Why do people abuse prescription painkillers?
While it is true that prescription painkiller abuse does frequently lead to an opioid addiction, it is also possible for someone using prescription pain medication as directed to become addicted. Opioid painkillers can cause addiction as an adverse reaction in a small percentage of pain management patients.
However, while some pain patients may become addicted, the risk of opiate addiction is much higher for people who abuse a prescription opioid drug. Crushing pills to snort them, or inject them, raises the risk of addiction dramatically.
When someone with severe pain takes a painkiller prescribed by their doctor for pain relief, the risk of becoming addicted is fairly low. However, pain patients often develop a physical dependence on prescription opioids, leading to painkiller withdrawal if they try to stop taking the painkiller abruptly.
What are the signs of pain pill addiction?
Some signs that someone is addicted to pills include pinpoint pupils, slurred speech, and slowed reflexes. The person may also frequently nod off, falling asleep spontaneously, while sitting up.
Painkiller addiction symptoms may include sweating, itching, nausea, and constipation. Someone overdosed on painkillers may have slowed breathing, and they may be sleepy, or unconscious.
Some signs that someone is addicted to pills are if they seem obsessed with obtaining pills at all times, and they are always talking about how to get more pills. Some painkiller addicted people will even harm themselves physically in order to get a prescription for painkillers from a doctor.
They may even schedule an unnecessary elective surgery, just to be able to get a prescription for painkillers. Surgeries may include dental procedures, or major cosmetic procedures.
Why Do People Get Addicted To Painkillers?
Why are painkillers so addictive? Prescription painkillers are drugs that activate the opioid receptors in the human central nervous system. While they are effective at killing pain, they also stimulate the reward center of the brain, causing some people to become addicted to prescription painkillers.
For many years, there was controversy over whether opiate pain relievers were addictive. Medical experts accepted that a prescription opioid could cause physical dependence, but they believed that prescription painkiller addiction was very rare.
Purdue Pharma, the manufacturer of OxyContin, promoted the view that prescription painkiller abuse and addiction were not a major problem. They convinced doctors, and the medical establishment, that doctors had an obligation to treat pain by prescribing opioid medication.
Unfortunately, we have learned over the years that drug addiction occurs more frequently than previously believed. While most patients who take prescription pain medication as directed for chronic pain do not become addicted, the risk of addiction is still significant.
For people who engage in prescription drug abuse, the risk of becoming addicted to an opiate painkiller is much higher than someone who follows their doctor’s orders. When a person crushes opioid painkillers in order to snort, inject, or smoke the drug, they are at very high risk for developing an opioid addiction.
Is there a painkiller addiction treatment program that is effective?
We need to make prescription painkiller addiction treatment more readily available for more people addicted to opiates and opioids. For many years, the media has been reporting on the opioid crisis. First, it was the wave of pill mills across the US, fueled by loose drug company and pharmacy policies.
Now, the drug enforcement administration is focused on a much deadlier opioid problem. Fentanyl analogs on the streets, imported from Mexico and China, are deadly synthetic opioids.
Fentanyl is now being found in nearly every street drug, including marijuana and cocaine. A new ominous development is the emergence of fake pills that look like prescription painkillers, but they are fake tablets, filled with deadly fentanyl.
An ideal drug addiction treatment program would be one that includes an inpatient detox program that transitions the client off of fentanyl, onto a known, short-acting opioid. After a washout period, when all the fentanyl is out of their system, the client may be started on Suboxone, or another form of buprenorphine.
Programs that use buprenorphine are now the gold standard of opioid addiction treatment. Unfortunately, fentanyl analogs stay in the body for many days, causing the Suboxone patient to go into precipitated withdrawal, due to the fentanyl interacting with the buprenorphine in Suboxone.
The hypothetical transitional detox program described above could help to make the transition off of fentanyl easier, but it is not allowed in the US currently. Short-acting opioids may not be used as part of any opioid addiction treatment program at this time.
What alternatives are there to Suboxone, Sublocade, Subutex, or other buprenorphine medications?
Methadone maintenance is one effective alternative that provides some advantages to people who are taking fentanyl from the streets. Many people who start out addicted to prescription painkillers find themselves using fentanyl, because it is cheaper than pills, and readily available.
A major advantage that methadone has over Suboxone is that it can be started immediately on the same day that the drug user quits fentanyl. There is no need for a wash-out period as there is with Suboxone.
Methadone also has a higher success rate compared to Suboxone. The success rate of methadone in treating opioid addiction is about 50% greater than that of Suboxone and buprenorphine, in general.
Of course, there are other options, other than methadone and buprenorphine. Many people addicted to opioids choose to go to rehab, where they are detoxed off of opioids and begin a program of complete abstinence from all drugs.
How do opioid withdrawal symptoms relate to opioid addiction?
A person may have a physical dependence on opioids, but not an addiction. They may never develop an actual addiction, where they persistently engage in self-harm with opioids, unable to stop obsessing over the drugs.
Physical dependence means that the person who takes opioids prescribed for pain will experience withdrawal symptoms when they try to reduce or stop their opioid usage. Symptoms include muscle spasms, achiness, runny nose, abdominal discomfort, nausea, vomiting, and diarrhea.
Many people describe opioid withdrawal as being like a severe flu. The symptoms are intolerable and hard to relate to for people who have not experienced it.
Quitting opioids cold turkey is very difficult.
It is easy to say that a person should just suffer through, and they will be done with opioid dependence. In reality, it is not that easy to get through the many days of withdrawal symptoms to a point where they start to feel better.
Another element of withdrawal that makes it difficult to get off of opioids is that taking an opioid during withdrawal makes the symptoms go away immediately. The person suffering from opioid withdrawal who has opioids in their possession has the key to stop the suffering at any time.
It is easy to imagine that a person going through the cycle of withdrawing and then taking more opioids might be at risk for developing an addiction, in addition to a physical dependence.
In fact, opioid cravings are one possible withdrawal symptom. The person withdrawing, in addition to having unpleasant withdrawal symptoms, begins to crave opioids.
What is the easiest way to quit taking prescription painkillers?
When a person is addicted and physically dependent, quitting painkillers is not at all easy. Going on methadone or Suboxone is relatively easy, but many people argue that these drugs are also opioids, so it is not really quitting.
Is taking prescribed Suboxone really just trading one drug for another? While Suboxone does contain buprenorphine, which is classified as an opioid, it is not at all a matter of trading one addiction for another.
Buprenorphine has unique properties as a partial opioid agonist, and a full opioid antagonist. When a person takes Suboxone, they do not get high from it, and they do not have opioid cravings throughout the day.
Long-term Suboxone therapy allows the patient to have time for their brain to heal from the opioid addiction. Changes that have occurred in the reward pathways of the brain improve over time.
While the patient may not act addictively while on Suboxone, or after they have completed treatment, they do develop a physical dependence on buprenorphine. Hence, quitting Suboxone is not easy, because the patient will experience many of the same withdrawal symptoms they would experience from other opioids.
Yet, if treatment has lasted long enough, ideally, as the patient gradually tapers off of Suboxone, they will not have opioid cravings. When the brain is not in a state of active addiction, it is able to heal from the constant obsessions that characterize addiction.
Where can I learn more about painkiller addiction and how to identify it?
Some people who are prescribed painkillers are concerned about addiction. They worry that they are addicted, when in many cases, they are not addicted to their prescription painkiller.
It is good to have resources to turn to in order to better understand pain pill addiction and opioid dependence. While blogs, such as this one may have a wealth of information, another source of knowledge to engage with is a podcast about opioid addiction and recovery.
Some people have described our podcast on this website as one of the best addiction recovery podcast resources available. I encourage you to look through our many episodes on the topic.
For example, we have two episodes with interviews with Dr. Adam Bisaga, one of the country’s top opioid addiction treatment specialists. Dr. Bisaga is a professor at Columbia University, and he is the author of Overcoming Opioid Addiction.
Are there rehabs that specialize in painkiller addiction?
While methadone and Suboxone treatments at a local doctor’s office are great, they do not work well for everyone. Some patients need a different type of addiction treatment in order to recover from active addiction.
Sometimes, the best way to start addiction treatment is to get away from family, friends, and a dangerous environment. Going away to rehab for at least a few months can give a person freedom from temptation and distraction.
At rehab, they can focus on their issues with painkiller addiction, and what they can do to address the triggers that arise that lead to relapse. They may also explore their past with a therapist, identifying what traumas during childhood may have put them at greater risk for pain pill addiction.
Pain pills relieve emotional pain as well as physical pain. When a person is in pain due to emotional trauma, or memories of physical trauma, they may turn to opioids to hide from the pain.
By engaging in regular psychotherapy, a person can learn to face their pain and overcome the emotions that remain as a result of past traumas. While therapy should also be a part of methadone and Suboxone therapy, therapy may be more effective for some people when they are in rehab and away from the drama of their everyday life.
If prescription pain pills are so dangerous and addicting, should they be illegal?
For many years, the pharmaceutical industry has searched for alternatives to opioids for pain management. Many of the products they have released turned out to be more dangerous than opioids, at least to physical health.
There have been non-opioid pain pills that increased the risk of heart attack and stroke. Another non-opioid painkiller on the market caused liver failure for patients who took it longer than ten days.
After the FDA discovered, in each of these cases, that the new pain drug was not safe for the public, the drug was pulled from the market. Many pain pills meant to replace opioids have been discontinued.
So far, opioids have proven to be amongst the safest drugs regarding physical health. The main issues with opioids include physical dependence, and for some, opioid addiction.
Unfortunately, while the drug companies still try to find safer alternatives, opioids remain essential to healthcare, in spite of the significant risks they pose. Making opioids illegal would lead to widespread suffering amongst people with severe pain who depend on opioids to function.
People with cancer pain, chronic spinal pain, and other pain syndromes have relied on opioids for many years. Opioids are also the gold standard for post-operative pain and for some acute injuries, such as broken bones.
Since the legalization of medical cannabis, some people have found that cannabis is an adequate replacement for opioids in treating their pain. While cannabis is not without its own issues, it is, in many ways, safer than opioids.
Hopefully, in the future, we will have many more solutions to address chronic and acute pain without as much reliance on opioid painkillers. It would be nice to no longer have to worry about the use of prescription painkillers leading to opioid addiction.
