Copyright ©2013 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

RENEE MONTAGNE, HOST:

Over the next few minutes, we're taking a look at an emotional debate over the most widely prescribed drugs: painkillers. Among them: Oxycontin, Percocet, Vicodin. Millions of people depend on these drugs to help them cope with terrible pain. There are also millions who are addicted to these narcotics, and thousands die from overdoses.

As NPR's Rob Stein reports, officials are struggling to fight prescription painkiller abuse without harming those who need them. And a word of warning: These tragic stories may be difficult to hear.

ROB STEIN, BYLINE: A few years ago, a doctor started prescribing Michael Israel pills for really bad cramps in his gut. His father, Ari, says Michael had been struggling with Crohn's disease, a chronic digestive disorder, since he was a teenager. [POST-BROADCAST CORRECTION: Michael Israel's father was incorrectly identified. He is Avi Israel.]

AVI ISRAEL: So he was prescribed, you know, Lortab or Vicodin, or whatever. They would flip-flop it, you know, from one to another.

STEIN: Then one day, Michael confessed that something was wrong, really wrong.

ISRAEL: And what happened, Michael came over to my bedroom one night and said, Pops, I have a - problems with the pills.

STEIN: Michael admitted that he was taking way more pills than he was supposed to. He was even crushing and snorting them. He was addicted. That started a long, hard fight to break his addiction, but nothing worked. He started losing hope. And then one day, something terrible happened.

ISRAEL: Michael walked into my bedroom; and he had a shotgun that he used to use for target practice 'cause that was one of his favorite things; locked the door; and I kept calling him - Mike, Mike.

STEIN: Ari Israel ran to the door, and heard his son cock the gun. And then, the blast.

ISRAEL: I kicked the door open. (Crying) There was my boy, laying on the floor.

STEIN: Michael was just 20 years old. Ari Israel, who lives in Buffalo, is now on a mission, a mission to prevent more people from dying from their addiction to prescription painkillers. And he's far from alone. These drugs have been a godsend for millions of people in pain, but millions of people are also addicted. Joseph Rannazzisi, of the Drug Enforcement Agency, says that's because they're opioids. They can make people high, and easily get people hooked.

JOSEPH RANNAZZISI: What we're seeing, increasingly over the last few years, has been widespread abuse. And the abuse just keeps increasing. It's a huge problem.

STEIN: Overdoses have been rising rapidly. More than 15,000 are now dying every year.

RANNAZZISI: It's not a white or black or Hispanic issue. It's not a male or female issue. It's everyone. We see kids as young as 12 years old; elderly patients.

STEIN: So the DEA wants something done about the most commonly used group of these drugs: those containing an opioid called hydrocodone. The most well-known is probably Vicodin. Right now, these drugs are not as tightly controlled as similar medications. Rannazzisi says the DEA wants to change that; to put drugs like Vicodin in the same legal category as drugs like Oxycontin and Percocet.

RANNAZZISI: There's this idea that a drug like hydrocodone, it's not as dangerous; it's not as addictive. And that's just a fallacy.

STEIN: The change would stop doctors from writing prescriptions for more than one month's supply at a time, and calling in new prescriptions without seeing their patients. But some doctors want even more restrictions. Addiction specialist Andrew Kolodny says all of these drugs should only be used for patients who really need them, like cancer patients; not handed out casually.

DR. ANDREW KOLODNY: This epidemic has been fueled by overprescribing of opioids, particularly for chronic, non-cancer pain - whether it's low back pain, headaches. I think that's really created a public health crisis.

STEIN: So Kolodny's group wants the FDA to rewrite the rules for how doctors should use these drugs; to say they should write prescriptions only for severe pain, at much lower doses, and for no more than three months.

KOLODNY: The way to begin to turn the epidemic around, is by getting doctors to prescribe more cautiously.

STEIN: But all this is terrifying many pain patients and their doctors. Lynn Webster, of the American Academy of Pain Medicine, worries these changes may make it impossible for many patients to get the drugs they need.

DR. LYNN WEBSTER: We have millions of people who are totally disabled because of their pain. Many people who do not have access to aggressive pain management may - simply - not be able to survive.

STEIN: Patients like Carolyn Tuft. She's been suffering constant pain since one terrible day in 2007, the day she went shopping with her 15-year-old daughter, Kirsten, near their home in Salt Lake City.

CAROLYN TUFT: I took my youngest daughter to the mall, to buy valentines. And there was a shooter that came into the mall and shot both of us; shot me three times, shot her twice.

STEIN: Carolyn's daughter was one of five people killed that day. Carolyn was one of four victims who survived. But she's been in unrelenting pain ever since.

TUFT: I have a really hard time just getting up in the morning because the pain is so, so severe that it takes me at least three hours just to put clothes on, and make myself stand up and get moving for the day.

STEIN: Even after she manages to get moving, the pain never eases; not for a moment, ever.

TUFT: In my arm, it's like having a severe sunburn but also, like it's frozen - the kind of pain when you have your hand in ice for too long. My shoulder just hurts all the time; it hurts to move it. And the pain in my back is just a constant, sharp, deep pain. It goes down my legs.

STEIN: The only thing keeping her going are her pain medications.

TUFT: I have so little fight left in me, just surviving every day. I don't think I would survive if I couldn't get them. I don't know that I would survive life at all.

STEIN: Carolyn Tuft is far from alone. The fear is that elderly arthritis patients; workers in rural places, with severe back pain; may not be able to get to a doctor for new prescriptions. Many doctors, worried about getting into trouble, may just stop prescribing them altogether; and insurance companies may stop paying for them. Carolyn's doctor, Lynn Webster, wonders: Who knows what desperate patients might do?

WEBSTER: They'll look for alternative medications, which may be less effective. They may be more risky. We can't anticipate the consequences by this proposed change.

STEIN: Advocates for tightening the rules say none of the changes would prevent doctors from getting the drugs to patients who really need them. For their part, officials at the FDA - like Douglas Throckmorton - say they're trying to figure out how to help without causing harm; to prevent more patients like Michael Israel from dying, while protecting pain patients like Carolyn Tuft.

DOUGLAS THROCKMORTON: It is as complex an issue as I've worked on; just for the variety of social, medical, scientific, legal things that are influencing the choices people are making.

STEIN: The FDA recently took steps to get drug companies to make the drugs in new ways, ways that would make them harder to abuse. And the agency is holding two hearings - one this week, and another next month - to try to figure out how to walk that fine line: preventing abuse without causing more suffering for people in terrible pain.

Rob Stein, NPR News.

Copyright © 2013 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.