Those at the highest risk for painkiller addiction continue to get opioid medications through a doctor’s prescription, according to a new study released today.

The U.S. Centers for Disease Control and Prevention (CDC) found that 27.3 percent of people who use opioid pain relievers more than 200 days out of the year for nonmedical reasons are able to get them from a prescribing physician.

This, according to CDC Director Dr. Thomas Frieden, reveals a hole in prevention efforts aimed at reducing the growing epidemic of prescription drug overdoses and deaths.

“Many abusers of opioid pain relievers are going directly to doctors for their drugs,” Frieden said in a statement to the media. “Health care providers need to screen for abuse risk and prescribe judiciously by checking past records in state prescription drug monitoring programs. It’s time we stop the source and treat the troubled.”

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Where Are the Pills Coming From?

The new report, published in the American Medical Association’s journal Internal Medicine, shows that many high-risk opioid users continue to obtain prescriptions from doctors. Other common avenues for these heavy users include getting pills from relatives and friends for free, or buying them from friends, relatives, or drug dealers.

The researchers used data from the National Survey on Drug Use and Health from 2008 to 2011, which included more than 12 million people who admitted to using opioid painkillers for non-medical uses. Nearly 64 percent used the pills for less than 30 days out of the year, and they typically got them from friends or relatives.

“These results underscore the need for interventions targeting prescribing behaviors, in addition to those targeting medication sharing, selling, and diversion,” the researchers concluded. “The essential steps health care providers can take to curb this serious health problem include more judicious prescribing, use of prescription drug-monitoring programs, and screening patients for abuse risk before prescribing opioids.”

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The Rising Tide of Opioid Overdoses

Opioids, a class of painkilling drugs, include oxycodone and hydrocodone and are sold under brand names such as Oxycontin and Vicodin. They are approved to treat chronic pain caused by injury or disease.

In a second study, also published in JAMA Internal Medicine, officials investigated the increasing use of opioids in Tennesee. Over the course of the five-year study, officials discovered that opioid prescription rates had increased by 32 percent and that, on average, one-third of all Tennesseans had filled a prescription for an opioid drug each year.

To combat the problem of drug misuse, the CDC recommends better drug overdose tracking, abuse-deterrent drug formulations, and requiring drug manufacturers to sponsor proper-use educational programming.  

The U.S. Food and Drug Administration (FDA) approved a new, stronger hydrocodone-based drug, Zohydro ER, last year, despite protests from 40 medical specialists29 state attorneys general, and the FDA’s own advisory panel. It will become available in the U.S. next month.

Rates of opioid painkiller abuse continue to rise sharply. From 1999 to 2010, deaths from opioid overdoses quadrupled to more than 17,000. Prescriptions from retail pharmacies hit 219,000 in 2011, nearly three times as many as in 1991, according to the latest figures from the CDC.

Drug-related overdoses are now the leading cause of accidental death for Americans ages 25 to 64.

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Heroin Making a Comeback

However, as authorities crack down on “pill mills”—clinics that provide hundreds of dubious prescriptions for narcotics—those addicted to opioids are switching to heroin, and heroin overdoses are on the rise as well.

Experts say the increase in heroin use is linked to prescription opioid abuse. Young people often become addicted to painkillers and progress to heroin—which provides the same euphoric high—when pills are hard to come by.

Heroin use rose by 75 percent between 2007 and 2011, with an 80 percent increase in first-time use among 12- to 17-year-olds since 2002, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).