Prescription drugs rank as the number one source of patient addiction in Dr. Berton Toews' practice, Wyoming Recovery.

"It's larger than meth," Toews said.

When Toews talks about abused prescription drugs, he is talking about opiates or opioids. Opiates are derived from opium plants. Opioids have the same properties of opiates but come from synthetic sources.

Another word for these is narcotics, but Toews said he hesitates to use this word because it can be misleading.

Examples include the prescription painkillers known by their brand names OxyContin, Vicodin, Demerol and Codeine.

"If it is prescribed by a doctor, people think it is safe," Toews said. "Even if they get it on the streets, they think it is FDA-approved and won't kill them."

Toews spoke to about 30 people at Casper College during the second day of the college's Wellness Conference. Prescription drug abuse was one of seven topics discussed Thursday.

"Abuse of opiates has increased," Toews said. "The number of people ending up in emergency rooms because of opiate use has increased."

Ed Atchison said he saw a lot of prescription drug abuse when he worked with homeless veterans.

He attended Toews' presentation because, as a mental health provider, he wants to know as much as he can about substance abuse.

"He came across with information I could understand," Atchison said. "I want to increase my level of awareness of what's going on."

He also received continuing education credits to help him keep his license.

Much of the responsibility of trying to prevent prescription drug addiction falls on physicians, Toews said.

Patients must be informed of the risks of addiction of opiates, Toews said, and doctors must pay attention to what they are prescribing.

"It's so much easier to start a prescription than stop, to say yes to a drug than to say no," Toews said. "It's much harder to do good treatment than to write a script."

One of Toews' patients, who is addicted to narcotics, had been put on three different opiates that she took three times a day. This should have never happened, Toews said.

It often amounts to malpractice, he said.

"I am troubled that physicians are not paying attention to this," Toews said. "Physicians are prescribing opiates for months and even years. They don't ask questions."

Although Toews admits there are some patients that can be treated with only narcotics, many treatment options are available that do not involve opiates.

There are non-narcotic medications and alternative medicine options such as acupuncture, physical therapy, prayer and meditation and herbal remedies.

If physicians are prescribing opiates, they must not be afraid to talk to their patients about the possibility of addiction and ask about patients' addiction history.

"I don't mind that the word is becoming more comfortable and rolling off the tongue," Toews said. "Anything that makes it easier to talk about addiction is good."

Contact health reporter Allison Rupp at (307) 266-0534 or allison.rupp@trib.com.

Breakout #1:

Criteria for prescription drug dependence:

1. Desire to cut down or quit

2. Preoccupation with substance use

3. Deteriorating values and a loss of interest favorite activities

4. Continued use despite problems

5. Built up tolerance to the drug

6. Withdrawal

- Dr. Berton Toews, addiction physician