If you’ve heard about the painkiller-addiction epidemic, you’re probably scared of these drugs—even wondering if you could become addicted if you ever needed one.

On the one hand, it is very easy to get hooked on painkillers. On the other hand, if you’ve been prescribed one of these strong opioids, such as hydrocodone, oxycodone, hydromorphone or fentanyl—which killed the musician Prince in an accidental overdose—and you know exactly how to use it, you don’t have to be on a slippery slope to dependency.

What tips the balance? Are you at risk? If you started to get hooked, would you recognize the signs? Would you get help—or even know where to start?

To learn more, we spoke with Michael Weaver, MD, professor and medical director of the Center for Neurobehavioral Research on Addiction at The University of Texas Health Science Center at Houston. He is a clinical expert on opioid-use disorder.

HOW TO KNOW IF YOU’RE AT RISK

A family history of addiction to any substance increases risk. Said Dr. Weaver, “There is a scientifically based genetic component to addiction.” The closer the family member, such as a parent or sibling, the stronger the genetic risk.

  • Gender. Women are more likely to become dependent on prescription painkillers than men are, and not only because they are more likely to have chronic pain—women tend to weigh less than men, so when they are prescribed standard doses, they are in effect taking higher amounts, which can jump-start them on the path to dependence. Also, while men are more likely to abuse illegal “hard” drugs such as heroin or cocaine, women are more likely to fall prey to prescription addictions, especially to opioids.
  • A family history of addiction to any substance. Said Dr. Weaver, “There is a scientifically based genetic component to addiction.” The closer the family member, such as a parent or sibling, the stronger the genetic risk.
  • Symptoms of anxiety and/or depression. You may knowingly or unknowingly use opioids to numb these symptoms and not just physical pain.
  • A history of abusing another substance—whether it’s nicotine, alcohol, marijuana, stimulants or sedatives. “Substance-use disorders tend to travel in packs,” said Dr. Weaver. “If you have one, you are at higher risk to have another.”

WARNING SIGNS TO WATCH FOR

Opioid painkillers often are prescribed for chronic pain  even though they aren’t very effective for chronic pain and should never be the “first line” prescription, according to recent Centers for Disease Control and Prevention guidelines.

Once they are prescribed, often for a hospital procedure, however, some people get used to the drugs’ feel-good effects and keep using them…which is to say abusing them. Here are some signs that that might be happening…

  • You’re using an opioid painkiller for something other than pain—to improve a bad mood, relieve stress or help you relax or get to sleep.
  • You feel that you have to take a painkiller just to feel normal—“or what you think normal should feel like,” said Dr. Weaver.
  • You find yourself taking higher doses to have the same effect—that means you’re building up a tolerance.
  • Family members or friends express concern about your painkiller use.
  • You spend a significant amount of time trying to get your hands on one or more painkillers, using them and recovering from their effects.
  • You find yourself trying to cut down on your use of painkillers—to no avail.

WHAT TO DO IF YOU THINK YOU MIGHT BE HOOKED

If any of the above describes you, the first and most important tip is, Don’t go it alone. Talk to your doctor about your concerns and your pattern of use, and ask for guidance on the best way to wean yourself from dependence. “Trying to deal with an addiction on your own is always more difficult,” said Dr. Weaver. “It is much easier with help, and there is help available.”

“Unlike with some other drugs, quitting opioids cold turkey can be very difficult because it can lead to opioid-withdrawal syndrome, which is very uncomfortable and often leads to relapse,” noted Dr. Weaver. Symptoms of opioid withdrawal can feel like a bad case of the flu, without a fever but with nausea, diarrhea, muscle cramps and aches, runny nose and watery eyes. These symptoms often are accompanied by considerable anxiety and “powerful cravings to use opioids since that will make the symptoms go away immediately.”

To prevent withdrawal symptoms and improve someone’s chances of overcoming an opioid addiction, medication-assisted therapy is often recommended. This involves substituting a different opioid such as methadone or buprenorphine, which is much less likely to produce euphoria, for the one that’s being abused, Dr. Weaver said. “It is better to be slowly tapered off over several days or weeks with a longer-acting, less reinforcing opioid with the help of a qualified physician or treatment program.” This is what’s often referred to as “detox.” Naltrexone, which blocks the effects of other opioids if you do use one, may also be prescribed for long-term maintenance.

Over time, with ongoing counseling or other forms of professional help, people can learn skills to help them quit abusing opioids and avoid relapse for the long haul. There are many effective options available, including individual addiction counseling, group therapy, working with a physician who specializes in addiction medicine or participating in an inpatient or outpatient addiction treatment program.

HOW TO AVOID ADDICTION…AND WHEN ADDICTION IS ACTUALLY OK

Of course, if you are at risk for opioid dependence—if you’re almost addicted, as it were—the best thing to do is to nip it in the bud before it becomes a full-blown addiction that needs treatment. “There are lots of nonopioid pain meds available for many different chronic pain conditions, so talk with your doctor about these,” said Dr. Weaver. “Think about whether you need a particular dose of opioid at a particular time, or whether you can try to skip it for now, or wait a while by using nonopioid pain management techniques.

“Consider comfort measures such as a heating pad, ice pack, massage or repositioning a painful body part,”  continued Dr. Weaver. “Other modalities can be useful as alternatives to opioids, such as biofeedback, hypnosis and chiropractic manipulation.”

Mind-body approaches can be more effective than opioids for debilitating conditions such as fibromyalgia. Learn more in these Bottom Line guides to nondrug ways to handle pain in your back, feet, hands, joints and head.

Finally, it should be noted that continuing use of opioid painkillers can sometimes have a place in medicine. The CDC’s new guidelines, for example, make it clear that they don’t apply to people who are actively battling cancer pain or who are being given opioids for palliative care at the end of life. For these patients, opioid painkillers can be perfectly appropriate.