It’s 1:30 p.m. and Sarah has slept through her 9 a.m. class for the second time this week. Maybe her cell phone died, and the alarm she set on it never went off. She snatches the phone from under her pillow and flips it open. It’s on. She doesn’t remember falling asleep last night and feels exhausted. She wishes she didn’t have to get out of bed at all.

The Wichita senior frantically stuffs the mass of papers scattered across her bedroom floor into her backpack and rushes out the door wearing the same hooded sweatshirt she passed out in the night before. Her head pounds as she makes the 30-minute trek to campus, hoping she will make it to her 2:30 class on time.

The negative side effects of painkillers are exacerbated when alcohol is added to the mix. The pills cause drowsiness, deaden responses and slow actions.

Sarah is groggy because she took two 5-milligram Percocet tablets last night. Percocet is commonly prescribed to relieve moderate to severe pain. She got it from a friend to calm her nerves while studying,. The pills don’t usually knock her out for that long, she says. “I was too stressed out. I was worrying my ass off,” she says.

Most people who take prescription medications use them properly, but others use painkillers and depressants recreationally as party drugs or to “relax.” The 2005 National Household Survey on Drug Abuse revealed that 6.9 million young adults aged 18 to 25 had abused prescription drugs at least once. Using these drugs without a prescription might lead to jail time and can lead to physical dependence, liver damage and possibly death.

Pill-poppin’ partying

Partying with a cocktail of alcohol and prescription painkillers or sedatives seems to be a growing trend.

Sarah last popped a pill at a weekend house party to loosen up. She felt really happy, she says, but after a few vodka drinks she couldn’t get off the couch. She thought the pill was Vicodin — it was round, light-blue and inscribed “Roche 10.” It feels good, really good, especially with alcohol, she says. “It made me forget about everything else.”

According to the pill identification Web site drugs.com, Sarah’s “Vicodin” was actually a 10-milligram dose of Valium, a sedative, or central nervous system (CNS) depressant commonly prescribed to reduce anxiety. Sarah trusts her friends who dispense the prescription pills to her, so it doesn’t bother her that she doesn’t know exactly what she’s taking.

Relief from the stresses of school, family and everyday life are Sarah's reasons for using prescription painkillers and sedatives. It makes her feel more relaxed and carefree than using alcohol alone, and she can drink less to get her desired effects, she says.

Fatal attraction

Hydrocodone (Lortab, Vicodin) is listed as one of the U.S. Drug Enforcement Administration’s drugs of concern. It is the most commonly prescribed painkiller, with more than 124 million prescriptions dispensed last year. It is generally abused for its narcotic effects of euphoria and relaxation, and is often combined with alcohol. In 2005, hydrocodone caused 42,491 emergency room visits, more than any other pharmaceutical narcotic, according to the DEA.

When used properly, painkillers work by blocking pain signals going to the brain or by interfering with the brain's interpretation of the signals. “So if someone punched you, it isn’t going to hurt,” says Cathy Thrasher, head of pharmacy at Watkins Memorial Health Center.

The negative side effects of painkillers are exacerbated when alcohol is added to the mix. The pills cause drowsiness, deaden responses and slow actions. The most lethal consequence is an increased chance of respiratory depression, says Thrasher. When that happens, the body loses its ability to breathe, which can lead to death.

Thrasher says a problem bigger than the drug’s physical effects is the amount of acetaminophen it contains. A typical painkiller contains 500 milligrams of acetaminophen, and the liver can only handle 4,000 milligrams of acetaminophen per day. So if, for example, eight painkillers are taken in one day, combined with alcohol that is also metabolized in the liver, there is a high chance for liver damage, Thrasher says.

The addiction debate

Painkillers can effectively mitigate chronic pain, but they can also lead to addiction. Some experts believe the pills can be taken safely for years with minimal risk of addiction, while others recognize the risk of severe dependency.

These commonly prescribed drugs can cause individuals’ bodies to start feeling that they need the drugs in order to feel normal. Some users experience feelings of withdrawal even when using their prescription as directed.

Rebcca, Topeka senior, had a prescription for Lortab after she had knee surgery a few months ago. She took her medication as prescribed, and when the pain in her knee went away, she quit taking the medication. “I began to feel really nervous and uncomfortable. Then I would take another Lortab, and feel normal again,” she says.

Rebecca believes she was experiencing withdrawal from her extended use of painkillers, but after her prescription ran out, she was forced to quit taking them cold turkey, she says. “I was really worried I had become addicted, but the uncomfortable feeling eventually went away.” The “uncomfortable feeling” was nervousness and an inability to fall asleep. These symptoms appeared on days she didn’t take her prescription and lasted for several weeks.

Addiction usually occurs because some people who use the prescription drugs experience a euphoric effect, says Andrew Barclay, a doctor at Preferred Medical Associates in Andover. About 5 percent of patients prescribed these drugs experience withdrawal symptoms, which are commonly sweating, nausea and abdominal pain. The longer a person has a prescription, the more likely addiction will occur, Barclay says.

Using the drugs without a prescription doesn’t necessarily mean a person is more at risk for addiction or the negative side effects than if they are using them as prescribed. “A drug is a drug is a drug, to anyone,” Barclay says.

Although Sarah now frequently misuses prescription pills, she was first prescribed painkillers after she had her wisdom teeth taken out when she was 14 years old. “The pain was unbearable and the Lortabs helped. Then I realized they not only relieved my pain but improved my mood,” she says.

A few days after the procedure the pain was gone, but three Lortabs remained in Sarah’s medicine cabinet. “I took them all at once and felt great all day,” she says. Sarah didn’t think she was addicted to Lortab, but if she could have refilled her prescription she would have, she says.

Getting the hook-up

It never crossed Sarah’s mind to use the drugs recreationally before her friends told her about it and gave her a few pills. Now she always obtains the drugs from friends, she says.

She got her latest batch of unidentified painkillers from a friend who cleans the house of an elderly woman who has hundreds of the “happy pills” lining her medicine cabinet. The friend takes small quantities at a time, hoping the woman will never notice. Because the friend knocked off the pills for free, Sarah doesn’t have to pay for them either, she says.

Obtaining prescription pills through friends is common. According to the 2005 National Survey on Drug Use and Health, 59.8 percent of those surveyed who misused prescription painkillers reported that the source of the drug was a friend or relative. Another 16.8 percent reported they they got the drug from one doctor. Only 4.3 percent got the pain relievers from a drug dealer or other stranger and 0.8 percent reported buying the drug on the Internet.

According to a 2005 report by the National Institute of Drug Abuse, narcotics providers should notice any increases in the amount of the drug the patient needs, as well as frequent requests for refills before the prescription is set to expire. Doctors should also be aware that abusers may engage in “doctor shopping” by visiting several doctors or pharmacies to obtain multiple prescriptions.

Dr. Barclay says he can usually tell when patients are attempting to obtain a prescription when they don’t need one. “I have a number of patients who try to get them over the phone on the weekends and say my partner prescribed them,” he says. However, this method typically doesn’t work because the rules of his practice prohibit him from filling these prescriptions without seeing the patient himself.

Watkins pharmacy also notices when patients try to fill multiple prescriptions before they should have run out. “We are used to what their prescription patterns are, then that raises a red flag,” says Thrasher, the head of pharmacy.

Risky business

In addition to the health risks, misusing prescription drugs is illegal. Painkillers containing hydrocodone (Lortab, Vicodin, Percocet) and oxycodone (OxyContin) are considered Schedule II controlled substances under the Controlled Substance Act of 1970 (CSA). They are listed among other highly-abused drugs such as methamphetamine and cocaine. Sedatives (Valium, Xanax) are considered Schedule IV.

Federal law prohibits buying controlled substances without a valid prescription from a doctor. This means there must be an actual relationship with the doctor, and most state laws require a physical examination before a prescription can be written.

The CSA mandates that the first offense of simple possession carry a sentence of up to one year in jail, a fine of $1,000 or both. The consequences increase with multiple offenses.

Prescription drugs that come from foreign countries can also be ordered from Web sites. Some of these sites provide prescriptions written by “cyber doctors” through online questionnaires. These are not considered valid prescriptions and trying to fill one may be punishable by imprisonment under federal law. It is also a felony to import drugs into the United States and ship them somewhere not approved by the DEA.

The American Medical Association and state boards of medicine and pharmacy have all condemned the practice of online pharmacies because applicants run the risk of receiving the wrong drugs, tainted or expired drugs or the wrong dosage strength. Often, these prescriptions have no dosage directions or warnings.

Sarah uses painkillers or sedatives every few weeks and purchases an average of 15 pills each month without a prescription. The pills cost anywhere from $1 to $5 each depending on their strength and availability, she says.

Sarah doesn’t have a problem taking painkillers, although it’s written directly on the bottle, “CAUTION: Federal law prohibits transfer of this drug to any person other than the patient for whom prescribed.”

“I just do it because my body feels really loose and happy,” Sarah says. “What’s the big deal about that?”