Here’s a common scenario: You’ve had surgery…or you threw your back out carrying groceries. To help you get over that distressing hump, your doctor prescribes an opioid painkiller—a class of drugs that includes morphine, codeine and hydrocodone (Vicodin) and newer heavyweights such as oxycodone (OxyContin) and fentanyl (Duragesic).
But a few weeks or even months later, the pain is still nagging you. Your doctor agrees to refill your prescription. Considering the daily drumbeat of scary statistics related to painkiller use and abuse, you’d think it wouldn’t be so easy to get a steady supply of these drugs.
But it often is, and the consequences are dire. In the US alone, more than 42,000 deaths from drug overdoses in 2016 were blamed on opioids. This translates into 115 Americans dying each day from an opioid overdose. A large percentage of these opioid users begin using the drug to treat pain.
DRIVING HOME THE DANGERS
Pain is a very real problem. More than one in four Americans have suffered from pain that lasts over 24 hours, according to the National Center for Health Statistics, and chronic pain is the most common cause of long-term disability.
But new research drives home the startling fact that opioids—once introduced—are habit-forming. A 2017 study involving 1.3 million noncancer patients showed that 12% of people prescribed an initial six-day supply of an opioid painkiller were still taking the drug a year later. Those odds doubled to 24% if a 12-day supply was prescribed. When a month-long course of opioid pain medication was prescribed, 30% were still taking a painkiller a year later.
Clearly, short-term prescriptions can create long-term problems if we don’t pay close attention to our use of these medications. It’s surprisingly easy for a person to inadvertently become dependent on these drugs…or even addicted.
DEPENDENCE VS. ADDICTION
In the world of addiction treatment, there are subtle but important differences between dependence and addiction. The distinction helps guide treatment decisions. What each means…
• Dependence is the steady use of a drug that stops short of addiction. It happens when you find yourself taking higher and higher doses of a painkiller over time to achieve the same level of relief from a physical condition. This is known as tolerance. As the cycle progresses, you become physically dependent on the drug…and can’t stop taking it without experiencing withdrawal symptoms. People keep taking the drug to avoid the distressing withdrawal symptoms they suffer between doses.
Physical withdrawal symptoms include tremors, sweats, nausea, vomiting and diarrhea. People who are dependent on a drug also may become depressed and anxious, have trouble sleeping or feel withdrawn without the drug. But in the case of dependence alone (not addiction), you’re not getting “high” or intoxicated by the painkiller and you don’t crave it—you’re just searching for continued pain relief. While dependence usually takes hold after 10 to 30 days, it can occur in as little as a week’s time.
• Addiction is more serious. When you are addicted to a drug, in addition to tolerance and physical dependence, you will crave it when it’s not being used—sometimes months or years after the drug was last in your system—even when you’re not feeling pain. When addiction sets in, you’ll use more of the pain medication than intended (a hallmark of addiction known as “loss of control”) and/or continue to use it despite the occurrence of serious harm or consequences.
It’s a disease involving the brain’s reward pathways and a vulnerability to having an enhanced response to mood-altering drugs, including painkillers. Some people will use these medications for their effects on mood (for example, to feel energetic, less depressed and less anxious), while others are genetically or environmentally predisposed to this intensified response.
DO YOU HAVE A PROBLEM?
To be diagnosed with addiction or dependence, you need to be assessed by a professional such as a psychologist, psychiatrist, addiction physician or drug-and-alcohol counselor. But you can begin to consider whether you might have a problem by answering the questions below. The more questions you answer with “yes,” the greater the odds that you’ve got a potential problem and should see a medical professional.
- As time passes, do you find yourself needing to increase the frequency or dose of your medication before pain returns?
- Are you increasingly preoccupied by thoughts of taking the painkiller between doses?
- Are you experiencing mood changes or changes in your motivation level?
- Are you noticing problems with your ability to think, concentrate or remember things?
- Are you experiencing new sleep disturbances, such as the inability to stay asleep?
- Have you gone to another doctor because the first wouldn’t renew your prescription for more medication or increase your dose?
- Have you ever lied to anyone about how much medication you’re actually taking?
- Have you ever run out of a prescription before you were supposed to because you used more than was prescribed?
HOW TO SEEK HELP
What should you do if you realize that you’re in trouble? No one wants to be labeled an “addict,” but fear of that diagnosis shouldn’t keep you from seeking expert help. Do not attempt to stop taking your medication cold turkey—this approach may actually be physically dangerous because it will precipitate withdrawal, which can lead to changes in blood pressure, pulse and even cardiac function due to hyperactivity of the nervous system.
Depending on your individual situation, outpatient or inpatient care may be necessary to properly supervise your withdrawal process. A specialist can assess your situation and make a treatment referral—self-diagnosis and selection of treatment are rarely enough. Seek professional help. To find an addiction specialist, consult the American Society of Addiction Medicine.