among the strongest are Oxycontin, Vicodin and Percocet. On a lower extreme, there is Tylenol 3.
Dependence on these pain medications follows a sequence of rising magnitudes. Recovering addicts say that one drug inevitably leads to another, that experimentation often forebodes much more. Those who develop tolerance to the drugs will resort to buying off the street if they can‘t procure enough from doctors. Some will turn to heroin for a more powerful high, placing them at even greater risk of overdose.
Between 2010 and 2011, Pennsylvania rose from 14th to seventh nationally in drug-related deaths, according to data released by the National Center for Health Statistics in June. The state received a score of four out of 10 for strategies to curb abuse in 2013.
As local lawmakers are recognizing the urgency of these numbers, doctors say their hands are tied where painkillers are concerned. The state has yet to make a prescription drug monitoring database available to physicians, as legislation remains stalled. Before Gov. Tom Corbett’s office teamed up with the Pennsylvania Medical Society to release statewide opioid prescription guidelines July 10, there had not been any official recommendations for prescribing practices.
The guidelines recommend more thorough pre-screenings to determine which patients might be more vulnerable to potential problems. For example, those with a history of addiction, psychiatric disorders or have sleep apnea may be at increased risk of harm due to opioid use. Doctors are also encouraged to consider alternative methods of pain treatment, such as physical therapy and psychotherapy.
The full set of guidelines can be found at pamedsoc.org/opioidguidelines.
Health care providers are hopeful that the guidelines will reduce some of the stigma currently associated with refusing to give a patient pain medication.
“As doctors, one of our main job functions is to treat pain,” said Kevin Garrett, a general surgeon and president of the Allegheny County Medical Society. “If I decide myself that a patient is exaggerating pain, I‘m going to be penalized for not helping them.”
Chuck Chappell, 40, of Indiana, Pa., began abusing opioids after he was prescribed Oxycontin and Percocet for back pain nearly two decades ago. The prescription lasted just 14 days, during which he took upward of four pills a day. From there, Mr. Chappell began pooling his scripts with co-workers so there would always be some medication on hand.
He knew he was taking advantage of the prescriptions, which were easily obtained because of his arthritis, but his doctor didn’t question the requests.
“It was always an option,” Mr. Chappell said. “My doctor never got suspicious.”
Pain treatment emerged as a medical specialty in the 1970s, when opioids became widely recognized as the best drugs for alleviating patients’ discomfort, explained Carnegie Mellon University medical historian Caroline Acker. As the research on drug addiction in recent decades has demonstrated, however, a movement once proclaimed “the end to pain” has since given way to a growing epidemic of abuse.
While physicians today are much more aware of the risks associated with painkiller addiction, opioids will remain the default medication until a safer but equally effective option is discovered.
“The quest for a non-addicting painkiller has been going on for 100 years,” Ms. Acker said. “We simply haven’t gotten there yet.”
Mr. Chappell, who has been in recovery for 10 years, credited a large part of his progress to Pennsylvania’s Certified Recovery Specialist Credential. The state-sponsored certification provides free training for recovering individuals who are interested in pursuing work related to drug addiction treatment and counseling.
He is now employed at New Directions, a Johnstown treatment center that serves adults transitioning out of inpatient rehabilitation.
Recovering addicts said their substance abuse ultimately became a disease much more serious than the pain that had warranted prescriptions in the first place.
“At the beginning , I enjoyed the feeling of that high,” Ms. McGee said. “Afterward, I became a slave to it. I always knew drugs were bad, but I didn‘t know where they could take you.”
She smiled as she fingered a silver chain around her neck. The necklace, which held an infinity-shaped pendant, had been given to her by a friend as a token of their enduring relationship.
But the piece of jewelry held an additional significance for Ms. McGee.
“It’s like recovery,” she said. “Never-ending.”
Yanan Wang: firstname.lastname@example.org, 412-263-1634 or on Twitter @yananw.