Addiction to prescription painkillers is a disease that has become increasingly prevalent in the United States and elsewhere. Opiate, or narcotic pain medications such as Vicodin, OxyContin, Norco, and Hydrocodone are commonly prescribed by physicians to treat pain. Often, patients continue taking their medication as prescribed and become physically dependent upon the drug.
Physical dependency means that even if they want to stop taking the medication, it becomes extremely uncomfortable due to symptoms of withdrawal. This happens because of the following physical process:
- The brain has responded to the presence of the pain medicine by increasing the number of receptors for the drug, and the nerve cells in the brain cease to function normally.
- The body stops producing endorphins (the body's natural painkillers) because it is receiving opiates instead.
- The degeneration of the nerve cells in the brain causes a physical dependency on an external supply of opiates, and reducing or stopping intake of the drug causes a painful series of physical changes called the withdrawal syndrome.
At this point the patient may continue taking the pain medication to avoid the withdrawal symptoms, rather than taking it to treat the pain that caused them to take the medicine initially. When this occurs the patient is considered to be dependent on or addicted to the prescription pain medicine.
Becoming addicted to pain medication is a disease. Taking the painkillers causes a change in one's brain chemistry that is not under the individual's control. It is absolutely not anyone's fault. Addiction is a chemical, physical disease, one that requires expert medical treatment in a safe, humane environment.
Prescription Pain Medicine Addiction is Common
The National Institute on Drug Abuse (NIDA) Director Nora Volkow has stated that up to 7% of patients who are prescribed narcotic or opioid analgesics to treat chronic pain will become addicted. It is estimated today that there are more than 4.7 million Americans dependent on prescription painkillers, which represents up to 2% of the US adult population overall, and this number continues to grow every year.9,14,21
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Pain Killers are Not Always Needed to Treat Chronic Pain
It is important to be aware that taking painkillers may in fact increase a patient's sensitivity to pain, a phenomenon called hyperalgesia.5-8,19 Often, patients are surprised to discover that, once off their opiate medications, their pain is much less than they thought, or even completely gone. This is because the chronic, long term use of opiate painkillers has caused a decrease in the ability to tolerate pain, and an increased sensitivity to pain. After long term use of prescription painkillers, even if the underlying injury has long ago healed, the intensity of pain is often significantly increased, leading patients to believe they need to continue taking the medication and at higher doses than they were on initially.
In addition, it is very easy to confuse the general body aches and pains of early onset withdrawal with the original underlying condition. The patient takes the pills and feels better, so it is assumed that the medication is working. In reality, the pills are no longer needed for the original problem, but only because the body has become dependent on them. Getting off the painkillers once they are no longer needed is important in order to avoid physiologic dependence and to return to normal life again.
Treatment Considerations for Painkiller Addiction
Sudden discontinuation of opiates, "going cold turkey," is associated with intense withdrawal symptoms, which although rarely life threatening, can be severe and prolonged, lasting up to two to three weeks. Opiate withdrawal is characterized by severe discomfort, including diarrhea, abdominal pain and cramping, vomiting, runny nose, eye tearing, yawning, sweating, agitation, restlessness, twitching and tremors, back and bone pain, and intense craving for the drug.
It is important to note that there is a difference between being dependent on narcotics and being addicted. Many patients can become dependent even in a relatively short postoperative course of narcotic medications. In such cases, withdrawal symptoms are to be expected, but the vast majority of patients can tolerate the withdrawal symptoms if they know that it is normal and not dangerous to feel anxious, flushed, etc. as the body withdraws from the pain medication. A few patients may need a medication such as clonidine, which helps block the sympathetic overdrive that makes them feel these symptoms. In these shorter lived problems, the symptoms should resolve in days and not weeks. These patients also need to know that they are not addicted but have only become dependent on the drugs. However, for patients who are addicted to narcotic pain medications, a detoxification program is often needed.
Traditional methods of detoxification force patients unnecessarily to suffer through this withdrawal, and as a result of the intensity and extreme discomfort of withdrawal, many individuals do not even attempt detoxification. Among those who do, there is a significant dropout rate.26 Even when patients complete traditional detox methods the success rates are poor and the vast majority of patients return to the drug within a few months. The ideal opiate detoxification method should be safe, relatively brief, with a minimum experience of withdrawal symptoms, providing individuals with the ability to achieve and maintain abstinence, and to return to healthy, productive lives.