Reports say the use _ and misuse _ of some powerful painkillers has more than doubled in New York in the past few years.

The causes can be as many as the patients prescribed the drugs, but one reason is clear _ we rely on drugs to reduce pain.

Perhaps we have become less tolerant of pain and don’t hesitate to ``take something for it.’’ Maybe we’re taking more because there is a wider variety of strengths available. With easy access to painkillers, either over-the counter or by prescription, it’s plain to see how overuse and abuse can develop.

Julie Dostal, executive director of the Leatherstocking Education on Alcoholism/Addictions Foundation in Oneonta, said medication abuse is the second-largest illicit-drug problem after marijuana. Alcohol use is the largest drug problem, she said.

Some people _ especially teens _ may think that using prescription or over-the-counter drugs to get high is OK because it’s medicine. But clearly, misuse of any drug _ legal or not _ can cause serious damage.

Dostal mentioned the "Tylenol effect," which happens when patients combine different painkillers that have acetaminophen and don’t realize they’ve exceeded the recommended limit. An acetaminophen overdose is one of the most-common poisonings, according to the National Institutes of Health. It can cause liver failure and death.

Some physicians at A.O. Fox Memorial Hospital in Oneonta and at Bassett Healthcare, based in Cooperstown, work with patients through "narcotics contracts."

Dr. Benjamin Friedell, a family practice physician with Fox, said that under the contract, a patient must agree to use one doctor and one pharmacy; not to call early for refills; to protect the medication; and not to sell the medication. Not following those rules can be grounds for a doctor dismissing a patient from the practice, which Friedell said he has done about a half-dozen times in 20 years.

Signs of misuse also appear in the police blotter. Charges including drunken driving and sales of controlled substances reflect drug abuse.

In some cases, drugs are stolen or given to others.

Clearly, all drugs, particularly prescription painkillers, must be used with caution.

If you are on a painkiller and it doesn’t seem to kill the pain, talk to your doctor about alternatives; don’t increase the dosage on your own. If you don’t need the prescription painkillers supplied to you anymore, flush them down the toilet. Also, talk to your doctor about all medication _ prescription and over-the-counter _ you take.

The physicians’ guidelines, the contracts with patients and the work of law enforcement add up to minimizing abuse of prescription painkillers _ and could save lives.