Sick of Pain Meds
Celebrity deaths and pill mill closings make the news, but accidental drug deaths are affecting every community. Too many tragic losses of humanity go unnoticed. More often, lives of people close to drug abusers or addicts are adversely affected long before death occurs. The intent of this blog is to inform the community and preempt the suffering and domestic strife before tragedy occurs, particularly from pain meds.
According to the CDC, prescription pain medication overdoses killed nearly 15,000 people in the U.S. in 2008, the last year for which good data is available. This is more than three times the 4,000 people killed by these drugs in 1999. Confirmatory data is lacking, but the trend is convincingly even worse for the past three years.
Unlike the crack cocaine epidemic of the 1990s, which was portrayed as mostly an inner-city problem, prescription drug abuse is far more suburban and rural. This problem crosses all walks of life, crosses all races and socioeconomic classes. In fact, the CDC reported in November 2011 that the death rate among non-Hispanic whites and American Indians/Alaska Natives was three times higher than among Blacks and Hispanic whites.
The vast majority of people who misuse prescription painkillers—7 out of 10, according to drug czar Gil Kerlikowske of the Office of National Drug Control Policy— get them from family or friends, not directly from doctors.
Secondly, most people addicted to these medications have used illegal drugs previously. They do not become addicted while being treated for pain. Law enforcement targeting prescribers and drug dealers—so-called supply side intervention—has accomplished relatively little to curb the problem. Therefore, we must appeal to the public if we are to stop this public health epidemic of unnecessary deaths from inappropriate use of pain medication.
Recreational abusers and legitimate pain medication users unfortunately too often end up in the same boat. When counseling patients, we must emphasize that it is not always the person. Sometimes, it’s the drugs. I am not diminishing the importance of personal responsibility. However, sometimes well-intentioned people fall prey to circumstance or even genetics.
Pain medications such as hydrocodone, oxycodone (brand name oxycontin), dilaudid and methadone, and illegal drugs such as heroin all belong to the same class of drugs known as opiates. And yes, oxycodone is oxycontin in generic form. Opiates are always potentially addicting.
People confuse and commonly misuse the terms: “physical dependency” and “addiction.” The distinctions have implications in considering treatment. Physical dependence means that a person will develop symptoms and signs of withdrawal (e.g., sweating, rapid heart rate, nausea, diarrhea, goose bumps, anxiety) if the drug is suddenly stopped or the dose is lowered too quickly. Addiction refers to a condition where a person has lost control over use of the drug and continues to use it even when the drug is doing harm to themselves or others. People who are addicted engage in unacceptable behaviors like obtaining pain medications from non-medical sources, altering oral formulations of prescription medications, or snorting or inappropriately injecting medications.
Both dependency and addiction result from a process called tolerance. Tolerance refers to the situation in which a drug becomes less effective over time. A person requires higher and higher doses to achieve the same response. It can be difficult to know the difference between tolerance, physical dependence and addiction. Sometimes the distinction is academic, but the bottom line is even when you are taking pain meds for a legitimate reason, when the treatment becomes worse than the disease (i.e. the consequences of the medication are more trouble than any benefit), then it is time to do something different.
The main point to understand is patients don’t set out on a mission to become addicted. By the time a problem is realized, consequences have already occurred. If you begin planning activities around the times you take your medication or if your medication starts to affect your family life or if you miss important events because of your prescription drug use, these are clear warning signs that you may have a problem.
Taking more of a medication than is prescribed or than you planned to take at one time is a sign that you're losing control. Drug addiction is clearly the problem when an individual starts asking for prescription meds from friends and relatives, falsifying prescriptions, stealing money or goods to pay for meds, trading services for drugs, and foraging for medications. When the treatment becomes worse than the disease being treated, get help.
Patients on pain meds cannot simply just stop them. It is not that simple. If your goal is to get off pain meds, you must structure a plan to do so over weeks, months or if necessary years. And it must be done under appropriate medical supervision. Your solution will not be the same as for the next person. You are unique. Sometimes, alternative medication to allow safe reduction of dosage over time or other therapeutic modalities—massage, physical therapy or additional and/or cognitive behavioral therapy—are necessary to reduce pain and withdrawal symptoms and to safely transition off of pain meds or other drugs.
Nevertheless, outpatient addiction treatment is effective, costs less and is truly a better fit for many clients (especially those still working, attending school, etc.). When appropriate, treatment with Suboxone is an effective option. Suboxone contains buprenorphine, a pain medication. In addition to facilitating detoxification, buprenorphine is a very effective pain medication. However, it causes much less tolerance, and is much easier than other opiates to taper off of when done properly. When used under proper medical supervision, Suboxone provides a safe outpatient based way to deal with dependency on or addiction to pain meds.
Coming next week: I will discuss the new prescription drug database as well as doctor shopping for pills. I'll also answer questions that arise during the week about topics in wellness and personal image enhancement. If you have questions or suggestions for topics, email askthedoctor@wisemedicalcenter.com.
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