Meperidine

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Meperidine

What Kind of Drug Is It?

Meperidine (meh-PER-ih-deen) is best known by its brand name, Demerol. It is a synthetic opioid, meaning that it is a drug created by chemists to imitate certain medicinal qualities of opium, a drug made from flowers called opium poppies. Opioids are narcotic drugs that cause drowsiness and mood changes by interacting with the nerve cells in a person's brain. They can cause physical addiction with extended use. Physical addiction occurs when the body becomes dependent on a particular chemical substance or a combination of chemicals.

Opioids are controlled substances. This means they are available only with a doctor's prescription. Meperidine is a narcotic analgesic, or pain reliever. It is most commonly used in hospitals for patients who have just had surgery.

An analgesic is any chemical substance that has the ability to control or relieve pain. Many familiar analgesics, including acetaminophen (Tylenol), aspirin, and ibuprofen (Advil; Motrin), are sold in drugstores without a doctor's prescription. These over-the-counter (OTC) drugs must be taken with care to avoid unpleasant or dangerous side effects, but they do not have the power to create physical or psychological addiction.

By contrast, meperidine and other narcotic analgesics are highly addictive substances. They are legal but controlled substances. The only people who are supposed to have access to them are those whose doctors have prescribed the medications to treat specific medical conditions. Some other well-known prescription analgesics include hydrocodone (brand name, Vicodin) and oxycodone (brand names, OxyContin, Percocet, and Percodan). (An entry on oxycodone is also available in this encyclopedia.)

Official Drug Name: Meperidine (meh-PER-ih-deen), meperidine hydrochloride, Demerol, Pethidine (PETH-ih-deen)

Also Known As: Demmies

Drug Classifications: Schedule II, synthetic opioid

As of 2005, drug treatment counselors and law enforcement officials were alarmed at the increasing use of prescription-only opioids such as hydrocodone, meperidine, and oxycodone for illegal, nonmedical purposes. Among those most likely to abuse drugs like OxyContin, Demerol, and Vicodin are teens and young adults who engage in recreational drug use, to experience the mood-altering effects of the drugs. Other abusers of prescription drugs include individuals who have become physically addicted to an opioid after using it to treat a legitimate medical condition.

Overview

Narcotic analgesics are prescribed by doctors to treat moderate to severe pain. The first narcotics were opiates, which are any drugs derived from the opium poppy or synthetically produced to mimic the effects of the opium poppy. Opiates tend to decrease restlessness, bring on sleep, and relieve pain. Opium is a plant-based, chemically complex drug that has been used for thousands of years as medicine and as a recreational drug. Although it does block pain, it is highly addictive. The intensity of its effects is difficult to regulate from one use to the next, which makes it impractical as a pharmaceutical drug.

Prescription Drug Abuse by Teens

The abuse of prescription drugs by teens has increased dramatically in the twenty-first century. Did you know that:

Nearly one out of five teenagers has taken Vicodin to get high.
In 2004, teens were more likely to use a prescription drug than a so-called "street" drug to get high.
Some middle and high school students falsely believe that prescription painkillers are safe to use as recreational drugs.
These same students also believe that using prescription drugs to get high is not illegal.
Some students misuse prescription drugs in an attempt to enhance their athletic performance.
Hundreds of Internet sites offer prescription drugs to anyone with a credit card; 90 percent do not always verify the age of the buyer.
Prescription drug sales have climbed 400 percent since 1990, in part due to "doctor shopping."
"Doctor shopping" is the practice of finding a doctor who will write illegal prescriptions, or of getting prescriptions for a particular drug from more than one doctor at a time.

One of the chemical components of opium is morphine, an addictive opiate that is used to kill pain and bring on relaxation and sleep. In 1806, German chemist Friedrich Sertürner (1783–1841) was finally able to isolate pure morphine from opium. This resulted in the first pure, highly effective analgesic (painkilling) drug for medical use. In 1832, codeine, the other major chemical in opium, was isolated and used as medicine. Both drugs are still in use, individually and in combination with other drugs, because they are very effective pain relievers. However, both are also highly addictive. That is why researchers have continued to try to develop better opiate-like drugs—that is, drugs that possess the pain-relieving power of morphine and codeine, but with fewer negative effects.

One of the first wholly synthesized opioids—or opiate-like drugs—was meperidine. It was first created in the 1930s. It was produced from human-made chemicals, rather than from any part of the opium poppy. Meperidine is still in medical use today.

More About Opioids

Semi-synthetic opioids are drugs that are synthesized with one of the natural opiates, morphine or codeine. Examples of these are hydrocodone (Vicodin) and oxycodone (OxyContin). Both the synthesized and semi-synthesized opioids are drugs specifically created to produce effects similar to opium. They each have particular benefits and drawbacks. Morphine and codeine are still used, however, because researchers still have not found anything that works quite as well as the natural opiates themselves. In addition to their pain-relieving characteristics, opiates and opioids also have something else in common: They are all physically and psychologically addictive to one degree or another. Scientists are still working to try to find a chemical compound that will function as effectively as an opiate-like substance without the dangers of addiction.

What Is It Made Of?

Meperidine hydrochloride (the drug's full name) is a synthetic opioid. It is created through the reaction of two chemicals: dichlorodiethyl methylamine (pronounced di-KLO-ro-di-eh-thyl meh-thyl-A-mine) and benzyl cyanide, an oily, colorless liquid. The chemical name for the resulting white crystalline substance is ethyl 1-methyl-4-phenyl-isonipecotate hydrochloride.

Meperidine is synthesized exclusively from laboratory-made chemicals, and not from any part of the opium poppy. That is why it is called a totally synthetic opioid. By contrast, other well-known narcotics that imitate the effects of opium are said to be semi-synthetic opioids. These drugs are produced with one of the naturally occurring opiates as a starting material. Natural opiates include codeine and morphine. A chemical modification of codeine, another opiate, results in hydrocodone, a highly addictive but effective painkilling drug. By contrast, a chemical alteration of morphine results in heroin, a dangerous and highly addictive narcotic that has no legal use and none of the benefits of narcotic medications.

How Is It Taken?

Meperidine is taken orally or injected. The oral forms of the drug include tablets and syrup. Tablet sizes range from 25 milligrams to 100 milligrams per tablet. The syrup form contains 50 milligrams of meperidine per 5 milliliters of liquid. A typical oral dosage of meperidine is 50 milligrams to 150 milligrams every three to four hours.

The body responds to meperidine more quickly when it is injected, so those dosages are usually about half that of the oral forms of the drug. Injections may be given in the muscle, under the skin, or directly into the bloodstream. Doses are usually given every three to four hours, although an intravenous (IV) administration of meperidine is often maintained at a low, continual therapeutic dose.

Hospitalized patients receiving meperidine for pain control after surgery sometimes use a system called patient controlled anesthesia (PCA). A PCA machine allows a specific amount of meperidine to be administered intravenously each hour. However, the patient has control over when the medicine is dispensed. This reduces the need for a nurse to give the patient an injection every three to four hours, and it keeps the drug at a more constant level in the body for better pain relief. The PCA machine is programmed so that it cannot give the patient too much of the drug. This prevents the potential for an overdose.

Meperidine is abused by people used to taking nonprescription street drugs. Sometimes they crush the meperidine tablets and then chew, snort, or dissolve the drug in a liquid and inject it. Misusing meperidine can dangerously affect the way the body processes the drug.

Are There Any Medical Reasons for Taking This Substance?

Demerol, the brand name for meperidine, is one of the most commonly used narcotic analgesics in U.S. hospitals. It is used to treat moderate to severe pain, especially immediately after surgery. It is sometimes used together with anesthesia before and during operations. Meperidine is also frequently given to pregnant women during labor and delivery. It is not recommended for treating pain in infants and small children or the elderly.

For several reasons, meperidine is used in hospitals more than it is prescribed for at-home use. First, it is more effective in treating the acute (immediate, short-term) pain that follows surgery than the chronic (longer-lasting, ongoing) pain that a patient might experience during recovery at home. It is also eliminated from the body quicker than other opioids, which means that it must be taken more often than other narcotic drugs in order to maintain pain relief. This rapid elimination of the drug also means that its pain-relieving effects are not as consistent as those of other opioids.

Usage Trends

Meperidine is a prescription drug with both legal and illegal usage trends. Meperidine was, and is, particularly useful for the treatment of acute pain, but it is not as effective in controlling chronic pain. Newer synthetic and semi-synthetic opioids include chemical compounds that relieve pain for longer periods of time, but many of the side effects are similar.

Designer Meperidine

In the early 1980s, a new drug was created that imitated the chemistry and effects of meperidine. This so-called "designer" meperidine was known as MPPP. It was manufactured in illegal drug labs where mistakes and unreliable conditions sometimes led to unintended results. One such consequence was the contamination of MPPP with a poisonous chemical by-product called MPTP. This is a toxin that can destroy nerve cells in certain parts of the brain.

When people ingested the MPPP that had been tainted with MPTP, they suffered neurological symptoms that mimicked Parkinson's disease. Their muscles became rigid and they exhibited uncontrollable twitching. The damage was permanent.

The dangerous "designer" meperidine was one of many drugs called "analogs," which means they were created specifically to be similar to, but not exactly like, other drugs. Why was this done? Because illegal drug labs could sometimes avoid Drug Enforcement Administration (DEA) consequences by making drugs whose specific chemical formulas were not listed on the Schedule of Controlled Substances. Illegal drug manufacturers could get away with making a drug that acted like a highly controlled substance, but had a slightly different chemical structure than the regulated drug. For a time this was not illegal.

In 1986, however, legislation was passed to stop this practice and make the manufacture of analog drugs illegal. It was finally against the law to create a drug that was designed to produce effects similar to any drug already listed as a controlled substance.

Although meperidine is still used in hospitals and emergency treatment settings, Drug Enforcement Administration (DEA) figures show that between 1990 and 1996, the legitimate medical use of meperidine in the United States decreased by 35 percent. Worldwide, the legitimate use of meperidine dropped 20 percent between the early 1980s and 1999. The decline in usage of meperidine is related to the development of newer opioids that are safer and longer lasting than meperidine.

Street usage of meperidine became a law enforcement issue during the 1980s, when it was frequently used as a substitute for heroin. In particular, two meperidine analogs, or imitation drugs, became popular: MPPP and PEPAP. Heroin users like MPPP because it produces a heroin-like euphoria when it is injected. The creation of these analogs is now completely illegal. This occurred, in part, because during the 1980s street drug labs produced an analog that contained MPTP, a poison that caused serious and irreversible neurological damage in users.

Among opioids, Demerol (brand name of meperidine) is not as frequently prescribed outside hospital settings as Vicodin and OxyContin, so its abuse is not as widespread or well-publicized as the abuse of these other drugs. Demerol is more readily available to medical professionals—doctors, nurses, pharmacists or others who work in a hospital or emergency care clinic—than to others. It is sometimes stolen from ambulances or standalone emergency care facilities through street robberies or "inside" thefts perpetrated by employees.

Prescription Drug Abuse Grows

The illegal use of prescription drugs, including opioids like meperidine, is a large and growing segment of the complete drug abuse picture. Several nationwide studies track the use of both legal substances (prescription medications and over-the-counter, or OTC, drugs) and illegal drugs such as marijuana and cocaine. The National Household Survey on Drug Abuse (NHSDA), which is conducted by the U.S. Department of Health and Human Services, collects yearly statistical data on five drug groups. These include: 1) marijuana and hashish; 2) psychotherapeutic drugs, which are generally prescription drugs that can be used illegally to get high; 3) cocaine and crack; 4) hallucinogens, which are substances that bring on hallucinations, which alter the user's perception of reality; and 5) inhalants. Psychotherapeutic drugs include stimulants, sedatives, tranquilizers, and pain relievers. Meperidine and other opioids make up the majority of the pain relievers in that group.

In 2003, the NHSDA found that 4 percent of all people between twelve and seventeen reported that they had used some kind of psychotherapeutic medication during the previous month for a nonmedical—illegal—purpose. More than 9.2 percent in that age group reported such use at any time during the year. In 2003, 6 percent of individuals between eighteen and twenty-five reported nonmedical use of prescription drugs in the month prior to the date on which they were surveyed. That was up from 3.6 percent in 2000 and just 1.6 percent in 1994.

According to the NHSDA's 2000 study, approximately 1.6 million Americans used prescription pain relievers nonmedically for the first time in 1998. During the 1980s, there were generally fewer than 500,000 first-time users per year. The trend shows steadily rising numbers of people using prescription drugs for nonmedical use.

New Generation of Abusers

Another yearly study is conducted by the Partnership for a Drug-Free America. In April 2005, the Partnership released the results of its seventeenth annual national study of teen drug abuse. The 2004 Partnership Attitude Tracking Study (PATS) reported that one of every five teenagers has used a prescription painkiller as a recreational drug. The most frequently abused brand-name opioids were Vicodin (reported by 18 percent of respondents) and OxyContin (reported by 10 percent of respondents). These are narcotic analgesics whose nonmedical effects on users are similar to those of meperidine (brand name Demerol). Overall, teen misuse and abuse of prescription drugs, including opioids, is growing rapidly. As a result, teens were given the nickname "Generation Rx." (See chart on this page.)

Teens are drawn to the use of prescription drugs for a variety of reasons, including ease of availability, relatively low cost, and a perception that the pills are harmless because they are legal. According to Carol Falkowski, a drug researcher at Hazelden, a well-known substance abuse treatment center in Minnesota, young drug users often prefer prescription drugs because they believe they are "cleaner, safer and less illegal." Teens also admit that they find prescription drugs more attractive than other substances because they are not as likely to leave signs of use, such as the visible disorientation of being drunk or the odor that results from smoking marijuana.

Generation Rx

"Rx" is a traditional abbreviation for the word "prescription." "Generation Rx" is a term coined in 2005 to reflect the soaring popularity of prescription drugs among teens. This nonmedical, and illegal, use of drugs such as Ritalin, Vicodin, OxyContin, Xanax, and Valium is sometimes called "pharming" by drug counselors and by teens themselves.

The phenomenon is not limited to teens, however. Well-known public figures including actors Matthew Perry and Melanie Griffith and athletes Brett Favre and Darryl Strawberry have publicly battled addictions to the prescription painkiller Vicodin. In October 2003, radio personality and former ESPN sports analyst Rush Limbaugh entered a treatment center to deal with his addiction to OxyContin.

While adults often become addicted to pain pills after using them for a legitimate medical reason, teen use of the drugs is typically more recreational. If there is no legitimate medical need to get a prescription from the family doctor, some teens resort to stealing pills from medicine cabinets at home or order them from Internet pharmacy sites.

Teens mistakenly believe that because these are brand-name drugs, manufactured by legal pharmaceutical companies, they are safe. Teens often do not realize how dangerous it is to mix prescription drugs with alcohol, or to combine different drugs "to see what happens." Even adults frequently are not aware that large quantities of the over-the-counter medicine acetaminophen—commonly known as Tylenol—can cause liver damage. This is important to know because one of the main ingredients in Vicodin is acetaminophen.

Students often do not realize, either, that the nonmedical use of prescription medicines is against the law. "Generation Rx" teens who commit crimes related to the abuse of prescription drugs not only risk addiction or other physical consequences, they also face job loss, jail time, or being denied access to scholarships and other financial aid to further their post-high school education.

Effects on the Body

Physical pain occurs when illness or injury causes pain signals to be transmitted to the brain through nerve cells in the body. The pain-relieving effect of an opioid like meperidine is produced when

the drug blocks these signals by interacting with proteins called opioid receptors that exist on the surface of nerve cells. The chemical relationship is something like keys and locks. The narcotic drug fits into the receptor proteins and opens a pathway for chemical changes that reduce the ability of the nerve cell to transmit pain signals. When this happens, fewer pain signals are received by the brain, which means that the person taking the drug feels less pain.

If opioids are used when one is not in pain, the chemical changes in the nerve cells and the brain can produce feelings of euphoria, or a state of extreme happiness and well-being. When this occurs over a period of time, the nerve cells become tolerant of the effect, which means that more of the chemical substance is needed to produce the same sensation. Over the course of time, the body also becomes addicted to the basic chemical action of the drug. Thus, if the drug is discontinued, the user experiences unpleasant physical symptoms of drug withdrawal.

Addiction Problems

Opioids can also cause psychological addiction or dependence. This is present when a person craves a drug and feels a compulsive need to take it, no matter what the consequences may be. This is what drives many people to commit crimes ranging from fraud to robbery in order to acquire the prescription drugs on which they are dependent. They become psychologically addicted to the emotional sensations that accompany the physical effects of the drug. Psychological addiction generally does not occur when people use prescription opioids for long-term, chronic pain. However, it is possible for legitimate use to turn into abuse in individuals who have developed physical dependence when their doctors decide that prescription narcotics are no longer appropriate as treatment. This is what has happened to many people who have become hooked on these painkilling drugs that were prescribed for them for long-term use after surgery or an injury of some kind.

Meperidine is generally used to treat acute pain, so medical use does not usually lead to either physical dependence or tolerance. Prescription users of meperidine do not need more and more of the drug to get the needed level of pain relief. However, when the drug is used specifically to get high, users typically develop both physical tolerance and addiction and psychological addiction. This means they not only crave the drug and physically need more of the drug just to get high, they also need to keep taking the drug to avoid the discomfort of chemical withdrawal.

When a person who is addicted to the physical aspects of a drug suddenly stops taking that drug, withdrawal symptoms occur. Opioid withdrawal is not life threatening, as is sometimes the case with the physical withdrawal from some heavily used substances, such as alcohol and barbiturates. It is unpleasant, however. Short-term withdrawal symptoms include anxiety, yawning, sweating, abdominal cramps and diarrhea, chills and "goose bumps," and a runny nose. Symptoms begin to appear about four or five hours after the last dose. They are at their most intense between thirty-six and seventy-two hours later, and are generally over within a week or ten days. Complete detoxification and recovery from physical addiction can take six months or more.

Side Effects of Meperidine Use

Even when meperidine and other opioids are taken under medical supervision, side effects can occur. Opioids relieve pain by temporarily altering the function of nerve cells. In addition to reducing one's pain, this may also cause mental confusion, drowsiness, dizziness and/or nausea, constipation, sweating, low blood pressure, or a slow heartbeat. More serious effects include convulsions and respiratory distress. These most frequently occur if the drug's dosage is too high, or if a patient combines meperidine with alcohol or other drugs.

Patients with kidney or liver disease may be at risk of nervous system damage if they use meperidine for a significant length of time. A by-product of meperidine called normeperidine is broken down in the liver and excreted by the kidneys. Someone with impaired function of either organ may develop high levels of normeperidine, which can be toxic (poisonous) to the nervous system.

People with a history of seizures, or those who have experienced recent head trauma, which puts them at risk of a first seizure, should avoid the use of meperidine. This is because meperidine presents a higher risk for seizures than other opioids. Other serious, but rare, neurological side effects include delirium, hallucinations, and tremors. Allergic reactions to meperidine are unusual, but severe cases can cause symptoms such as cold, clammy skin, generalized weakness, respiratory arrest, and unconsciousness or coma.

Reactions with Other Drugs or Substances

Because meperidine acts as a central nervous system depressant, no other similarly acting substance should be taken with meperidine, unless it is under the close supervision of a physician. Alcohol is a prime example of this. So are drugs known as sedatives, which are used to treat anxiety and calm people down. A large enough dose of any opioid, including meperidine, can stop a person's breathing completely, resulting in death. In combination with alcohol or sedatives, this reaction can occur at much lower doses.

Drugs to be avoided while taking meperidine include most antihistamines, sleeping pills, and any drugs that are in the same classification as Valium. Several types of antidepressants should be used with great caution or not at all in combination with meperidine. These include tricyclics (brand name examples include Elavil and Aventyl); SSRIs (selective serotonin reuptake inhibitors; some name brand examples include Prozac, Zoloft, and Paxil); and MAOIs (monoamine oxidase inhibitors; examples include Marplan and Nardil). Even moderate therapeutic doses of meperidine administered up to two weeks after a patient has used an MAOI-class drug can result in unpredictable and severe reactions, including coma and death.

Treatment for Habitual Users

Meperidine is a highly addictive, Schedule II opioid narcotic. A high potential for addiction usually means that long-term use is risky. Long-term use may be measured as years of continual use, or as a repeating cycle of periods of use interrupted by times when the drug is not being used. The longer a narcotic drug is used, the more likely it is that a person may need help to quit using it. People who become addicted to drugs like meperidine or other prescription painkillers are less likely than users of street drugs to seek assistance in withdrawing from taking the drug.

When an opioid is suddenly discontinued after a long period of use, serious and uncomfortable withdrawal symptoms generally occur. Most people who manage to overcome an addiction to meperidine do it on their own, but many cases require professional help. Symptoms of physical withdrawal from meperidine may include restlessness, pain in bones and muscles, insomnia, diarrhea, a runny nose, chills with goose bumps, and involuntary leg movements. Symptoms of psychological addiction include becoming severely depressed and having an almost uncontrollable craving or desire for the drug.

For a chronic addiction, meaning drug use and addiction that has lasted more than a year, methadone may be used in a medically supervised withdrawal process. (An entry on methadone is also available in this encyclopedia.) Methadone is another opioid. It is used in progressively smaller doses to help users break free of addictions to more powerful drugs. Methadone helps reduce withdrawal symptoms, including the craving of another opioid, and it has fewer side effects than other opioids.

An Alternative Treatment

Since 2002, drug treatment specialists have experimented with a new drug called buprenorphine (BYOO-preh-NOR-feen). One day it might replace the use of methadone to treat withdrawal symptoms. Early results are promising, but access to the drug is still strictly limited by government control.

Researchers are hopeful that buprenorphine can help people break free of addiction to opiates such as heroin and codeine, and to opioid pain pills like Demerol, Vicodin, and OxyContin. Also known by the names Suboxen and Subutex, the drug has similar effects on the body as methadone but it is not as addicting as other opiate or opioid-like drugs. Controlled doses of buprenorphine help people withdraw from their addiction to drugs like heroin and Vicodin without some of the complications of methadone treatment. Doctors who have used buprenorphine consider it a successful treatment option and they wish more patients could benefit from it.

According to federal law, only doctors who earn special certification from the Drug Enforcement Administration (DEA) are allowed to prescribe buprenorphine. In addition, the law specifies that each certified doctor or group practice is limited to treating thirty patients at a time with the drug. By early 2005, only 4,850 of 600,000 U.S. doctors—fewer than 1 percent—had earned certification to dispense the drug. Of those, only 1,500 had treated patients with it.

Cost of Abuse

At between $300 and $350 per month for treatment, buprenorphine is expensive, and many insurance companies will not pay for it. However, people with pain pill addictions often spend more than $300 every month to support their habits. Plus, the true cost of addiction can include the breakup of a marriage or family, the loss of a job, and a criminal record.

What is the best balance between controlling access to the drug and making it available to all who need it in a treatment setting? The DEA wants to maintain close restrictions on the use of buprenorphine to prevent a possible new drug abuse "epidemic." Doctors who use it to treat patients with opioid addictions want to be able to help more people, and sooner, rather than later. While the waiting lists grow, doctors and other addiction treatment professionals will have to work with federal lawmakers to figure out how to best use this resource.

Consequences

Meperidine and other opioids offer specific benefits when they are used appropriately. However, the benefits of the drugs must be weighed against the possibility of abuse or addiction. An established addiction is costly to maintain—financially, emotionally, and physically. Sufferers admit that a serious opioid addiction consumes all their energy. Everything in their lives eventually revolves around obtaining more of the drug. When the drug becomes the focus of life, they lose friends, alienate family members, and often find themselves unable to hold a job.

Those who are caught committing crimes to maintain their addiction may end up serving jail or prison time. The ultimate consequence may be the loss of life that can result from the abuse of a prescription drug—whether it is from the physical effects of an overdose or through violence that occurs as a result of the addiction.

When meperidine is used exclusively as a recreational drug, consequences include the very real possibility of overdose or severe interactions with other substances. According to the Partnership for a Drug-Free America, nearly half of all teens believe that the recreational use of prescription drugs is safer than the use of illicit street drugs. About one-third of teens do not realize that narcotic painkillers are addictive.

Unexpected Outcomes

Teens are drawn to the use of prescription drugs for a variety of reasons, including ease of availability, relatively low cost, and a perception that the pills are harmless because they are legally obtainable by prescription. This lack of knowledge about the physical effects of narcotics, as well as the consequences of using them illegally, can result in unexpected and tragic outcomes.

Healer or Dealer?

On April 14, 2005, Dr. William E. Hurwitz, a well-known pain doctor from McLean, Virginia, was sentenced to twenty-five years in prison. He was convicted in December 2004 of narcotics trafficking and running a drug conspiracy. The doctor was held responsible in the death of one patient and the serious injury of two others.

The case was watched closely because it reflected the ongoing debate over whether doctors should be allowed to prescribe large quantities of narcotic medications to patients who are in chronic pain. Critics of Dr. Hurwitz said that he continued providing patients with massive doses of highly addictive drugs, even when he knew that some of them were misusing or abusing their medications or selling them to others. The doctor's supporters said that he was a dedicated and caring medical professional. They believed he was determined to provide chronic pain sufferers with the relief they needed, despite intense government scrutiny of his drug prescription activity.

How the outcome of this case will affect the prescribing activity of doctors who specialize in pain control remains to be seen. However, the United States has an aging population that is living longer. With more people living more years with chronic conditions that cause pain, the "access vs. control" debate over pain relief drugs will continue.

The misuse of meperidine and other opioids affects people who live with chronic pain, because doctors become reluctant to write prescriptions that are needed for adequate pain relief. Members of the medical community agree that more education is needed by both doctors and patients to help prevent abuse and addiction. They want to ensure that patients truly in need are not denied access to meperidine and other narcotics based on misperceptions and fear. The benefits for individuals and society are great when pain is treated safely and effectively.

The Law

Meperidine is classified as a Schedule II controlled substance, which means that it is strictly regulated by both United States and international laws and agencies. In the United States, the Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA) control the manufacture and distribution of meperidine. International control is coordinated by the International Narcotic Control Board (INCB).

A Schedule II drug is available by prescription only. It is illegal to write a prescription or an order for meperidine without a valid medical license. Medical doctors, osteopathic doctors, podiatrists, dentists, and veterinarians are the only professionals allowed to legally prescribe meperidine and other Schedule II drugs. Medical professionals who intentionally write multiple prescriptions for patients without a valid medical reason may end up in prison. It is an even more serious crime to write and fill phony prescriptions for profit.

Doctor Shopping and Other Illegal Methods

It is illegal for individuals to obtain prescriptions for meperidine and other opioids by lying about their symptoms. Another dishonest way that people try to get drugs for illegal use is by going to several different doctors within the same time period and receiving prescriptions from each of them. Then they pay cash to buy each prescription at a different pharmacy to avoid being tracked by pharmacy or insurance records. This practice has been given the name "doctor shopping." As of 2004, at least nineteen states had laws against doctor shopping. Prescription Monitoring Programs (PMPs) are used on a state-by-state basis to track this activity.

Sometimes people try to acquire Schedule II drugs illegally by stealing prescription pads from doctors' offices, or by printing up phony prescription forms. Then they use those to write false prescriptions with forged signatures. These tactics are rarely successful over the course of time. Pharmacists often verify the validity of prescriptions for opioids by contacting the doctor listed as the prescribing physician. Bogus prescriptions can be stopped at this point. Pharmacists are also among the first to notice high numbers of Schedule II prescriptions being written by particular doctors. One unintended effect of this kind of monitoring is that many doctors have become reluctant to prescribe enough effective medication for patients who experience chronic pain.

For More Information

Books

Gahlinger, Paul M. Illegal Drugs: A Complete Guide to Their History, Chemistry, Use and Abuse. Las Vegas, NV: Sagebrush Press, 2001.

Kuhn, Cynthia, Scott Swartzwelder, and Wilkie Wilson. Buzzed: The Straight Facts about the Most Used and Abused Drugs from Alcohol to Ecstasy, 2nd ed. New York: W.W. Norton, 2003.

Mogil, Cindy R. Swallowing a Bitter Pill: How Prescription and Over-the-Counter Drug Abuse Is Ruining Lives—My Story. Far Hills, NJ: New Horizon Press, 2001.

Pinsky, Drew, et al. When Painkillers Become Dangerous: What Everyone Needs to Know about OxyContin and Other Prescription Drugs. Center City, MN: Hazelden Foundation, 2004.

Youngs, Bettie B., and others. A Teen's Guide to Living Drug Free. Deerfield Beach, FL: Health Communications, 2003.

Periodicals

Leinward, Donna. "Prescription Abusers Not Just after a High." USA Today (May 25, 2005).

Markon, Jerry. "25-Year Sentence for Pain Doctor." Washington Post (April 15, 2005): p. B1.

Weathermon, Ronnie A. "Controlled Substances Diversion: Who Attempts It and How." U.S. Pharmacist (December, 1999): p. 2.

Web Sites

"Federal Prosecution of Pain Docs Impedes Pain Treatment." Our Chronic Pain Mission.http://www.cpmission.com/main/painpolitics/impedes.html (accessed July 26, 2005).

Gayette, Curt. "In Vicodin's Grip." MetroTimes: Detroit's Weekly Alternative, May 22, 2001. http://www.metrotimes.com/editorial/story.asp?id=1824 (accessed July 26, 2005).

"Generation Rx: National Study Reveals New Category of Substance Abuse Emerging: Teens Abusing Rx and OTC Medications Intentionally to Get High" (April 21, 2005). Partnership for a Drug-Free America.http://www.drugfree.org/Portal/DrugIssue/Research/Generation_Rx_National_Study_Reveals_New_Category/Teens_Abusing_Rx_and_OTC_Medications (accessed July 26, 2005).

"How Can Mis-using or Abusing Rx Drugs Hurt You?" Freevibe.com.http://www.freevibe.com/Drug_Facts/prescription_effects_abuse.asp (accessed July 26, 2005).

"Kids Getting High—and Hooked—on Prescription Drugs." The Official D.A.R.E. Web site.http://www.dare.com/parents/Parents_NewsRoom/kidsgettinghigh.asp (accessed July 28, 2005).

Monitoring the Future.http://www.monitoringthefuture.org and http://www.nida.nih.gov/Newsroom/04/2004MTFDrug.pdf (both accessed July 26, 2005).

"National Household Survey on Drug Abuse (NHSDA)." U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.http://oas.samhsa.gov/nhsda.htm (accessed July 28, 2005).

National Institute on Drug Abuse.http://www.nida.nih.gov and http://www.drugabuse.gov (both accessed July 26, 2005).

"Opioids: Beyond the ABCs." Alberta Alcohol and Drug Abuse Commission.http://corp.aadac.com/other_drugs/the_basics_about_other_drugs/opioids_beyond_abcs.asp (accessed July 26, 2005).

"Prescription Drugs." National Institute on Drug Abuse.http://www.nida.nih.gov/drugpages/prescription.html (accessed July 26, 2005).

Rubinkam, Michael. "Heroin Addicts Clamor for Scarce Medicine." Associated Press My Way News.http://apnews.myway.com/article/20050429/D89OO4JG0.html (accessed July 26, 2005).

"Teen Drug Use Declines 2003–2004—But Concerns Remain about Inhalants and Painkillers" (December 21, 2004). National Institute on Drug Abuse.http://www.nida.nih.gov/Newsroom/04/NR12-21.html (accessed July 26, 2005).

"Trouble in the Medicine Chest (I): Rx Drug Abuse Growing" (March 7, 2003). U.S. Department of Health and Human Services and SAMHSA's National Clearinghouse for Alcohol and Drug Information: Prevention Alert.http://ncadi.samhsa.gov/govpubs/prevalert/v6/4.aspx (accessed July 26, 2005).