Most Americans who abuse prescription pain killers get them free from friends or family, but a new study released on Monday shows that addicts who use these opiates most frequently gravitate toward doctors or dealers to get their fixes.
U.S. government researchers found that nearly one in three "high use" abusers - people who take opioids between 200 and 365 days a year - obtained a doctor's prescription for the drugs, compared with about one in five of those who used the drugs less than 30 days over the course of a year.
High users were also more than three times more likely to buy these drugs from dealers, researchers wrote in the Journal of the American Medical Association Internal Medicine.
Less frequent users were more likely to obtain the narcotics at no charge from people they knew, compared with high use abusers, 62 percent versus 26 percent, according to the review.
Researchers said their analysis shows the need to shift the focus of prevention to targeting the abuse of prescription narcotics such as morphine, codeine, oxycodone and hydrocodone.
Prevention programs should concentrate much more on ensuring that doctors prescribe pain killers judiciously, screen patients
carefully and conduct follow-up monitoring of frequent users.
"This is the group where we really need to be targeting our efforts because they're most at risk for overdose or dependence," lead author Christopher Jones, former head of the CDC's prescription drug overdose team, told Reuters.
Jones, now at the Food and Drug Administration's policy office, added that the results also show the "need to think about what role do physicians play. How can they be better equipped to identify patients who are non-medically using and help assist them?"
The findings come as Zohydro, a high-potency prescription opioid from Zogenix Inc, is set to hit the U.S. market this month, despite objections from law enforcement officials, addiction experts, drug treatment providers and physicians.
Jones and his colleagues reviewed data from a government survey on drug use from 2008 to 2011 and found that, on average,
more than 12 million people age 12 and older were estimated to have used prescription opioids at least once a year to get high.
They found several ways people obtain such drugs for non-medical use: free from friends or family, purchased from someone they know, purchased from a drug dealer, stolen from a known person, or obtained through a doctor.
Attention has focused in recent years on the control of prescription pain killers to help stem abuse, in particular oxycodone, sold by Purdue Pharma under the Oxycontin brand.
The FDA, which approves medicine for sale in the United States, has taken measures to curb abuse, such as requiring drug makers to have risk management plans and to educate doctors.
Zogenix Executive Vice President Bradley Galer said on Monday the company's risk management program for Zohydro, which includes more safety information, "will help prescribers understand better what small subset of patients" are suited for the drug. These are people who need daily, around-the-clock pain treatment, but have found no relief with other opioids.
The FDA has recommended tighter restrictions on hydrocodone products. Last week, the Drug Enforcement Administration said drugs containing the ingredient should be more tightly restricted along the lines of morphine and oxycodone. That would make them harder to obtain, requiring, for example, that doctors write a prescription, not call one into a pharmacy.