How Real is Painkiller Addiction?

Discussion in 'Fibromyalgia Main Forum' started by JLH, Jan 19, 2010.

  1. JLH

    JLH New Member

    How Real is Painkiller Addiction?

    By Kate Francis

    Experts agree that prescription painkiller medication addiction is real, and the risk for some can be great.

    According to the Office of National Drug Policy, emergency room visits resulting from the abuse of painkillers has gone up 163 percent since 1995. "Painkiller addiction is a very real addiction," says Dr. Dennis Lin, psychiatrist and attending physician on faculty in the Department of Psychiatry at Beth Israel Medical Center in Manhattan. "Prescription painkillers like Vicodin, OxyContin, and morphine work on the same neuro-receptors in the brain as heroin. They are highly addictive substances," he says.

    "The number of people addicted to prescription pain pills in this country exceeds the number of people addicted to all other illicit drugs combined (excluding the use of marijuana)," says Dr. Lee Tannenbaum, addiction specialist and founder of the Bel Air Center for Addictions in Maryland. According to the National Institute on Drug Abuse, estimates are that 5 million individuals in the country are misusing prescription painkillers.

    Laurene Spencer, MD, Medical Director at the Reliance Center, an outpatient addiction treatment facility in San Francisco, agrees: "There is now an orderof magnitude greater number of prescription pain pill addicts than heroin addicts in the US: About 5 million prescription opiate addicts vs. 500,000 heroin addicts."

    The demographic of greatest concern, says Dr. Spencer, are young users, teens and 20s, who may start out with the perception that since these drugs are legal and pharmaceutical quality, they are therefore less dangerous.

    Early misuse, she says, often comes from family medicine cabinets or from medications prescribed for a real injury (or other pain) but are then taken longer and in larger amounts than medically indicated, or saved for what turns out to be later use.

    "The stigma of having an addiction keeps most people from discussing their situation with their doctors. Most doctors do not have a good understanding of addiction and they would just as soon not discuss this with their patients either, and thus both sides are more comfortable in just maintaining the addiction and pretending that it is OK than dealing with the difficult topic of addiction," says Dr. Tannenbaum.

    Are Some Individuals More at Risk?

    Doctors agree that some people are more at risk for addiction than others--primarily those with any type of family history of addiction. "Addiction is caused by an interaction of chemical substances (drugs) and receptors in the brain. Receptors are genetically coded proteins, and thus their susceptibility to damage or influence by a variety of drugs is determined by their genetic code," says Dr. Tannenbaum.

    "Many of my patients describe a family tree riddled with alcoholics and addicts, both within their immediate families as well as afflicting cousins, aunts, uncles, and grandparents," says Dr. Spencer.

    Other doctors say that patients also often describe growing up in an environment so full of drug use that their use of drugs seems almost inevitable.

    Another risk factor includes people with anxiety and depression. According to Joseph Califano Jr., chairman and president of the National Center on Addiction and Substance Abuse at Columbia University, people who are depressed, prone to anxiety, or are alcoholics, are more likely to develop an addiction to prescription drugs.

    Is the Risk with Some Painkiller Medications Greater than Others?

    Experts agree that those painkillers that are quicker in action (meaning how fast the drug gets to the brain), the greater the addiction potential. In the realm of prescription painkillers, Percocet and OxyContin (which contain the drug oxycodone), are very quick acting and very potent, and thus they do present a very significant risk for addiction.

    "Among my patients, OxyContin is the most prized," says Dr Spencer.

    She says that while OxyContin is enjoyed when taken orally, many progress to grinding it up and smoking it because it gets to the brain faster that way (about 7 seconds vs. about 20 minutes when taken orally). Thus, it provides more of a rush.

    "When the brain craves an addictive substance it wants that addictive substance as quickly as possible. This is why people abusing drugs have the tendency to move from swallowing pills whole, to chewing them, to snorting them, to shooting them intravenously. Each advancement in the way people choose to use drugs increases the speed at which the drug hits the bloodstream and the brain, says Dr. Tannenbaum.

    Dr. Lin adds that any painkillers that contain an opioid-like substance, such as Vicodin, Percocet, OxyContin, or morphine, are all highly addictive. "Over the counter painkillers that do NOT contain opioids, like Tylenol or ibuprofen, are not addictive," says Dr. Lin.

    How to Identify a Painkiller Addiction

    When people "hit bottom" and beg for help, then it's easy to know what is going on. But what are the signs that come before that?

    "If someone is using painkillers on a regular basis, and has done so for any significant period of time (more than several weeks)--and they are either escalating their dose or continuing to have symptoms that are only relieved by their pain medication, you need to consider the possibility that they might be developing an addiction to painkillers," says Dr. Tannenbaum.

    Another way to identify a painkiller addiction is when a person's behavior significantly changes. For example, the person may become unreliable (is late or misses appointments), their personal grooming deteriorates, or their finances become troublesome. In another case, a person's mood may become very changeable. For example, they are happy one minute and irritable the next.

    Anyone requiring multiple refills of painkiller medication from their doctor, or obtaining their painkiller medications from friends, family members, or multiple doctors, needs to be evaluated for a possible addiction. If you notice that someone you care for is running out of their prescription opiod medications before the refills are due, suspect addiction and abuse.

    Physiological signs of opioid withdrawal (as the result of addiction) include nausea and vomiting, chills, fever, sweating, muscle pains and aches, and general great physical discomfort.

    What to Do If You Suspect an Addiction

    Once that you suspect an addiction, what to do about it depends on who the person is, what the behavior is, and your relationship with the person, says Dr. Laurene Spencer. "Formal interventions or working with a counselor can be very helpful," she says.

    Dr. Tannenbaum suggests that if an addiction is suspected, the patient should be evaluated by an addiction specialist. He says that most primary care doctors, and even pain management specialists, are not necessarily trained in recognizing addictive symptoms and differentiating them from appropriate use of painkillers for ongoing true pain issues. The general rule is that if you suspect your loved one is addicted to painkiller medications, take them to see an addiction specialist.


    California Society of Addiction Medicine.

    Goldman, R. A Familiar Fiend: Painkiller Addiction. January 4, 2008.

    Griffin, R.M. Reviewed by Brunilda Nazario. Back Pain: Medication and Addiction. August 2004.

    National Institute on Drug Abuse.

    Interviews with:

    Dr. Dennis Lin, MD. Psychiatrist and attending physician on faculty in the Department of Psychiatry at Beth Israel Medical Center in Manhattan.

    Dr. Laurene Spencer, MD, Medical Director at the Reliance Center, an outpatient addiction treatment facility located in San Francisco.

    Dr. Lee Tannenbaum, MD. Founder of the Bel Air Center for Addictions in Maryland and addiction specialist board-certified by the American Board of Addiction Medicine.
  2. cynicaldog

    cynicaldog New Member

    According to a 2009 in Pain Physician Journal (I'm looking for the direct link, be back asap), fewer than 5% of chronic pain patients using narcotic medication ever become addicted. In fact, most studies place the number of potential addicts at a mere 1% to 3%. Another way of looking at it: at least 95% of people taking narcotic pain medication will never have addiction issues. Some of us need narcotic pain medication to have any sort of quality of life, and most of us use the medication responsibly and as prescribed. If you can get away with a couple of aspirin (or less), that's great, but don't assume you know how much pain the rest of us are in, and please don't try to scare people away from medication that could turn their lives around.


    Edited because my link to the Pain Journal was to the incorrect study, and I'm still hunting down the correct issue. However, this study in the NEJM reported an addiction rate of .03% (Porter J, Jick H. Addiction rare in patients treated with narcotics (letter). N Engl J Med 1980; 302:123). Also, this other study found two instances of addiction in 38 patients, and in both cases the patients had prior addiction issues:

    One last thing: a study published in June 2008 in the journal Pain Medicine attempts to quantify the risk of addiction and aberrant drug-related behaviors in long-term opioid use for chronic nonmalignant pain. The authors, led by David A. Fishbain, MD, performed a structured evidence-based review of all available studies on the development of abuse/addiction and aberrant drug-related behaviors (ADRBs) in chronic pain patients with chronic opioid analgesic therapy. The study found that the incidence of reported addiction in chronic pain patients exposed to chronic opioid analgesic therapy was only 3.27%, below the 10% addiction rate in the general population. The incidence of addiction in patients with no history of abuse was only 0.19%.
    [This Message was Edited on 01/19/2010]
  3. TigerLilea

    TigerLilea Active Member

    My S-I-L has FM, and she could take aspirin by the handfuls and not get any pain relief. You must have a very mild case of FM if a couple of aspirins a day helps you. I very much doubt that many people here would be helped by that.
  4. JLH

    JLH New Member

    This article was just for your information, and not to cause any angry or negative responses.

    Don't get your panties in a wad!
  5. cynicaldog

    cynicaldog New Member

    The article you posted contained information which could be construed as alarmist, because it looked at a problem which only occurs in a small percentage of patients who take narcotic pain medication yet implied the problem was present on a much larger scale. You can't post something so one-sided without expecting to hear some rebuttals (a rebuttal, btw, isn't the same as being "negative" or "angry").

    I'm glad people who have family histories of drug and alcohol abuse now know, because of your post, that they're at higher risk for narcotic addiction. However, I'm also glad that <i>everyone</i> knows the overall rate of addiction is very tiny. There are lots of people on this board who avoid treatment with narcotic pain medication because they fear addiction, and there are others who are estranged from family and friends because of negative attitudes towards narcotics. It's important the whole truth gets told, not just a tiny part of it.
  6. shari1677

    shari1677 New Member

    I have to agree with TigerLilea. I have FM and rheumatoid arthritis. I am only 42. I recently stopped taking a narcotic and am in severe pain. I'm taking Advil, but that isnt touching it at all.

    I also think that some of us need to take the taboo out of taking narcotic pain medication. My family urged me to go off of my current narcotic and I listened. They told me my pain was all in my head and that I would see that if I would only go off the narcotic (I was on it for about 1.5 years I think, cannot recall).

    I'm off the narcotic and I cant do ANYTHING!! I'm in pain.

    I'm now thinking - so what if I am taking narcotics - at least I am living a life![This Message was Edited on 01/19/2010]
  7. nah.stacey

    nah.stacey Member

    When I first came on this board in Sept. I came on for that very question. I was taking 2-10/650
    Percocet 2Xdaily. My husband was convinced that I was addicted to the percocet and that was what was causing most of my problems. I cold turkey'd off the percocet to prove to him that I was not addicted. We learned some very valuable lessons from this little episode.

    1) There is a GREAT difference between "addiction" and "dependance". As my pain Dr. explained to me "do we call people who need insulin, addicts"?

    2) For me and my hubby agrees, life without percocet was far worse than life with.

    3) I don't take percocet for a "high" I take it for pain and to have an ounce of relief from the debilitating pain.

    4) I proved to myself and my hubby that by being able to go off the opiad and YES it was miserable, gave ME power over the drug not the drug over me.

    This is only my experience and everyone deals with their pain and medications differently. Some have severe reactions to many RXs, others like me, have had so many things broken both inside and out that they have been on one narcotic or the other for the better part of their lives. Just because your body and/or mind can't tolerate the pain anymore and therefor needs help dealing with it does NOT make you an addict. If you were taking it to get up in the morning, like a cup of coffee, then you might consider that you have an addiction.

    Pain + narcotics does NOT = and addict.

    You are you own best advocate, if you NEED it for pain and to have a life TAKE it, don't let someone else's issues and opinions deter you from doing what you NEED to do to have life.

    Best of Luck with your choices,
  8. Janalynn

    Janalynn New Member

    I agree, we need to get this Taboo off this message board. Our condition is one that often needs this type of relief. We come here for support in needing it sometimes, often feeling like we have to fight the stigma from the outside world and don't need to find it here.

    I read the same information on the National Pain Association and also the Pain Foundation, less than 3% of people with Chronic Pain ever face addition problems.