Rebecca Collins, 65, a former professional dancer who is still active, has a demanding job that occasionally causes her severe back pain.

When it gets really bad, the Hawaii Kai resident reaches for Vicodin, one pill at a time, and only if she has to. She’s never had a problem with taking too much, only using it when the pain is intense, but she understands how some folks get a little euphoric when taking Vicodin. She grew up in the 1970s, knows what addiction feels like, and is extremely careful with any type of habit-forming pills.

She is not alone. According to a recent study by the National Institutes of Health, about 25.3 million adult Americans have chronic pain.

While Collins has never had a problem with her use of Vicodin, she wonders about those who aren’t as careful as she is with their pain medication. Do they start off using it like she does, and then get hooked on the pills?

It’s estimated that almost 2 million Americans are addicted to narcotics.

Sharyn Morrow/Flickr.com

Who is to blame when someone gets addicted? Patients who keep coming in for prescriptions, or doctors who give it to them without proper warnings or monitoring?

The West Virginia  Supreme Court recently ruled that patients can sue their doctors if they get addicted to prescription drugs, even if they committed a crime such as doctor shopping to get there. This may lead to fewer prescriptions, but it’s doubtful that it will fix the problem.

Recent studies have highlighted the overuse of narcotic pain medications, like Vicodin, Tylenol with codeine and Oxycodone. In fact,  80 percent of heroin users nationally start with prescription drugs, and once they are cut off, look to cheaper street versions of the narcotic that provide the same high along with pain relief.

Just last week on Maui, a man wielding a gun robbed the Makawao Town Pharmacy and absconded with an unknown amount of Oxycodone pills. This was the third such incident in Maui since February. Nationwide, 382 pharmacies reported armed robberies from January to June. The prime target is narcotics. Some long-acting tablets have a street value of up to $100 a pill.

“Addiction is not pretty, it shouldn’t be whitewashed into a spa trip to a rehab center in Malibu.”

Why are so many folks are getting addicted, and in some cases resorting to crime to get their fix?

Narcotic pain medications work by binding chemically with receptors and blocking the transmission of nerve impulses. These medications do not cure the source of the pain, but rather alter the perception of pain.

When the body has been given narcotics for even a short time, it recognizes that the receptors are blocked, and in response, makes more. This is why the same dose of medicine often doesn’t work for those who take these pills regularly, a phenomenon called dose escalation. More medication is needed for the same pain relief because there are more receptors that have to be blocked.

This is where the use of narcotics on a regular basis can get someone in trouble. If the medication is stopped too quickly, all of those empty receptors can cause a whole cascade of uncomfortable physical symptoms, in addition to the increase in perception of pain. This withdrawal effect can be medically dangerous as well.

Addiction can happen to anyone. Claire Santos, a registered nurse and patient advocate in Honolulu, described her own family tragedy as a result of narcotic addiction this past December. She lost her sister to an accidental overdose after taking the prescribed amount of medication from her doctor.

In the United States it is estimated that almost 2 million people are addicted to narcotics, another 500,000 to heroin.

What should be done to help adequately treat people in pain without subjecting them to the risks of addiction?

Collins thinks that the answer lies in following the example of a recent campaign to educate the public about the ravages of smoking. After seeing television commercials featuring people suffering from cancer — people with no voice after the removal of their vocal cords, or using oxygen tanks to breathe — she wonders why we haven’t done something similar with narcotics.

“Addiction is not pretty, it shouldn’t be whitewashed into a spa trip to a rehab center in Malibu,” she says. “It’s dirty, it’s uncomfortable, and it’s hard. Showing that side of the abuse of pain pills might make people think twice before they take them.”

She wishes more people knew of the consequences of abusing narcotic pain pills. She thinks a  public awareness campaign on television and other forms of social media about prescription drugs might help.

As someone who needs to take an occasional pain pill to treat her symptoms, she’s learned that it only masks the underlying cause. She’s working on strengthening her back and avoiding the activities that make her hurt.

Meanwhile, she’s hoping that more people learn about the potential for pain pills to cause more pain than they treat.