Prescriptions for painkillers in the United States have nearly tripled in the past two decades and fatal overdoses reached epidemic levels, exceeding those from heroin and cocaine combined, according to the Centers for Disease Control and Prevention (CDC).
At the same time, the first-ever global analysis of illicit drug abuse, published this month in the British medical journal The Lancet, found that addictions to heroin and popular painkillers, including Vicodin and OxyContin, kill the most people and cause the greatest health burden, compared with illicit drugs such as marijuana and cocaine.
High-income nations, such as the United States, the United Kingdom and Australia, had the highest rates of abuse, 20 times greater than in the least affected countries, according to the Lancet study.
In the United States, enough painkillers were prescribed in 2010 to medicate every American adult around the clock for one month.
Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing, told Al Jazeera that the U.S. is facing a dangerous epidemic of overdoses and addictions related to painkillers. "According to the CDC, this is the worst drug epidemic in U.S. history," he said. "CDC has data demonstrating that around the same time doctors began aggressively prescribing these medications in the late 1990s, there have been parallel increases in rates of addiction."
The Food and Drug Administration, Kolodny said, is "failing miserably" at curbing the epidemic.
"The way to turn this epidemic around is for doctors to prescribe painkillers more cautiously," he said. But that can only happen, Kolodny said, when the FDA changes labeling requirements for painkillers, "making it easier for medical schools and the larger medical community to prescribe these meds more cautiously." He called current FDA-approved labeling "very broad," because the drugs have no suggested maximum dose or suggested duration of use.
Kolodny is part of a group of health officials who signed a citizens' petition (PDF) in 2012 urging the FDA to change labeling requirements on how and when doctors should prescribe painkillers. The group called on the FDA to limit the drugs' approved use to those suffering from "severe" pain, as opposed to the current FDA-approved standard of "moderate to severe pain."
FDA spokeswoman Morgan Liscinsky, however, said that prescription painkillers are an important component of modern pain management. The FDA, she said, is working to balance the dual responsibility of addressing misuse, abuse and addiction with continuing to ensure appropriate access to effective pain management for patients who need these medications.
The FDA "is extremely concerned about the inappropriate use" of painkillers, she said, "which has become a major public health challenge for our nation," and the agency "is committed to ongoing efforts to address the problem and supports broader initiatives to address this public health problem, including regulatory, educational and scientific activities."
But according to Kolodny, the notion that there are two different groups of people using painkillers -- those who need them and those who abuse them -- is a false dichotomy. "The bulk of these prescriptions are unnecessary and can lead to addiction," he said. "Painkillers in many cases are actually ineffective in treating long-term pain."
Nevada state Sen. Richard Segerblom, a longtime backer of efforts to curb prescription drug abuse, told Al Jazeera that the overprescribing of painkillers is the equivalent of "legalized heroin." One of the dangers of physicians recklessly prescribing painkillers, he said, is that once patients are taken off the medication, some of them turn to heroin, a cheaper alternative with similar effects.
Nevada had the third-highest rate of prescription-drug overdose deaths in 2008, according to a 2013 CDC report. The same report found that in 2010, the state was tied for second among states in the amount of prescription painkillers sold per 10,000 people.
Segerblom, a Democrat, was behind a controversial bill introduced in February that would have allowed patients addicted to painkillers to sue their doctors and the drugmaker for the cost of rehabilitation programs. "Reckless doctors and drugmakers should pay the consequences for dangerous overprescribing," he said.
Although the bill failed to pass, Segerblom said the attempt garnered "a lot of publicity" and helped to raise awareness.
A global problem
The study published in The Lancet examined four categories of illegal drugs -- opioids (which include painkillers and heroin), cocaine, amphetamines and cannabis.
Worldwide, of the estimated 78,000 deaths in 2010 stemming from illicit drug use, more than half were due to opioid addictions. More than two-thirds of addicts were male, and rates of abuse were highest in men ages 20 to 29.
The United States consumes 80 percent of the world's supply of painkillers, according to 2011 congressional testimony from the American Society of Interventional Pain Physicians.
A Los Angeles Times article in August revealed that the maker of OxyContin, Purdue Pharma LP, had been compiling a database for the past decade of some 1,800 doctors suspected of recklessly prescribing the painkiller. Shortly after the article was published, Segerblom asked the Connecticut-based company to turn over information on Nevada doctors suspected of overprescribing the painkiller, information that would be used by the state medical board in any potential investigation.
Representatives from the company met with state health officials Aug. 29 and supplied the names of 29 doctors, according to Segerblom.
"The epidemic is getting worse, and it's not going away anytime soon," he said. "I think the states are working hard at finding solutions, and we'll keep pushing for them."