07:57 PM EDT on Monday, May 8, 2006

BY DANIEL BARBARISI
Journal Staff Writer

You feel like you have the flu. But it doesn't make sense -- It's been weeks, verging on months, that you've been feeling this way. You're run-down, not yourself, dragging through every day. You know you can't be sick, but you can't figure out what's wrong.

The last time you felt good was when you were taking that medication for your back, or your knee, or to help you sleep. It seems like this poor feeling started when you stopped taking the medication; so, you think, it must be that old injury acting up, bringing you down overall.

AP photo

Rep. Patrick Kennedy speaks during a news conference May 5 in Washington. Kennedy said he was entering treatment for addiction to prescription pain medication.

You just want to feel normal again.

You go to your doctor, and convince him to give you another prescription of that medication, to make the back or knee pain go away. You take it, and you suddenly feel right again. The back is better, sure, but more than that, the dragging feeling is gone, and your head is finally clear.

You may not realize it, but you're a prescription drug addict, and you've just gotten your fix.

Like U.S. Rep Patrick Kennedy, who admitted a prescription drug dependency last week and has checked himself into the Mayo Clinic in Minnesota to rehabilitate, millions of Americans suffer from a dependency on prescription medications.

Kennedy has not disclosed what drug he is addicted to. But he said he has been using various prescription drugs for years, stemming from efforts to deal with back surgery nearly 20 years ago. Kennedy said he took the prescription drugs Phenergan and Ambien before he crashed his Mustang convertible into a security barrier in Washington, D.C., early Thursday.

The National Institute on Drug Abuse estimates that 20 percent of the U.S. population have used prescription drugs for non-medical reasons during their lifetimes. According to the 2003 National Survey on Drug Use and Health, 6.3 million Americans had taken prescription drugs for non-medical reasons in the past 30 days.

Prescription drug addiction is usually nothing like the addictions we see in the movies, where with a drug like cocaine, the user is constantly looking for the next high. According to Alan Gordon, director of drug and alcohol treatment services at Providence's Butler Hospital, a prescription drug addict is just trying to drag himself back to normalcy.

"It's very, very easy to get addicted without even having any desire to rebel, to seek pleasure, or anything," Gordon said. "The tragedy of prescription drug addiction is that you're usually using them just to feel comfortable."

When a prescription drug is first taken, Gordon said, it can flood the user with large amounts of endorphins and chemicals normally produced by the human body. With an outside source available, the body temporarily ceases production of these endorphins, which are needed to keep emotions and bodies balanced, he said.

As long as the drug provides these chemicals, the person feels fine. When the prescription ends and the drug works its way out of the system, however, in some cases the body fails to recognize that it needs to start producing these chemicals again, Gordon said.

Suddenly, the person does not feel right, and a protracted feeling of sickness -- like a bad case of the flu, mixed with a stomach virus -- and mild depression can result.

"You can't get a clear head, can't stop your bones from aching. There is an urge to feel better. It's 90 percent physical, 10 psychological," Gordon said. "Most people are just trying to be like you and I. They're just trying to get what their body requires or needs," Gordon said.

PRESCRIPTION DRUG addicts come from all walks of life, and unlike with some drugs, socioeconomic status is no hint of a pattern of addiction.

"From Rush Limbaugh to Patrick Kennedy to the truck driver to the homeless person," there is little rhyme nor reason to who becomes addicted, Gordon said.

However, those with other addictions, or a history of mental illness -- such as Kennedy's bipolar disorder, which causes dramatic mood swings -- are at much higher risk.

Once the addict has developed a dependency, a regular source for the drug must be found. Initially, doctors are often hard-pressed to figure out which patients are just looking for another few weeks of relief from an ache or pain and which are facing a burgeoning addiction. There is no brain scan, or blood test, that will confirm the problem.

The addict will press the doctor for as long as is possible, but eventually the doctor will likely refuse to provide another dose.

"At some point, you've got to start getting crafty by taking some from your mother's medicine cabinet, or buying it on the street," Gordon said.

They also start wanting larger doses of the drug, said Dr. Ron Golinger, an addiction psychiatrist in private practice in Providence.

"Something gets turned on in the brain of the user, that they not only become dependent on it, but they also start to want more of it," he said.

But for months or even years, prescription drug users can appear outwardly normal while they are addicted, Golinger said. Close friends will tell them they have a problem, but denial is almost a certainty in such cases.

"The people don't get that they're addicted in the early to middle stages. They hear it from other people, or the negative consequences start to add up. But they truly don't see the connection to the fact that they're using the drug," Golinger said.

Work is often the last thing to fall apart, so many people in the public eye can maintain a problem-free facade while their private life deteriorates.

At a certain point, after another relationship lost or car crashed, users may start to recognize that the drug is damaging their life, Golinger said

But the fear of life without the drug can be overpowering.

"They think, 'How could I function without it?' " Golinger said.

Very few users have the epiphany where they wake up one morning and decide to stop. More often, it is a catastrophic circumstance, a great embarrassment, or the intervention of friends or family that forces the user to stop.

"Terror, or pain, or both. Pain and terror are what get people clean and sober almost all of the time," Golinger said.

UNFORTUNATELY, THERE is no quick fix for prescription drug addiction, as Kennedy's case makes clear. He said he has been battling his addictions since he was a student at Providence College almost 20 years ago, and his rehabilitation stay at the Mayo Clinic is his second in five months.

Upon checking into a rehab center such as the Mayo Clinic, the first step is to stabilize the patient medically. The user must be weaned off the drug.

Until recently, with prescription drug addicts, this would likely have meant the misery of cold turkey -- the visceral images of an addict locked in a room, curled up in the fetal position, sweating and screaming as the cravings ravaged the body.

The alternative was methadone, which could reduce the body's cravings, but could lead to dependencies of its own.

In just the past few years, however, a new drug has come on the scene that some say is a panacea for drug addicts: Suboxone, or by its generic name, buprenorphine.

"It replaces the body's craving and physical dependency on prescription narcotics, but it doesn't have a euphoric or mind-altering effect, so there's little potential for abuse," Gordon said.

"It's changed the face of treatment options, and the lives of many people. It's really, in my mind, comparable to the discovery of penicillin," he said.

With Suboxone, a patient can return to feeling normal within 24 to 48 hours, rather than the days or weeks of withdrawal symptoms common in the past. "It's very good for people who are determined to stay clean and need physical help to do that," Golinger said.

Once the patient is medically stable, the education phase of treatment begins, Gordon said. This can be up to six hours per day of psychiatric analysis and classroom discussion, where the patient learns to understand the addiction and tries to identify triggers that may lead to a relapse.

They discuss potential changes in lifestyle, stressors that can be removed, and maintenance steps that will keep them in control of their cravings -- devising an exercise schedule, for instance. In many programs, family members will join the patient for a week or more, and participate in the treatment.

But the patient is taught to recognize the reality that this is a lifelong problem. Even though Suboxone is non-habit-forming, many prescription drug addicts leave the clinics knowing they will have to take it for the rest of their lives, and monitor their dosages like a diabetic does with insulin.

This can mean permanently cutting out friends who are negative influences, finding other people who may be struggling with the same problem, and regularly attending counseling and support-group meetings.

"They're told you've got to make it (your) number-one priority in life," Golinger said. "Nothing comes before it. No relationship, no activity, because you won't have anything, and you won't do anything for the people you're close to, or society in general, if you're on it."

In Kennedy's case, he says he finally realizes he must give up alcohol. It's these life changes, Golinger said, that will make the difference in whether Kennedy will keep himself sober or suffer a relapse.

"You don't speak with lobbyists in a bar on Capitol Hill, you speak to them in your office. You don't put yourself into the lion's den unless you want to get bitten," Golinger said.

dbarbari@projo.com / (401) 277-8062