Category Archives: Opioids and Painkillers

Why is it so Easy to Get Addicted to Pain Pills?

Pain Pill Addiction
Let’s get two things on the table right away.

First, anyone can get addicted to pain pills.

Anyone.

Me, you, your doctor, your neighbor, and anybody in your family or circle of friends.

Remember Brett Favre, NFL Hall of Fame quarterback, Super Bowl winner, star and starter for the Green Bay Packers? He got addicted to pain pills while recovering from a shoulder injury. How about music legend Prince? Yes, the Purple One, famous not only for his music, but for avoiding – and criticizing – the use of drugs by his peers during his thirty-five years in the celebrity limelight. He got addicted to pain pills while trying to manage problems with his hips. Then he died from an accidental overdose in his own home. How about Rush Limbaugh? Yes, the fiery, often-controversial conservative talk radio host. He got addicted to pain pills while trying to manage pain after back surgery. He battled the addiction for years, checking in and out of rehab, and even got tangled up in a criminal investigation related to obtaining prescriptions illegally.

That’s the first thing, worthy of repeating: no one is immune to opioid addiction.

Second, getting addicted to pain pills has absolutely nothing to do with your character. Getting addicted to pain pills doesn’t make you a bad person. Not getting addicted to pain pills doesn’t make you a good person. Addiction does not care about your good deeds or your bad deeds. It doesn’t care if you’re a good parent or a deadbeat dad. You could be as good as Mother Theresa, or as bad as Jack the Ripper. It doesn’t matter. It simply happens.

That’s the second thing, worthy of repeating as well: getting addicted has nothing to do with your value as a human being.

Getting Addicted is Easy: The Biological Reasons

Let’s get another thing out of the way: when we talk about addictive pain pills, we’re talking about opioids. Here’s a short list of pain medications being prescribed today whose pain-relieving properties rely on our endogenous opioid system:

  • Codeine
  • Oxycodone
  • Oxycontin
  • Fentanyl
  • Percocet
  • Vicodin
  • Lortab
  • Lorcet
  • Dilaudid

These familiar drugs are the opioids that have been in the news so much lately. They’re the pain pills that are currently ravaging our nation, sparing no population. Rural, urban, suburban. White, black, Latino. Young people. Old people. Rich people. Poor people. The opioids that caused the new President of the United States to sign an Executive Order forming a Special Commission to handle the crisis – a commission which, in its first public report, recommended that the President declare national emergency because of the crisis. It’s that serious, and it’s happening to everyone, everywhere.

Why?

Because it’s natural.

That’s right. Getting addicted to opioids is almost as easy as getting addicted to food, sex, exercise, or anything that feels good. Synthetic opioids contain the most powerful pain-relieving molecules known to medical science because of a quirk of human physiology: the endogenous opioid system present in the human nervous system. Synthetic opioids relieve pain by leveraging this naturally occurring pain-relief system, and they’re so easy to abuse because they hijack this naturally occurring system. Opioids are problematic because this internal pain-relief network is linked, at the cellular level, to how humans experience feelings of pleasure, satisfaction, and reward. When we do something that makes us feel good, our brain guides us back to that behavior. That’s how our neurobiological reward system works. Our brain remembers what feels good, and when the opportunity to experience that good feeling presents itself again, our brain tells us to go for it – even if another part of our brain knows we shouldn’t.

This is an oversimplification, but it’s true: we get addicted to opioids because we’re hard-wired for them.

The Problem(s) With Opioids:

Long-Term Effectiveness

Opioid pain medications have a significant set of limitations and complications that are neither widely known nor publicized. While they’re incredibly effective at relieving acute pain and there are many situations for which opioids are the logical and appropriate choice for pain management, the effectiveness of long term use of opioids for chronic pain management is not supported by medical research.

That may come as a surprise to most people, but it’s true. In 2016, the Centers for Disease Control (CDC) released CDC Guideline for Prescribing Opioids for Chronic Pain, a comprehensive and systematic review of existing scientific evidence “to identify the effectiveness, benefits, and harms of long-term opioid therapy for chronic pain.” The study defines long-term as use of opioids for over three months. The conclusion as to the effectiveness and benefits of opioid therapy for chronic pain management is concise and unequivocal:

“…no study of opioid therapy versus placebo…evaluated long-term (≥ 1 year) outcomes related to pain, function, or quality of life. Most placebo-controlled randomized studies were ≤ 6 weeks in duration. The body of evidence…is rated as insufficient.”

Risks and Harms

The absence of clinical support for long-term opioid therapy in chronic pain management may come as a shock, but the complications of long-term opioid use are well-known and broadly publicized in online, print, and television media. The statistics reveal a pattern which, taken at face value, should cause a complete re-evaluation of the long-term use of opioids for chronic pain:

Getting Addicted is Easy: The Problem with Prescriptions

Prescription opioids are big business. Experts estimate the value of the North American opioid market at $12.4 billion for 2015, a figure which quadrupled between 1999 – 2014, and is projected to grow to over $17 billion by the year 2024. This enormous increase occurred even though the amount of pain reported by Americans during the same period did not change.

When correlated with CDC data indicating a dramatic surge in opioid prescribing between 2007 – 2012, and the steady increase in abuse, overdose, and opioid-related fatalities since 1999, a clear picture of the past decade and a half emerges. Profit, expediency, and our cultural tendency to trust physicians and the prescriptions they write combined to create a perfect storm in which medication developed to alleviate suffering has arguably done more harm than good, and likely caused more pain than it has relieved.

If you’re addicted to pain pills, it’s likely your addiction happened something like this: you had a surgery, an injury, or a condition that caused you so much pain your day-to-day life became difficult. Your doctor prescribed you an opioid pain medication, and you took it as ordered. You didn’t realize it, but by taking the pills every day, you built up a tolerance, meaning you had to take more pills, or a higher dose of the same medication, to achieve the same analgesic effect. You didn’t think much of it. You simply took an extra pill, or asked your doctor to prescribe something stronger. Then, after a few weeks, you started getting cranky between doses.

You didn’t know it, but that crankiness has a medical term: anhedonia.

Anhedonia is the opposite of euphoria, the pleasurable sensation that accompanies opioid pain relief. You probably didn’t know that anhedonia is an early symptom of opioid withdrawal. You didn’t make the connection because addiction probably wasn’t on your radar. Why should it have been? You trust your doctor, and you were following orders. Besides, your crankiness disappeared when you took your medication – as ordered by the doctor. After a couple of months, you crossed an invisible line: you started to need the pills just to feel normal.

You tried to quit, but couldn’t.

And now there you are: addicted to pain pills, and all you did was follow doctor’s orders.

It’s an awful situation, and you’re not alone. It’s playing out every day across our country. The media attention and the new CDC guidelines for prescribing opioids have caused many doctors to scale back their prescription writing practices, which is a double-edge sword: of course, it’s a good thing that they’re not prescribing as many opioids as in the past decade, but they’re also leaving many people in the lurch. Their patients are addicted, and they’re cutting off their supply of drugs. People are quite literally left out in the cold. Sick, in withdrawal, with no idea what to do next.

Desperate, they turn to street drugs like heroin or black-market knock-offs of the prescription medications they began with. The problems with street drugs and illegally produced pills are numerous, but can be distilled down to three basic issues:

  1. There’s no way to guarantee what you’re getting.
  2. There’s no way to be sure of your dosage.
  3. They’re illegal. If you buy them, you can get arrested and thrown in jail.

But that doesn’t have to be you. You don’t have to go down that road. There’s another option. A much, much better option.

You Can Get Help

At Summit Estate, we understand opioid addiction. We’ve spent years on the front lines, helping people detox, helping people rebuild themselves from the ground up, and helping people take control of their lives. We don’t want you to become a statistic. We want to offer you a way out. We want you to explore our Medical Drug and Alcohol Detox Center, our Residential Programs, our  Day Programs, and our Outpatient Programs. We want to work with you to create a custom treatment program that meets your needs. We’ll help you find your way back to a healthy, sustainable life, free from the cycle of addiction you find yourself trapped in – through no real fault of your own.

Summer 2017—The Opioid Epidemic:  Where Are We Now?

The good news is that the number of opioid prescriptions being written by doctors is starting to decrease. The number peaked in 2010, but since then, prescriptions for high, dangerous doses have dropped roughly 41 percent. To put that in perspective, the prescribing rate in 2015 was triple the rate in 1999, when the current opioid problem began. The reasons for the decrease range from tighter state and insurer limits on how many pills can be prescribed, to stricter regulations concerning pain clinics, to a new set of prescription guidelines released by the CDC in 2016.

However, there’s still much work to be done – and that’s putting it mildly.

Many people are looking to President Trump and the new administration in Washington to help end the epidemic. When he was elected, President Trump said he’d make the opioid crisis a priority, and addiction experts raised their voices in support of swift and forceful action. On March 29th, 2017,  two months after being sworn into office, he signed an Executive Order establishing the Commission on Combating Drug Addiction and the Opioid Crisis, and appointed New Jersey governor Chris Christie to head the commission. Christie convened the commission’s first meeting in June and recently issued an interim report. He promised to deliver a final report in October.

The commission advised Trump to declare the opioid crisis a national emergency. The report does not shy away from the facts, stating “The opioid epidemic we are facing is unparalleled. The average American would likely be shocked to know that drug overdoses now kill more people than gun homicides and car crashes combined.”

The report makes several recommendations, including:

  1. Mandating prescriber education and training for both opioid prescribing and the risks of developing a substance use disorder.
  2. Rapidly increasing treatment capacity.
  3. Eliminating barriers to treatment resulting from exclusions within the Medicare program.
  4. Expanding access to medications that help treat opioid addiction.

(Read a full draft of the interim report here.)

It remains to be seen where all this will lead. Not everyone is hopeful. Michael Fraser, the executive director of the Association of State and Territorial Health Officials, recently told The New York Times, “It’s really about drawing attention to the issue and pushing for all hands on deck. It would allow a level of attention and coordination that the federal agencies might not otherwise have, but in terms of day-to-day lifesaving, I don’t think it would make much difference.” One governor called the report incomplete because it doesn’t do enough to ensure that people with mental health and substance abuse issues have access to healthcare.

In another development, a report appeared this summer describing a new legal tactic to battle the opioid crisis: in one area on the east coast, prosecutors began charging drug dealers with second-degree manslaughter and criminally negligent homicide if they could prove the dealers were responsible for an overdose death. In such cases, prosecutors are required to provide evidence that the accused “knew the risks of the drugs yet provided them anyway.” Observers point out that this requirement could be problematic, since defense lawyers might argue that drug dealers want to cultivate customers, rather than kill them.

Meanwhile, the epidemic rages. The CDC estimates that 142 people die every day from drug overdoses. As with most bureaucracies, organizations like President Trump’s new commission tend to move slowly. Unfortunately, where the opioid epidemic is concerned, there is no time to lose.