Another factor that's leading patients down the path to addiction, says Colvin, is that many doctors don't check in with patients after those patients start taking these drugs. Use of OxyContin, for example, should not exceed seven days without reassessment by a doctor; use of Xanax should not exceed two weeks without reassessment, according to The Essential Guide to Prescription Drugs 2003, an annually published reference manual for patients. But in some states, doctors rarely hold patients to these rules and instead merely refill prescriptions over the phone. (Some states require patients to visit a doctor for a refill.) "A refill may be accompanied with very little information, 'You had it before, here it is again,'" says H. Westley Clark, M.D., director of SAMHSA's Center for Substance Abuse Treatment. "When it comes to drugs that can lead to dependence, it's a problem."

How Lives Are Ruined

Mindy Jewkes, 32 of Canadian, Oklahoma, knows all too well where doctors' carelessness can lead. In 1993 she was prescribed Lortab, an opioid, after injuring her sternum. Although she was a registered nurse, Jewkes had never heard that Lortab was addictive; she figured that the drug's pleasant effects were merely a perk. "On Lortab I felt calm," says Jewkes. "It have me the courage to speak up and make friends. It made me feel like I could do anything. It was the greatest feeling I'd ever had, and I couldn't get enough."

For six months she continued getting Lortab by phoning in prescriptions; then her doctor called her in for a routine checkup. "Only then did I notice how much Lortab I'd been taking and refused any more refills," she says. He didn't offer her help with coming off the medication; still, Jewkes felt she'd be fine. "I knew I liked the way I felt on these pills, but I didn't think I was an addict," she recalls. But within six hours of her last pill, Jewkes got a shocking reality check: She started suffering symptoms of withdrawal, including shakiness and anxiety. Desperate to put an end to her misery, Jewkes started forging prescriptions. "As a nurse, I called prescriptions in to pharmacies all the time for doctors. It was easy," she says. While she knew at this point that she was addicted and needed help, shame kept her quiet. "My husband was a police officer, and he would come home and tell me about all the drug addicts he'd arrested and how much he hated them," she says. "All my mind hears was that he hated me. So I kept my addiction a secret."

A pharmacist eventually discovered Jewkes's faked prescriptions and informed her that she was going to report her to law enforcement. Devastated, Jewkes walked out of the pharmacy feeling numb. "I remember driving home contemplating how I was going to tell my husband," she recalls. Rather than face this confrontation, she tried to commit suicide, downing a month's worth of sleeping pills and the rest of the Lortab she had. Jewkes woke up in an emergency room with a crisis worker and her entire family, including her husband, surrounding her. "The crisis worker asked if I wanted some help," recalls Jewkes. "My mouth said yes before I could even think about it."

Over the next six months, Jewkes, who was put on probation, tried unsuccessfully to get clean. In 2000 her husband decided he'd had enough and filed for divorce, eventually getting custody of their 3-year-old son. Although Jewkes was heartbroken, she figured this was best. "I knew our son would be better off with his dad than with an addict," she says. Giving up her son was the wake-up call she needed to strengthen her resolve to get better. In april 2001, at the suggestion of a friend, she entered an Oklahoma drug-treatment facility called Narconon, where she detoxed for one week and resided as an inpatient for five months more. After that, Jewkes started working there, helping others free themselves from the grip of addiction. Doing so, she says, helps remind her that despite her losses, she's lucky to be alive.

"I sacrificed everything I cared about - my job, my husband, my child," says Jewkes. She sees her son, who lives in Salt Lake City, once every six months but phones him weekly. "Recently he's started asking why Mommy and Daddy don't live together," she says. "I still don't know how to answer that."

Women in Withdrawal

Once hooked on prescription drugs, many women, like Mindy Jewkes, do whatever they can to get more: They lie to their doctors about symptoms to get refills, or "doctor shop," visiting numerous physicians with carious complaints to load up on prescriptions. But even patients who do make an effort to stop taking these meds can run into trouble. That's what happened to Lisa Berry, 37, a mother of four in Atlanta, Missouri. In 1999 she was prescribed Ativan, a sedative, to treat her panic attacks. But after a month the euphoria she felt on Ativan wore off and left her feeling so lethargic, she could barely get off the couch. Her short-term memory also suffered. "My husband said I'd make him watch the same movie on TV ten times, swearing I'd never seen it before," she recalls. "He said, 'I've lost my wife.'"

Rather than explore alternative medications, Berry's doctor kept her on Ativan for three years, believing it was the best treatment for her panic attacks. (The Essential Guide to Prescription Drugs 2003 discourages use of this drug for longer than three weeks.) At that time Berry trusted her doctor and continued taking Ativan. "But in retrospect, I feel that she treated my symptoms but didn't take the time to solve my problem," she says. "It was just easier for her to write a prescription." In hindsight, Berry believes that a thyroid medication she took from 1999 to 2002 caused her panic attacks. "The attacks began and ended with that drug," she says. "The Ativan wasn't effective for the attacks."

In february 2002, Berry decided to take matters into her own hands and taper off her Ativan use. She found information online about how to do it. (How quickly patients can taper off depends on how long they've been on the drug and on how much they've been taking, according to experts.) But within a week Berry began experiencing symptoms of withdrawal. An endless series of health problems that Berry believes are the direct result of her Ativan addiction - heart palpitations, dizziness, severe vomiting - have sent Berry to the emergency room more than 30 times and actually caused her to be admitted once, costing her more than $100,000 in hospital-admission bills.

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