A new tool to help you recover from pain pill addiction: Are you addicted?

Are you addicted to pain pills?  You certainly have company.  The cycle of use, dependence, and use isplaying out, over and over, in every community across the country.  Note that I describe the cycle as ‘use,dependence, use’—a description that is accurate, because in most cases thecycle of dependence starts when you appropriately use medication administered bya person who you trust—your physician.

Pain pills are often called ‘narcotics’--a term that comesfrom the Greek word ‘narcosis’, or ‘sleep’—because of their sedativeeffects.  Physicians use the word‘narcotic’ to refer to different things in different situations.  For example, when referring to controlledsubstances, ‘narcotics’ may be used to denote drugs regulated by the DrugEnforcement Administration.  Ananesthesiologist uses ‘narcotic’ to refer to the portion of the anesthetic thatis comprised of drugs that bind to brain ‘opiate receptors’.  ‘Opiate’ is another word used by physiciansin reference to pain pills.  The wordcomes from ‘opium’, a substance derived from poppies and used to make heroinand morphine.  The ‘opiate’ reference isalso used for synthetic pain medications that have no connection to poppies oropium save their pain-killing effects.

Most people have heard of ‘endorphins’.  Endorphins are produced in the human body,and when released, block pain.  Endorphinsare often referred to as ‘endogenous opiates’ because of their role in painsensation, even though they have no relation to poppies or opium, and arestructurally quite dissimilar.  Thesenatural pain relievers have other functions in the body, roles not relevant tothis discussion.  Endorphins are onegroup out of dozens of ‘neurotransmitters’, substances involved in thecommunication between nerve cells. Endorphins and other neurotransmitters act at ‘receptors’, the receptorbeing a lock on a nerve cell, and the neurotransmitter being the key that fitsin the lock.  Amazingly, poppies producea substance that looks different from the natural key, but that acts like endorphinsby fitting the exact same keyhole.  Thatsubstance—one molecule from the sap of a red flower—has given the human speciesthe ability to ease suffering in countless individuals, and has resulted in thedeaths of millions of others.

Over the years scientists have developed synthetic ‘opiates’with potencies far beyond anything produced by nature.  Anesthesiologists use ‘sufentanil’ reduceresponses to pain during surgery. Sufentanil is extremely potent; an amount the size of one grain of salt, say one tenth of one milligram,placed on the tongue would cause respiratory arrest in a large man withinseconds.  More commonly opiates are takenby patients in the form of codeine, hydrocodone (Vicodin), oxycodone (Oxycontin),or hydromorphone (Dilaudid).  Prescriptionsfor these substances are handed out to millions of people each day in responseto complaints of pain. 

Opiates relieve pain, and work in different areas of thebrain to elevate mood, ease tension, give a subjective sensation of warmth, andcause sedation.  They can cause nauseaand vomiting, particularly in patients who are naïve to them.  Finally, they change the response of thebrain to low oxygen and high carbon dioxide in the blood, and slow respiration.  The most common cause of fatal overdose isrespiratory arrest, where the brain stops sending impulses to the diaphragm,and the patient suffocates.  This fatalresponse is most common during sleep, or when opiates are taken in combinationwith other sedative medications.

Opiates are addictive. There is no way to take them without the body adapting and becoming dependenton them.  ‘Tolerance’ to pain medicationbegins after the first dose, when the ‘locks’ on nerve cells adjust in responseto all of the ‘keys’ floating around. With time it takes more and more keys toopen enough locks to cause the reaction at the nerve cell.  Tolerance is one half of the process ofaddiction, and is the reason for ‘withdrawal’, the sickness that occurs whentolerance has developed and the drugs, or keys, are taken away.  The other half of addiction is so-called‘psychological’, which I suppose is accurate to a point.  For some reason, once something is assignedto the psychological category, it is treated differently by physicians,patients, and the rest of society. ‘Psychological’ does not imply that a person has more control than witha ‘physical’ condition—if anything, things occurring on a psychological levelare far more difficult to recognize and treat than are physical conditions.  The psychological addiction to opiates alsodevelops very rapidly, and there is little if anything that can be done toprevent it.  Psychological addiction isreal, and is extremely powerful.  Theresult is a desire to take opiates.  Thedesire may take the form of physical symptoms, such as an increase in pain, andso psychological addiction and physical addictions are intimately connected.

To health systems, time is money.  Patient complaints are handled as quickly(and sometimes as superficially) as possible. When a person presents in pain, the first determination is whether thepain is a serious threat to health.  Thesecond determination is whether enough tests have been done to identify thecause of the pain.  If the first answeris no and the second answer is yes, the goal is to clear out the room for thenext patient.  There is a clock on thewall and a patient list in the hall, and the list has to be clear before thedocs and nurses go home.  And so there isthe doctor—patients waiting in six rooms, more in the waiting area, and a personin the room complaining of something that isn’t going to kill him/her.  And in the doc’s pocket lies a pad ofpaper.  Amazingly, all that the doctorhas to do to clear the room is write on the pad and wish the patient well.

That is how addiction starts.  Everyone intends well; everyone is honest;everyone is innocent.  The patient is nottold much about addiction.  The patientisn’t told that within a few days, he will have some difficulty stopping themedicine.  He isn’t told that after aweek when he stops the medicine he will have some diarrhea, he won’t be able tosleep, and he will feel depressed.  He isn’ttold that the pain that he has might not go away, and so he may get more potentmedicine, and so on, and that it will get harder and harder to stop as themedicine gets stronger.  I don’t know ifthe lack of information really matters; most patients would likely take thepain relief medicine now, and worry about the rest later.  Besides, the doctor doesn’t seem too concerned…andthe patient is correct.  The doctor isn’tconcerned, because this was a quick case that got him nearly caught up toschedule.

Unfortunately, there are pains that do not go away, even aswe patients demand relief.  Doctors hateto feel impotent with patients--it is difficult to take a person’s money, andthen tell him that there is nothing that can be done.  And so prescriptions are written, even when theproblem may be complicated, and the best advice to the patient would be ‘learnto live with it’.  This phrase angerspatients with pain, but sounds intelligent to patients who have struggled toget off opiates. But usually, the person with pain walks out with aprescription. As tolerance develops, the pain comes back, and the patient goesto the doctor again, this time leaving with stronger medication.  Tolerance continues, meds are changed, andtolerance develops again.  The doctor getsnervous over the situation, realizing that at some point he will not haveanything stronger.  Suddenly calls to thedoctor are not returned, or are returned by a curt nurse who sounds like thepatient’s mother.  The patient realizesthat he is stuck, and becomes depressed. Sound familiar?

It is not your fault. I know about this stuff inside and out—I earned my PhD in Neurochemistryat the Center for Brain Research in Rochester New York, studying drugs thatcause addiction and tolerance.  I administeredopiate medications every day as an anesthesiologist.  I literally know everything that there is toknow about opiates…expect how to stop taking them.  I thought I was smart enough to avoidaddiction, but I was wrong—laughably wrong—and the outcome nearly killedme.  It is not your fault.  To get better, you will need to understandthe meaning and truth of that statement. That is difficult for some, but possible for everyone.

My next installment has better news.  You can become free.  You don’t need to leave your family to go toa far-away rehab center, and you don’t need to go through painful detox andwithdrawal.  Watch for my nextinstallment, or visit me at my address below. There is a new development in treating people dependent on pain pills, adevelopment that will revolutionize the way that doctors treat addiction.