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.
So 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 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.
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.