From 1992 to 2003, the number of Americans who admitted to using prescription drugs for non-medical reasons almost doubled, from 7.8 million to 15.1 million, and abuse among teens more than tripled, according to a survey by the National Center on Addiction and Substance Abuse at Columbia University in New York.
"When you look back at it, the train is coming down the track at you," said Mark Kleiman, a UCLA professor of public policy. "I have to say that most of us were asleep at the switch."
Prescription drug sales have soared nearly 500% since 1990.
Experts attribute the rise in the use of painkillers in part to recognition among medical experts that pain was under-treated in the past.
But they also cite direct marketing to consumers.
"The marketing of pharmaceuticals that we've seen on television in the last 10 years -- the whole 'get some medicine for whatever you need' attitude -- has really increased the acceptability of prescription drugs," said Richard A. Rawson, a UCLA professor of psychiatry and associate director of its Integrated Substance Abuse Programs.
Most media accounts of Ledger's death, Rawson said, reported that no illegal drugs were found in the apartment. Such distinctions may lead the public to assume that the medications that were found were harmless.
"There's a stigma that's associated with illicit drugs that isn't associated with legal drugs," he said.
Brad Keith, founder of Axis Residential Treatment in Los Angeles, said prescription drugs and especially painkillers have become so easy to obtain that they are the leading drugs of choice for his clients.
Keith said doctors should be more careful about the quantity and kinds of drugs they prescribe.
Elvin Berrios, manager of Liberty House, a sober-living house in Century City, said more of his clients were getting prescription drugs online, often from little-regulated sites based overseas: "They can buy what they want and as much as they want and it arrives on their doorstep."
It is illegal to possess controlled substances without a prescription. But response from state and federal governments and pharmaceutical companies has been limited.
In 2004, the Bush administration introduced an effort to control prescription-drug abuse that focused on reducing sales of narcotic medications online or by doctors who write pain prescriptions too freely.
Makers of prescription drugs -- including Abbott Laboratories Inc., Hoffmann-La Roche Inc. and Pfizer Inc. -- say they have instituted public awareness campaigns about the dangers of prescription drug abuse, including giving doctors and parents brochures about monitoring the pills.
The new White House campaign is aimed at the parents of teenagers, Walters said.
He cited surveys showing that most teenagers who abuse prescription drugs get them from the medicine cabinets of their parents or friends' parents. Parents have no idea it's a problem, he said.
"We want people to have access to pain relief that's changed people's lives for the better," Walters said.
"We don't want them to fear beneficial medications. But we want them to control them, to dispose of them when they're done with them and to talk with their kids."
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mary.engel@latimes.com
daniel.costello@latimes.com
