RICHMOND - They ask you all the time: On a scale of 1 to 10, what is your pain level? They are doctors and nurses, in emergency rooms, at hospital bedsides, in rehab centers. In connection with my husband's recently broken thigh bone, we heard the question innumerable times. It often seemed -- perhaps because at first he was already on some serious painkillers -- that he was answering at random. Five, seven, even nine, he'd say. And they'd give him some more medication.

"Nine?" I asked one day. "How could it be nine?" The leg surgery was over, the pin was in. If a 10 was what he experienced when he fell, I wanted to know, was this really a nine now? He backed off. "Maybe a seven," he said. And they gave him some more medication.

That one-to-10 formula is all too easy. It occurred to me that my husband of decades rarely wants Novocain when he goes to the dentist. I want it as soon as I turn into the dentist's parking lot. It appears my one to 10 and his cannot possibly be the same. But my 10 and his 10 will get the same meds.

We're in the throes of a major campaign to rid Berkshire County of heroin, and that's a good thing -- if it's possible. Even reducing the amounts sold (police investigations, arrests) and the amounts desired (treatment) would be great, especially when the newspaper reports that one dealer in North Adams admitted selling 1,000 heroin packets in a day.


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But heroin is only one piece of the package, and even if the dealers are doing a land-office business, they're probably not keeping up with another facet of the drug-taking American public -- the pill poppers.

Three years ago, according to an ABC news report, 131 million doses of the popular painkiller Vicodin were prescribed in this country. That was up from 112 million doses prescribed in 2006. We use 80 percent of the world's opioids, even though we make up less than 5 percent of planet earth's human population, and we swallow nearly all of the world's hydrocodone, the opiate that is in Vicodin.

What needs to be clear to all those who blithely say "nine" when asked about pain is that it's all about poppies, opium poppies, whether it's Vicodin or heroin. The street corner dealer and the medical professionals are basically giving out the same stuff, and it's time to pay more attention to the quiet side of this story in addition to the criminal aspect.

The word in the medical world these days is to "stay ahead of the pain." We Americans apparently can't bear pain at all (except for my husband) because we just say yes. And whether it's oral surgery, a kidney stone or chronic muscle pain, the prescribers are generous. You get a slew of pills when you might take only three or four. The rest live in a bathroom cabinet, a solution when your head hurts or your knee jolts or your back resists spring cleanup. Possible addiction awaits, insidiously.

Some 600,000 physicians are licensed to prescribe Vicodin. And probably few of them prescribe only a day's worth. The alarming fact is that accidental overdoses of Vicodin and other chronic pain relievers killed more people than car crashes in a study of 17 states. Every 19 minutes, writes Dr. Sanjay Gupta, someone dies because of misuse of a prescription medication, a total of close to 30,000 people a year.

These powerful drugs are a godsend to the truly needy -- such as cancer patients. But the disturbing fact is that some 1.9 million Americans are now addicted to prescription pain medications and, if they give them up, they'll find it harder than fighting alcoholism or quitting cigarettes.

Opioids alter the brain. It's something to remember when you say "seven" or "nine" or "10" and get euphoric relief.

Ruth Bass is an author and free-lance writer. Her web site is www.ruthbass.com.