A Pained Life: Who Gets Addicted?

A Pained Life: Who Gets Addicted?

It is very disheartening to me when I read and hear stories in the news about the “painkiller abuse epidemic.”

It’s disturbing because the number of deaths and overdoses being reported are not broken down and often merely presented as a whole — then usually put on the shoulders of those who have chronic pain and rely on these medications.

Insult is often added to injury by “experts” — people with good solid credentials who fail to distinguish between addiction and dependence.

In addition, the statistics on addiction are all over the place. According to the National Institute on Drug Abuse, estimates of addiction among chronic pain patients vary widely from as little as 3 percent to as high as 40 percent.

bigstock-Young-Blond-Woman-With-Medicin-12068330So who is at more risk for addiction?

According to WebMD, many factors are known to increase the risk for opioid addiction. Our genes account for about half of it. Studies of identical twins, who share the same genes, found that if one twin develops a drug addiction, there’s about a 50% chance the other twin will, too.

That leaves the other half of the risk in the “environmental” category.

“This includes everything from your social group, your economic status, your family environment, and probably most importantly, stressful events during childhood,” says Andrew Saxon, MD, professor of psychiatry and director of the addiction psychiatry residency program at the University of Washington.

Those stressful events can include physical or sexual abuse, losing a parent at a young age, or witnessing violent acts. Psychiatrists believe childhood trauma creates changes in the brain that last into adulthood and make people more prone to prescription drug abuse.

Adults who abuse other substances like alcohol or cocaine are also more likely to become opioid addicts. Smokers and young people are also at higher risk.

Just being around opioid drugs is another obvious environmental factor. Two teenagers might both be genetically predisposed to opioid addiction. But if one goes to a high school where prescription drug abuse is considered “cool,” he might be more at risk of becoming addicted. If the other teen is never exposed to opioids, he may be more likely to stay clean.

The problem I hear from members of the chronic pain support groups to which I belong is that their doctors rarely if ever ask about their addiction history. I cannot recall a doctor ever asking about my social history.   How can a physician know if they should be prescribing a narcotic to a patient if they don’t have this very important and basic information?

Most of the people I know who take opiates for their pain do not like the way it makes them feel.  Personally, I hate the dry cotton mouth and spacey feeling I get from them (and I am on one of the weakest of the opioids).  I resist taking it and having to deal with the awful side effects.  The result is that my pain gets out of control.  I end up taking extra and feeling even more dry and spacey, and in worse pain, because I did not want to feel dry and spacey in the first place.  A complete Catch-22.

The American Chronic Pain Association tells us this about addiction and opiates:

“Whether its insulin, or blood thinners, or antidepressants everyone who relies on medication to maintain normal function is, in one sense or another, dependent on that medication to do things their body can’t do. Calling that addiction is like saying you’re addicted to food, because you can’t live without eating. Dependence is not addiction.

If tolerance isn’t addiction and dependence isn’t addiction, then what is addiction? Perhaps the simplest answer is that addiction is what happens when a drug stops being a means to an end and becomes an end itself. When taking the drug becomes more important than controlling the pain, that’s addiction.”

At the end of the day we cannot count on our doctors to monitor who should and should not be given narcotic medications, and who should be monitored closely vs. who can responsibly and safely use prescribed opiates.

The onus falls on us to be honest with ourselves and our doctors.  We know who we are and what our relationship to opiates may or may not be.  Even though it can be embarrassing and hard to talk about, we cannot leave it up to the doctor to ferret out who may or may not become addicted.  We have to take the bull by the horns, speak honestly, and force them to hear us.

Carol Levy

Carol Levy

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol was accredited to the United Nations Convention on the Rights of Persons with Disabilities, where she helped get chronic pain recognized as a disease.

Carol is the founder of the Facebook support group “Women in Pain Awareness”. Her blog “The Pained Life” can be found here.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

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Authored by: Carol Levy, Columnist

There are 11 comments for this article
  1. laurin800 at 9:17 pm

    I hate that there is such a stigma and fear associated with these medicines that we don’t use their name. It is horrible it is that way, it makes some of us that use these feel like a criminal. Maybe in time it will get better. When I was diagnosed with RSD in 2004, I went to 7 doctors and none of them heard of it! Now most know. Hope you all have a good night 🙂

  2. BL at 7:05 pm

    laurin800, more is not always better. There is nothing wrong with telling your dr you would rather try a lower dose of a med and it might be to your advantage. There were several strong pain meds my dr wanted to try me on and I say no, they were too strong. One of the meds he insisted on I wasn’t comfortable with the mg he wanted to start me out on. So I asked him if he would start me out on the lowest dose and he did. He said that I was going to hurt, but he was wrong. I stayed on the lowest dose he agreed to start me off on until he left several yrs later.

  3. laurin800 at 6:05 pm

    I just wanted to add one more group of chronic pain sufferers to the list, these would be the “Over medicated”. I was prescribed The max dosage for nerve blocking, and a dosage way to high for pain, along with an antidepressant. I would pass out anywhere. it was worse than the pain. So there are those of us who started decreasing our dosages- with resistance from my doctor!! I was on a study for Neurontin because I was taking 3600mgs a day. I cut that in half. I cut the pain meds in half, and same with the antidepressant. It took 2 years to do that, and I am in some pain every day. 2-4 days a week I may have to keep my legs up for a few hours. But I have a clearer head, and my cost has dropped. I know of others that weaned themselves off the meds. How do we know if we need them if we don’t check it sometimes? Hard painkillers can cause pain themselves during weaning. It is an issue that needs to be checked.

  4. BL at 7:43 pm

    Becky, the thinking is if your pain is more than your current pain meds can handle and you need additional medication, you should be able to get in to see your pain dr. A week really is enough time. The majority, if not all pain contracts, state that you aren’t to go to or receive pain meds from any other dr. If your pain contract states this is ok for you to do, it is very unusual.

  5. Becky at 5:17 pm

    I cannot get treatment for level 7 and up pain episodes that none of my home medications can treat. ER’s in my town will not treat chronic pain patients, not because of a law, but because they are afraid of liability, they have poorly trained medical staff that doesn’t understand what chronic pain is, and from listening to the misinformation on TV and newspapers. One doctor laughed at me when I mention breaking the cycle of pain, the very term my pain doctors use. My pain doc explained dependence to me. I am very compliant with my doctor’s orders and follow my pain contract to the letter. Not being treated when my pain is a 13 is like saying to me, you don’t count to have the same consideration we give to patients with other emergencies. We are made to be a lesser class of person. So it is no more ER for me unless my doctor can assure the hospital can and will treat me humanely, according to their vision and mission and just like a person who needs help and compassion. Being given benadryl at the ER is not a treatment it is a motion to make me feel like they are treating me. I am physically and emotionally devastated to be considered a drug seeker or addict by ER personnel who have not kept up to date on current pain treatment protocols in the ER or hospital boards who are afraid we are drug seekers. The FDA change in how opiod scripts are handled have solidified these people’s opinions that we are bad people and treating us will go against our pain doctors way of treating us. If they would look at my contract that I carry, they would know. Now I have to talk to my primary about how to get ER treatment for intractable pain episodes that disable me for a week at a time. This is not what Hippocrates would like to see.

  6. Kimberly Kay Miller at 1:14 pm

    There is absolutely NO DIFFERENCE between the need to function on one type of medication versus another type. If you need Metformin today, you will likely need it have it increased or additional medication added for you Diabetes as the disease worsens and NOBODY will say, “another rationalization by users to continue to use”. Nobody with chronic intractable pain will tell you they asked for the disease or diseases and conditions they SUFFER from, no more than the diabetic or heart patient asked for their lot in life, but there it is all the same.

    The only difference is that SOME people have chosen to abuse the drugs needed by chronic pain sufferers, chosen to overdose on them, and chosen to cause tremendous problems for the patients who actually NEED them to have any type of quality of life. As a result of the unfortunate actions of these sick, addicted individuals, the entire community of chronic pain patients have become a community that’s assumed to be guilty before being accused of ANY wrong doing.

    This is where the true criminal action lies. Letting people, who never asked to be in chronic pain, suffer relentlessly due to the actions of those who WILL find another way to “get their buzz” and those of us in pain will NOT find another way to alleviate out suffering because we are following the rules.

    In the chronic pain community, when you follow the rules, you suffer. You suffer physically, emotionally, and financially due to increased number of doctor visits, increased number of labs (drug screening) and the number of trips to the pharmacy as surely the number of medications you are allowed are cut and with less refills possible due to changing laws, you are at the doctor’s office constantly getting a piece of paper with a written RX as this is necessary now.

    Having never broken the laws of the pain medication standards, it seems, most definitely that we, the chronic pain community, have been singled out to suffer the burden the DEA and local police could not handle.

    It IS UNFAIR to pick on the weakest and sickest in our society and is certainly an abuse of the Americans for Disabilities Act as we are called upon to WORK very hard to receive any type of minimal relief for our situations. Makes being a diabetic seem much less daunting. Nobody looks twice at them as they get more and more of their medication, now do they?

  7. Kurt W.G. Matthies at 10:14 am

    When speaking of addiction, it is important to note the condition of ‘pseudo-addiction’, a side effect of opioid tolerance, which mimics behaviors of addiction in those with chronic pain.

    When our opioid medication stops working because of the physiological response to long-term opioid therapy — opioid tolerance — we seek a higher dose of medication for relief.

    In the untrained practitioner, this behavior looks like addictive craving, when in fact we’re simply looking for pain relief.

    Other pseudo-addictive behaviors can follow. For instance, when denied an increase in medication, a pain patient can look to another doctor to help, receiving an adequate dose from two sources.

    While this behavior is labeled as “doctor shopping” in addiction circles, in some chronic pain patients it may seem a logical adaptation to an intransigent doctor.

    As Carol notes, medical papers claim rates of addiction from 10% to 50%, depending on the definition of “addiction.” Generally, the studies with numbers higher than 10% include pseudo-addictive behaviors as markers of addiction.

  8. BL at 7:34 pm

    Bruno26, it is obvious that you do not have to take a opioid medication to be able to get dressed or take a shower or prepare a meal that takes 15-20 mins. I can only speak for one person. That person is on a low dose opioid, they have refused going to stronger meds or higher doses. But, in order to be able to get out of bed and walk, literally from their bedroom to their bathroom and kitchen, they require this medication. This medication allows them see family members and friends every 3-4 months for a max of 1 1/2 to 2 hrs. They aren’t able to do their grocery shopping because of severe chronic pain, they can’t take their trash out or do the most basic of housekeepng due the severe chronic pain. If they didn’t have the little medication that they do take, what would you suggest they do ? They are on a fixed income and can’t afford to pay someone to do these things for them.

    I understand the concern with patients and drs who continue to increase pain meds. Life style adjustments have to be made. They aren’t pleasant, they aren’t fair, but they need to be made. Patients don’t think about what will happen down the road if they have cancer and have built up a tolerance to the pain meds they currently continue to increase. Combining opioid and other medications along with non medications forms of pain management also need to be made. Not treating chronic severe pain that prevents a person from doing the most basic things with low doses of opioids isn’t an option.

  9. Bruno26 at 12:08 am

    I find this poor analogy of “…Insulin, or blood thinners, or antidepressants everyone who relies on medication to maintain normal function is, in one sense or another, dependent….” nothing more than another rationalization by users to continue to use. Because other conditions require medication, somehow an extremely dangerous level of dependence on opioids, is somehow justified? In fact, the further comparison to being “dependent” on food, further illustrates the desperate attempts to justify opioids as some harmless drug. Certainly overdosing on important medications for diabetes, heart disease and depression can cause serious side effects, including death, but definitely don’t have the same impact as accidently double dosing on high levels of opioids. And these drugs are given to address conditions that are objectively diagnosed (though depression certainly is not as objective as the medical community would like, so I place them in the same category as opioids). Pain, is in fact subjective, you can’t take a blood test to confirm your level of pain, you certainly can test for blood sugar. Also, the only purpose of taking Warfarin is to thin the blood, you don’t “feel better” after taking it, there is no potentially dangerous psychological aspect to taking a blood thinner. The psychological aspects of opioids is well documented. The “you don’t know my pain” or “I take them so I can function” excuse is simply filled with subjectivity and more importantly a definite lack of medical insight as to the implications of long term use, that is a fact. Another fact is that most opioid users increase dosage overtime, and for those who maintain a set dose for a long period, will always be subject to the dangers of missing a dose and upsetting their proclaimed happy equilibrium and all that goes with their supposedly safe level of dependence. The science and the numbers we use to determine medical outcomes overtime will determine the future of opioid therapy for chronic non-cancer pain, definitely not the personal opinion of existing opioid users, nor the “pain” organizations and drug makers who are looking to expand their profits. I feel for those in chronic pain, I am a member of this unfortunate group, but the fact is too much rationalization and not enough science is being discussed, especially in the article above.

  10. BL at 6:29 pm

    It’s a shame they don’t spend more money on teaching people how to be tolerant of each other and each other’s differences. If they did, their might be a decrease in the violent acts that children witness and that could help reduce the number of people dealing with addiction in the future.

    I know someone who takes Effexor. If they run out, they will do anything to get the medication to stop the withdrawals they experience. But, because this common side effect is physical and not psychological, there isn’t concern over it in the medical community and government regulators.

  11. Kimberly Kay Miller at 4:57 pm

    Carol Levy,

    Thanks for always seemingly finding a way to explain what others are wanting, needing to say. I have a very good pain specialist who actually does ask about family history. He is, however an addiction specialist as well. The following description of the difference between dependence, tolerance and addiction is the best way I have heard it explained all at once:

    “Whether its insulin, or blood thinners, or antidepressants everyone who relies on medication to maintain normal function is, in one sense or another, dependent on that medication to do things their body can’t do. Calling that addiction is like saying you’re addicted to food, because you can’t live without eating. Dependence is not addiction.

    If tolerance isn’t addiction and dependence isn’t addiction, then what is addiction? Perhaps the simplest answer is that addiction is what happens when a drug stops being a means to an end and becomes an end itself. When taking the drug becomes more important than controlling the pain, that’s addiction.”

    Thanks for being there for Chronic Pain Patients! You’re a treasure for our community and I am sure I speak for many when I say, “I appreciate all that you have done for us”

    Sincerely
    Kimberly Miller